Sonny met with the Rad Oncologist Today

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Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 11/5/2009 2:06 PM (GMT -6)   
As you guys may recall, my first one month post surgery PSA test was 0.40. We discussed the fact that it could be blip because of PSA still in the bloodstream and that I should wait until the January surgery follow-up before I do anything.

In the interest of being prepared and learning I had an appt with the Rad Onco. at my Uro's office today. As one might imagine, he is all for my beginning the treatment now and not waiting until January.

Additionally, I kind of knew they would recommend treatment now and this is further documentation for my submission to the VA for the PCa and Agent Orange 100% disability claim.

He is proposing IGRT fro 37 treatment at 66.6gy.

However he pulled out an interesting study that was just published March 2009 that showed the advantage of T3's being treated within 18 weeks of surgery.

"Adjuvant Radiotherapy for Pathological T3N0M0 Prostate Cancer Significantly Reduces Risk of Metastases and Improves Survival: Long-Term Followup of a Randomized Clinical Trial"

This link is the published study;

http://www.jurology.com/article/S0022-5347%2808%2903059-0/fulltext

I would appreciate any and all feedback. I am not planning any long walks off of short piers because of my PSA test, I just want to know my options and have a plan.

Let me know what you think of the article and the premise.

Sonny
61 years old
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative

da Vinci 9/17/09 Dr. Mani Menon Henry Ford Medical Institute

Post Surgery Pathology:
Gleason: Changed to (4+3) = 7
Stage: T3a
Tumor Volume 12.5%
ALL NERVES SPARED
Margins: focally positive right posterior mid level
Perineural Invasion: present
Seminal Invasion: absent
Venous Invasion: absent
Angiolymphatic Invasion: absent
Left Internal iliac lymph node: reveals zero
Right Internal lymph node: reveals zero


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 11/5/2009 2:27 PM (GMT -6)   
Another article that I found that referenced the above study. Shows some pretty impressive numbers. One thing that jumped out to me was it resulted in a much lower prognosis of the requirement for ADT following surgery.

Now I readily admit that there are some of you guys here that are experts on Rad and ADT, so please step forward and give a guy a hand here.

Sonny
61 years old
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative

da Vinci 9/17/09 Dr. Mani Menon Henry Ford Medical Institute

Post Surgery Pathology:
Gleason: Changed to (4+3) = 7
Stage: T3a
Tumor Volume 12.5%
ALL NERVES SPARED
Margins: focally positive right posterior mid level
Perineural Invasion: present
Seminal Invasion: absent
Venous Invasion: absent
Angiolymphatic Invasion: absent
Left Internal iliac lymph node: reveals zero
Right Internal lymph node: reveals zero


Opa N
Regular Member


Date Joined Sep 2009
Total Posts : 150
   Posted 11/5/2009 2:44 PM (GMT -6)   
Sonny,
I read the same article, and it reinforced my decision to start HT right away, then begin IMRT after 8 weeks on HT. We are both T3, and I have additional seminal vesicle involvement, (which takes me to T3b) that you don't have. I took my first Lupron injection on 10/21/09, which will have me starting RT just before Christmas.

Even though my 2d psa test came back at <0.01, I am confident that the conclusion that my team came to (consisting of the Uro, Hemo/Onco, and Rad Onco) to recommend adjuvant therapy was the right one. I am moving ahead with confidence and determination to kill this SOB ASAP.

That's my choice. You've got all your nerves, only focally positive margins and perineural invasion. I would take your outcome if I could, and might not do the HT part. But, it's your call to make.

All the best.
Roger

 Age 67 at diagnosis. Treated for coronary artery disease (CAD) since 1998, and under control with medications.

2/6/09              Routine physical, with DRE and PSA Test. PSA 4.02. Referred to Uro

4/20/09            TRUS  w/needle biopsy

4/23/09            Diagnosis PCa with Gleason 4+3 in 2/2 cores, Gleason 3+3 in 5/10 cores.

                        CT scan and Bone Scan both negative. Stage T2C.

8/27/09            DaVinci RP at WakeMed Cary NC with Dr. Tortora. Discharged 8/28.

9/8/09              Catheder removed. Path post-surgery confirms PCa, with Gleason 3+3 with scattering of 4. Positive margins in L & R posterior, R and L seminal vesicles, with perineural invasion.  Stage pT3b.

9/30/09            PSA Post-Op <0.01. Met w/Uro/Surgeon to review surgery and path report. Referred to Prostate Oncologist and Radiation Oncologist. Appointments set for 10/8.

10/8/09            Met w/ both oncologists. Adjuvant Combination Therapy to begin ASAP.

10/21/09          First Lupron injection. 30 mg dose (4 month)

11/2/09            PSA 2-month <0.01. Cystoscope w/calibration and dilation to remove scar tissue from urethra. Big relief.

 

Initial incontinence pretty bad, starting w/6 Depends pants/day. Gradually getting better, with dramatic reduction in leakage around 9/20. Currently on 1 pad during the day and one at night (for security). Actually totally dry at night.

 

 

 


lja3
New Member


Date Joined Oct 2009
Total Posts : 13
   Posted 11/5/2009 3:05 PM (GMT -6)   
Hi Sonny,
 
Just wanted to say I am sorry to hear your news.  Don't know much about that part of PCa treatment yet.  I am praying for you.  As you have been so helpful for others on this board I hope you get the informed responses you need.  Like I said, I am praying for you.  I go in for da vinci this Monday.  I'll be on this board looking for you and posting my results when I am back from the hospital
 
Larry 
Larry
55 years old
Diagnosed 8/27/09
PSA went from 1.2 to 3.4 over 18 months
Gleason 4+3=7
3 of 12 cores positive
Cancer 5% of biopsied tissue
Perineural invasion not identified
Cat scan negative
Bone scan negative
Sheduled fo da vinci rp on Monday, November 9th
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 11/5/2009 3:06 PM (GMT -6)   
Sonny, sounds like a plan in the making. If you are convinced you have re-occurance, than sooner is better than later, espec. since you are a Stage 3 to begin. Little surprised that they aren't want to put more radiation in you. Mine, is 72 gys at 39 treatments, and my psa was lower than yours and I am a Stage II. But different doctors see it different ways.

Keep me posted. Waiting to see your psa rise even more makes no sense as far as trying to kill off the rest of the PC that might be lingering in your, that was the one point my uro/surgeon and radiation oncologist agreed about with my case.

My best to you brother.

David in SC
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


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 11/5/2009 3:19 PM (GMT -6)   
Opa, I asked the RO about HT and he said that they were not planning to do any at this point. Just the IGRT.

David, my brother, after following your trials and others will rad, don't mind telling your that this scares the carp out me. My surgery was so un-eventful, I can't fathom that I could be so lucky twice.

Haven't really made my mind up yet to go ahead. Still weighing all of the info. Took a long time to get to the surgery decision point, I don't plan to be any less thorough this time.

Thanks for the feedback guys. I have said so many times, HW and the folks here are the best.

Sonny
61 years old
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative

da Vinci 9/17/09 Dr. Mani Menon Henry Ford Medical Institute

Post Surgery Pathology:
Gleason: Changed to (4+3) = 7
Stage: T3a
Tumor Volume 12.5%
ALL NERVES SPARED
Margins: focally positive right posterior mid level
Perineural Invasion: present
Seminal Invasion: absent
Venous Invasion: absent
Angiolymphatic Invasion: absent
Left Internal iliac lymph node: reveals zero
Right Internal lymph node: reveals zero


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 11/5/2009 3:24 PM (GMT -6)   
Sonny, how soon before you can re-test your psa, if that .40 is/was real, then you are already getting close to the .5 line in the sand that my doctor's preach. If really is already .4, waiting till January could put your over that mark. Just concerned for you.

And Sonny, there are many men here that can be poster boys for SRT working well and being uneventful, I can guarantee you that I am in a very small group of probematic SRT folks.

David
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


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4229
   Posted 11/5/2009 3:25 PM (GMT -6)   

Sonny,

David's experience with radiation is very unusual; most of us that have had radiation have had very few problems. Don't delay your treatment because of the possibe side affects. Most likely there will be few and you won't have an issue.

Good Luck.

JohnT


64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 11/5/2009 3:37 PM (GMT -6)   
Thanks guys.

David, had my blood drawn for the last PSA on October. I guess that means I could do it again on Monday the 23rd. Is one more at 1 month okay at this point post surgery, or do you think it is too soon for realistic results?

Got a couple more reasons for not waiting too. Could get this done by the end of the year and include it in this years out of pockets for healthcare.

The other is that I am already getting my assignments for the upcoming College umpiring schedule. Already have about 30 top notch games on the books and some of the conferences I work haven't started assigning yet.

If I wait until January to start it would pretty much wipe out 2010 for me. Man I love umpiring. It ain't so much about the pay as it is working with the youth and doing something that I am really good at.

It's almost like when I was going through the decision process on the surgery. The PCa is almost secondary, it's the not letting it affect or change my life and that of my wife that is more paramount to me.

I'll get it figured out.

Sonny
61 years old
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative

da Vinci 9/17/09 Dr. Mani Menon Henry Ford Medical Institute

Post Surgery Pathology:
Gleason: Changed to (4+3) = 7
Stage: T3a
Tumor Volume 12.5%
ALL NERVES SPARED
Margins: focally positive right posterior mid level
Perineural Invasion: present
Seminal Invasion: absent
Venous Invasion: absent
Angiolymphatic Invasion: absent
Left Internal iliac lymph node: reveals zero
Right Internal lymph node: reveals zero


Opa N
Regular Member


Date Joined Sep 2009
Total Posts : 150
   Posted 11/5/2009 3:39 PM (GMT -6)   
Sonny,
I echo Purgatory about the psa result. If it were me, I would get re-tested ASAP, and this time with the ultra-sensitive test, which my Uro says is better post-op.

But, I think that the RO is looking at a protocol that says, if you're T3, you do RT. So maybe the rsa result is immaterial to his thinking. But .4 would likely reinforce his recommentation, IMO.

Roger

 Age 67 at diagnosis. Treated for coronary artery disease (CAD) since 1998, and under control with medications.

2/6/09              Routine physical, with DRE and PSA Test. PSA 4.02. Referred to Uro

4/20/09            TRUS  w/needle biopsy

4/23/09            Diagnosis PCa with Gleason 4+3 in 2/2 cores, Gleason 3+3 in 5/10 cores.

                        CT scan and Bone Scan both negative. Stage T2C.

8/27/09            DaVinci RP at WakeMed Cary NC with Dr. Tortora. Discharged 8/28.

9/8/09              Catheder removed. Path post-surgery confirms PCa, with Gleason 3+3 with scattering of 4. Positive margins in L & R posterior, R and L seminal vesicles, with perineural invasion.  Stage pT3b.

9/30/09            PSA Post-Op <0.01. Met w/Uro/Surgeon to review surgery and path report. Referred to Prostate Oncologist and Radiation Oncologist. Appointments set for 10/8.

10/8/09            Met w/ both oncologists. Adjuvant Combination Therapy to begin ASAP.

10/21/09          First Lupron injection. 30 mg dose (4 month)

11/2/09            PSA 2-month <0.01. Cystoscope w/calibration and dilation to remove scar tissue from urethra. Big relief.

 

Initial incontinence pretty bad, starting w/6 Depends pants/day. Gradually getting better, with dramatic reduction in leakage around 9/20. Currently on 1 pad during the day and one at night (for security). Actually totally dry at night.

 

 

 


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 11/5/2009 4:05 PM (GMT -6)   
Opa, yep another PSA test is in order. The question is should I wait for 30 days, or do it now? My last one was done in house at the Uro Center where my doc and the RO both reside. I was lead to believe the last one was done as a post surgery sensitive test, but I will verify. Maybe I would be better off getting an order from my GP and going to an independent lab for the test.

Sonny
61 years old
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative

da Vinci 9/17/09 Dr. Mani Menon Henry Ford Medical Institute

Post Surgery Pathology:
Gleason: Changed to (4+3) = 7
Stage: T3a
Tumor Volume 12.5%
ALL NERVES SPARED
Margins: focally positive right posterior mid level
Perineural Invasion: present
Seminal Invasion: absent
Venous Invasion: absent
Angiolymphatic Invasion: absent
Left Internal iliac lymph node: reveals zero
Right Internal lymph node: reveals zero


Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 11/5/2009 5:49 PM (GMT -6)   
Hey Sonny, I was not a happy camper to read this. Sorry to hear that you likely need the second whack. As I've reported here before this happened to a friend of mine --- who went to London U.K. with his wife earlier this week to see the theater (what in New York they call the shows) --- and this was 18 years ago! Today, and for the past 18 years he's been in perfect shape. Go and do likewise, Sonny.

Best,

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9, so far, so good
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
First post op PSA Sept 09  less than 0.02
PSA on Oct 23 test again less than 0.02
Oct 1st 09 -- dry at night, during day some stress issues, but better every week. 
Feel free to email me at:  sheldonprostate@yahoo.com    


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 11/5/2009 6:25 PM (GMT -6)   
Sonny, who was doing your PSA before dx and surgery? Your GP, like me? If so, I would schedule your next one through him/her, so that there is some consistency with the results. Just my take.

David in SC
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


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 11/5/2009 6:39 PM (GMT -6)   
Sheldon, thanks I needed to hear that.

David, my GP was the first with the 6.3PSA which started all this carp. Don't really trust him though anymore. 15 months earlier it was 3.5 and he didn't say anything to me.

The Uro did not run one when he did the DRE and biopsy because the 6.3 was ran just 2 weeks before. The Uro does it in house and the GP sends it out to a lab.

I'm thinking to have it run at an independent just for peace of mind. Don't know though. Ain't really feeling too much about wrapping my head around this right now. Just know I have to because I can't stick my head in the sand.

I did just tell my wife at dinner that if I went through this, she better stay here on earth at least 10 years to pay me back. LOL Also told her, I'll do the surgery, I'll do the RAD, but I'm drawing the line at the hormones.

Thanks guys for being here,

Sonny
61 years old
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative

da Vinci 9/17/09 Dr. Mani Menon Henry Ford Medical Institute

Post Surgery Pathology:
Gleason: Changed to (4+3) = 7
Stage: T3a
Tumor Volume 12.5%
ALL NERVES SPARED
Margins: focally positive right posterior mid level
Perineural Invasion: present
Seminal Invasion: absent
Venous Invasion: absent
Angiolymphatic Invasion: absent
Left Internal iliac lymph node: reveals zero
Right Internal lymph node: reveals zero


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 11/5/2009 6:55 PM (GMT -6)   
Sonny, that has been my personal approach. I volunteered for the surgery, had to be talked into the radiation without HT, and it the radiation fells, then will have to be talked into HT. Of the three Radiation Oncologists I "interviewed", only one suggested HT with SRT, and he was the one when pushed, said that he couldn't tell me if it would work, and couldnt tell me if I needed it. The other 2 rad oncol. said I didnt need it nor would they recommend adding the HT at this time. I went with my gut and the majority view this time.
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


Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4106
   Posted 11/5/2009 7:42 PM (GMT -6)   

Sonny:  Good luck with you decision making.  I can tell you I had a freind (A teacher that I worked with) He would leave school go to the Red Clinic and get his treatment and return to work each day.  he never had a problem.  Just a comment for your encouragement.

Beast of wishes

Jeff T


Jeff T Age 57

9/08 PSA 5.4, referred to Urologist
9/08 Biopsy: GS 3/4=7
10/08 Nerve sparing open RRP- Path Report: GS 3+3=7 Stg. pT2c, margins clear
3 mts: PSA .05 undetectable

10th month PSA <0.01
1year psa <0.01
ED- 5 mg Cialis daily, pump daily, going to try MUSE next. Next step injections.


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 11/5/2009 7:43 PM (GMT -6)   
Thanks Jeff,

Really appreciate it,

Sonny
61 years old
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative

da Vinci 9/17/09 Dr. Mani Menon Henry Ford Medical Institute

Post Surgery Pathology:
Gleason: Changed to (4+3) = 7
Stage: T3a
Tumor Volume 12.5%
ALL NERVES SPARED
Margins: focally positive right posterior mid level
Perineural Invasion: present
Seminal Invasion: absent
Venous Invasion: absent
Angiolymphatic Invasion: absent
Left Internal iliac lymph node: reveals zero
Right Internal lymph node: reveals zero


lewvino
Regular Member


Date Joined Jul 2009
Total Posts : 384
   Posted 11/5/2009 7:53 PM (GMT -6)   
Sonny, THis is the other "larry'" have talked on the phone. Sorry to hear all this news. Just got online and started reading about your latest. I don't know what I would do if I were you though might be facing it down the road with my positive margin. I'm thinking of just hanging in there since I got the 0 on my 1st psa. Wait and see what happens. It seems to me that your PSA was pretty soon after your surgery. Perhaps rechecking end of this month and then making your decision might make some sense but then I'm new to all this like you are! Decisions, decisions.

Keep tuff like I know you will!!!!

Larry in Tennessee
Age 55 / age at diagnosis 54, PSA 5.1
Robotic surgery 08/12/09 at Vanderbilt, Nashville TN. 
Final Path report:
20% of the prostate Invovled
Tumor graded at T2C
Overall Gleason 3+4 (7)
Lymph Glands Clear, Positive Margin Noted in Right Apex
 
First post Surgery PSA - 0


wesd40
Regular Member


Date Joined Sep 2009
Total Posts : 41
   Posted 11/5/2009 8:01 PM (GMT -6)   
Sonny,
Nothing new to say advice wise but I want to tell you good luck with everything. My surgery was the same day as yours so I really pay attention to your post. My first post op psa test is scheduled for Dec. 11th. I guess my surgeon wanted to wait that long for all of the reasons we read about on here, but it sure does not make it easier to not think about it.In my case there is a 50/50 chance that I am cured according to my surgeon when he was explaining the path report. I will be thinking of this for another month. Take care, Wes

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 11/5/2009 8:11 PM (GMT -6)   
Sonny,

I went to the radiation guys because of my Gleason 9. My guy claimed a study that said I had a 5 % better chance of non reoccurence, but that there was a 1 to 1 1/2 % chance of radiation tumors. Because my PSA is still undetectable, I am not starting adjuvant therapy, which is the approach Cleveland Clinic is recommending.

If I was in your situation, and I was sure the PSA was accurate, I am sure I would be doing the same thing. Obviously according to the study, there is some time advantage. I also went to U of Mich and they said 4 months was the magic number.

What a journey this PC can drag us through. We are forced to make decsions that we have little or no real reason to make based on our own knowledge, or even real scientific knowledge of others. Studies are statistcs, with a whole lot of variables that may or may not be in line with our variables.

Good luck Sonny. I think at this point a week or 2 or 4 won't make a tremendous amount of difference, so take your time and make sure the decsions you are making feel right to you.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injections


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 11/5/2009 10:04 PM (GMT -6)   
Larry, Wes, GL,

Thanks guys for the good wishes.

I have no idea what I am going to do in the future, but right now I am going to wait it out until a month has passed since the last PSA and then test again. I don't think I will wait until my January trip to Detroit for post surgery follow up though.

Actually, I had the 1 month 10/21; I can do a 2 month 11/23 and another right before Christmas. Then the 4th month will coincide with my schedule for Detroit.

Of course if the numbers are climbing or hanging in at 0.4, I may have to make a move.

So thanks everybody, we now have a plan of attack to gather more information. Then I can make an informed decision.

Here's hoping that I just had a little stubborn PSA that decided to hang around for a while after I took their house away. Must be the weather. Every year about this time in Orlando we begin to see a big rise in the transient and homeless population. Maybe my little homeless PSA guys are afraid to hit the road after their home was ripped out from under them. LLOOLL.


Bless all of you folks at HW for your support,

Sonny
61 years old
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative

da Vinci 9/17/09 Dr. Mani Menon Henry Ford Medical Institute

Post Surgery Pathology:
Gleason: Changed to (4+3) = 7
Stage: T3a
Tumor Volume 12.5%
ALL NERVES SPARED
Margins: focally positive right posterior mid level
Perineural Invasion: present
Seminal Invasion: absent
Venous Invasion: absent
Angiolymphatic Invasion: absent
Left Internal iliac lymph node: reveals zero
Right Internal lymph node: reveals zero


Modelshipwright
Regular Member


Date Joined May 2009
Total Posts : 215
   Posted 11/6/2009 7:27 AM (GMT -6)   
Hi Sonny,

Sorry to hear that you are having to make more decisions regarding Pca. I hope that you get all the information that you need to make what is the right decision for you. Good luck and we are all here for you through this next stage.

Keep well,
Regards,
Bill
Pre-Op: Age 64. Diagnosed with Pca January 2009.
PSA 5.6, Gleason 3+3=6, T1c
Biopsy: TRUS biopsies of prostate left adenocarcinoma of prostate involving part of 1/4 biopsy fragments, less than 10% of the surface area involved, CT scan clear.
Treatment choice: Robotic Assisted Laparoscopic Prostatectomy - September 29/09.  Pre-op PSA down to 5.28 which I attribute to visualization techniques and a new vegetarian diet.
Post-Op: Robotic Prostatectomy - 09/29/09, back home 10/02/09.
Pathology - 10/14/09  Gleason Score remained at 3+3 = 6 as it was when originally diagnosed. There were no positive margins. Tumors were found in both lobes and involved 3-5% of the prostate. There was no Seminal Vesicle, Perineural, Lymphovascular or Lymph node involvement, and the bladder neck was also cancer free. 
Continence 10/16/09 - 3-4 pads a day and working on pelvic floor exercises as prescribed.
Potency: 10/16/09 - Zip, nada
State of mind: Excellent - always positive.
 
 


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 11/6/2009 9:01 AM (GMT -6)   
Good Morning all you happy campers at HW,

Okay, I have decided to take the Bull by the Horns on this. I personally need some reassurance on the accuracy of the PSA testing done (In House) by my Uro.

I have called my GP and they are writing orders for me for a PSA test. They will write them for "Post Surgery - Ultra-Sensitive" testing. I have called the lab they use, Lab-Corp., an independent lab, and they have confirmed that they can run the US testing.

I am going directly to the lab today at 1pm, they will draw the blood for the tests and will have the results to me on Monday.

At least I can approach the weekend knowing that I am doing my part as a pro-active PCa brother and with some level of confidence in the findings.

If the results come back the same (.4) I can deal with it from a confidence standpoint in the testing. If they come back as undetectable, WELL, that may be a different story in my confidence with my Uro and their testing procedures.

We always talk about going with our gut on some things. And my gut just can't fully resolve my conflicts about the URO, their da Vinci surgeon, and the Rad Oncologist, all being under the same roof, the same practice and the same revenue stream.

Either way I can enjoy the weekend and put it out of my mind for a few days. I really thought I would be in that Non-Worry state of mind at least until my January follow-up.

Jeez, but this PCa thing can be a real p*sser, can't it.

Sonny
61 years old
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative

da Vinci 9/17/09 Dr. Mani Menon Henry Ford Medical Institute

Post Surgery Pathology:
Gleason: Changed to (4+3) = 7
Stage: T3a
Tumor Volume 12.5%
ALL NERVES SPARED
Margins: focally positive right posterior mid level
Perineural Invasion: present
Seminal Invasion: absent
Venous Invasion: absent
Angiolymphatic Invasion: absent
Left Internal iliac lymph node: reveals zero
Right Internal lymph node: reveals zero


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 11/6/2009 10:40 AM (GMT -6)   
Part of the joys of having PC, never an easy answer, nothing ever cut and dry, hard to use logic with the non-logiacal. But you are doing all the right stuff. Sonny has to do what is best for Sonny.
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


BillSD
Regular Member


Date Joined Sep 2008
Total Posts : 143
   Posted 11/6/2009 1:11 PM (GMT -6)   

Hi Sonny,

I had RRP surgery 9-15-08 and began adjuvant radiation 12-08-08. When the Doctor said, "You will never have as little prostate cancer in your system as right now!" it was a no-brainer to get on with the adjuvant IMRT rather than waiting for a recurrance. That was my decisin, and I do not regret it. So far, so good.

Best to you,

Bill in San Diego


Age 61 (59 @ Dx) PSA 4.4

Biopsy 5/15/08 Gleason (3+3=6)

Bone scan and pelvic CT: clear

HT - 2 mo Casodex, 3 mo Trelstar

RRP Surgery 9/15/08

Post-OP Gleason 3+4=7, Stage pT2c pN0 MX

SV, perineural margin, 18 lymph nodes, bladder neck: all carcinoma free

Perineural invasion & Distal Margin: Carcinoma present

IMRT adjuvant radiation (35 Treatments) Ended 1/27/09

PSA Tests: (10/13/08) (3/13/09) (7/10/09): all <0.1

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