visited oncology

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gregory m helman
New Member


Date Joined Oct 2009
Total Posts : 16
   Posted 11/3/2009 7:43 PM (GMT -6)   
well i had my visit with the radiation oncologist on monday and had my psa checked again .
it is now 0.45. the oncologist said, if my psa had gone down more than we would wait and check it again. now since its elavating and told me if it goes higher
he wants to start radiation.he don't want it goe to 1.0 and the cure rate will go down.he also told me their is no way of finding  such  small cells with any kind type of machine, etc. he told me the side effects, like, diarrea, scaring where they reconnected bladder could close shut.the oncologist said, where they took out the prostrate out and the bladder would move down lower , and trying to do radiation would be some concern. he wants to do  radiation at the prostrate site. he thinks it maybe have some cells around that area. he says 6 weeks of treatments ,5 days a week.he wants me to stay at the hospital for the week and go home on the weekends , instead of me traveling  2 1/2 hours every day. my wife wants me to use our local hospital which has a cancer center, and i don't have to miss work. but i don't know if i will have bad side effects or not. oncologist said if my psa stays  where it is now  , i will be safe until holidays are over. but i don't know if i should wait or not. i am going to see our oncologist  at our cancer center and see what he has to say.
  age 52
had rectal exam and found prostrate nodule detected.
psa was .097 before exam.
referred to urologist and also rectal exam , but couldn't feel anything.
we discussed about biopsy to be on safe side.
Final   Diagnosis----------------------
specimen  is received in formalin in 8 parts labeled A-H.
 
prostrate biopsies, right apex,right mid, right base, left apex , left mid, left base , right anterior horn,
and left anterior horn.
 
A-G ------ no atypia or malignancy found.
H---- prostrate needle biopsy, left anterior horn:   Adenocarcarcinoma,
gleason score 3 + 4= 7,    4 mm in greatest linear dimension, involving approximately 20% of tissue from this site. less than 1ml cancer and less 1% of gland involved.
 
 
 
 
 
 
 
 
 
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 11/3/2009 9:18 PM (GMT -6)   
Gregory, glad you got your oncology visit in.

The radiation oncologisits I spoke with ahead of time, 3 of them, all agreed that you want to get treated before it reaches .5 for the best results. They said at 1.0 it can only be half effective, and essentially, over 1.0 not much point. I know there are and will be exceptions to these limits and not all oncologists agree to the same line in the sand.

As far as side effects. Most men that have went through RT or SRT, have limited side effects. Least the doctor you talked to was being honest enough to tell you of worse case scenerios.

If you have been following my journey with salvage radiation, 39 treatments totally 72gys, I have had issues with side efffects all along. I had RT 10 years ago and had terrible experience with it. Again, most people don't. So far, I have had nausea starting in the very first week, lots of tenderness in my lower adomen and penis, some diareha and stomach pains.

Becasuse I had such a bad track record after my open surgery last November of strictures at the bladder neck, and before I started on this radiation, I had already spent 101 days on 7 different catheters, my uro/surgeon and radiation oncologist agreed that for the duration of the radiation treatments and perhaps a month after due to post radiation swelling, a suprapubic (SP) catheter was surgically installed in me. I had it for 33 days, and just yesterday a new once was installed. It will be replaced again early in December. It exits just below and to the left of my navel. Had it not been done, in my case, I would have swollen shut again long before now, and it would have been difficult to fix while undergoing radiation.

Do you have any pre-existing problems like mine that would make the oncologist think you would have similar problems? If not, then you would probably do fine.

I have never heard of staying in a hospital for having radiation done, not in our time and age. Plus the toxicity of the radiation builds up over time. The first two or three weeks for most people are the easiet. So staying at the hospital for a week at the start really didnt make sense to me, unless, again, you have other issues.

Your posted stats are a bit confusing to me. Can I assume you did not have any kind of prostate surgery? The PSA numbers you are reporting are more like post surgery re-occurance, like I am dealing with. Perhaps you can clearify your whole situation.
Please keep us posted.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sess/72 gys cath #8 33 days, 11/2- SP Cath #9 in place


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 11/3/2009 9:22 PM (GMT -6)   
Re-read your post, you are saying your doctor wants you to stay at the hospital the entire 6 weeks of radiation treatment? That even made less sense than I thought on the first pass. Unless you are extremely wealthy, I couldn't imagine anyone's health insurance paying for the hospital time when it wouldnt be required for either the treatment or the recovery. there must be more to your story
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sess/72 gys cath #8 33 days, 11/2- SP Cath #9 in place


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 11/3/2009 9:31 PM (GMT -6)   
If this is before any treatment then you need some more opinions. With a very low PSA and only one positive core I would think that you are a candidate for `seeds as well as radiation. In fact, with a good doctor, watchful waiting might be a reasonable choice.

Any kind of treatment presents quality of life issues that need to be seriously weighed.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads
6 mo. PSA 0.00 -- 1 light pad/day


gregory m helman
New Member


Date Joined Oct 2009
Total Posts : 16
   Posted 11/4/2009 6:34 PM (GMT -6)   
let get this hospital thing cleared up.
i haven't posted my post surgery and pathology reports when prostrate was removed.
i did have a radical perineal surgery. i had a 2 1/2 day stay at the hospital and went home with a catherter.
had it for 10 days and removed .only leakage i have now is when i cough , or lifting.
the report you saw was from the pathologist. this was my biopsy.
now after surgery and waited for 6 weeks i had a psa and it was 0.55, and then month later it was 0.39.
just had  one done on monday and now it is 0.45.so it is now climbing back up. oncologist want to do  radiation treatments.
he doesn't want psa at 1.0 and then cure rate will be down. you are right what a small cancer nodule . if i didn't get routine  physicals evey year this might
gotten worse.thanks to my family doctor for finding this.i don't know if surgeron  got all of it when he removed it or it moved into the tissue nearby.
i don't know if i should jump into this right now, i am going to another cancer oncologist  and get another opinion.the cancer center that wants me to stay at the hospital is 2 1/2 hour drive one way.actually its near the hospital.the place i will stay, its called house of care and they told me its about 20.00 a day. my local cancer center is at my hospital and  i don't know if i can still work, or take a leave . i hear about the side effects on forum that  doesn't sound pleasant.
 i am getting kinda scared on waiting to hear from oncologists and this waiting might not be good.my psa should of been zero after surgery, but dr. told me it takes some time to get all it out of system. oncologist thinks that the tissue that was near where prostrate was taken out might have some cells there and this where he wants to zap with radiation. i hopeing it is. this where my bladder sits and this is a concern.
 
 
  age 52
had rectal exam and found prostrate nodule detected.
psa was .097 before exam.
referred to urologist and also rectal exam , but couldn't feel anything.
we discussed about biopsy to be on safe side.
Final   Diagnosis----------------------
specimen  is received in formalin in 8 parts labeled A-H.
 
prostrate biopsies, right apex,right mid, right base, left apex , left mid, left base , right anterior horn,
and left anterior horn.
 
A-G ------ no atypia or malignancy found.
H---- prostrate needle biopsy, left anterior horn:   Adenocarcarcinoma,
gleason score 3 + 4= 7,    4 mm in greatest linear dimension, involving approximately 20% of tissue from this site. less than 1ml cancer and less 1% of gland involved.
 
 
 
 
 
 
 
 
 
 


Magaboo
Veteran Member


Date Joined Oct 2006
Total Posts : 1210
   Posted 11/4/2009 7:28 PM (GMT -6)   
Hi Gregory,
 
I really can't comment on your situation since I'm certainly no medical expert, but I can tell you my personal experience with salvage radiation. I had 33 sessions (see signature) and travelled by city bus every day (about 45 min each way). My side effects from the RT were somewhat uncomfortable, but nothing that prevented me from travelling every day. However, if I had to drive 21/2 hours every day, I would have stayed at the hospital for $20.00/day if it were offered. It would probably cost that much on gas. From talking with my medical team (including the Oncologist), salvage RT is most effective when started as soon as a recurrence is suspected. If I were you, I would attack the beast ASAP.
Wishing you all the best. Stay in touch.
 
Magaboo


Born Sept 1936
PSA 7.9
-ve DRE
Gleason's Score 3+4=7, 2 of 8 positive
open RP 28 Nov 06 (nerve sparing), Post op staging T3a
Gleasons still 3+4=7
Seminal vesicles and lymph nodes clear
Catheter out 15 Dec 06, Dry since 11 Feb 07
All PSA tests in 2007 (4) <.04
PSA tests in 2008: Mar.=.04; Jun.=.05; Sept.=.08; 3 days before Rad Start=0.1
Salvage RT completed (33 sessions - 66 Grays) on the 19th Dec., 08.
PSA in Jan., 09, = 0.05; July 09, <0.04

Post Edited (Magaboo) : 11/4/2009 6:31:09 PM (GMT-7)

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