Met with my new Radiation Oncologist Today

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Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 11/17/2009 7:56 PM (GMT -6)   
As previously noted, my wife and I met with my new RO today. Dr. Patrick A. Kupelian, of MD Anderson, Orlando.

What a meeting! I thoroughly enjoyed talking with this guy and came away with a very good feeling and a bunch of new and understandable information. Now a bunch of this many of you guys already know, so bear with me. This is as much for the new guys as you senior members of HW.

Now I know from previous posts and threads that there will be exceptions taken to some of the info, but please DON'T SHOOT THE MESSENGER. I am just telling it like it is, with no embellishments.

Prior to our meeting I did a few searches on the dr and found some very interesting info. Very well respected in the RO commmunity, an MD search found and listed 102 articles, studies and publications credited to him as author or in some other way. I was told that he would be leaving MDA for UCLA mid 2010.

When I asked him about this at the end of our meeting he said it was an opportunity that had come up suddenly and was too good to turn down. He is to be the Co-Chair of Radiation Oncology at UCLA. The guy must have something going for him.

So we talked about my PSA scores, scans, surveys and surgery. As everyone knows, following surgery you want an undetectable PSA. Mine was 0.4 at 30 days and 0.53 at about 55 days. He offered a few explanations that to me made sense.

First their is some microscopic level of PCa activity.

Secondly, there may be some prostate organ tissue left behind that is producing PSA. This is why there are some folks that report having a .1-.2 psa that never goes up and sometimes goes down. Over time the remaining tissue may die off or maybe not.

Think about it. We all talk about margins. The prostate does not sit there with this vacuum of space around it, not does it have delineating dotted lines that read cut here. If there is a margin it is a cut through the wall of the gland, so something has to be left behind. Now if you have a rising PSA, chances are that is not where it is coming from. But then again maybe.

I asked about the extraprostatic extension and margins and invasions and does that mean if it is PCa is it likely to be in the prostate bed. He said most likely. But at these micro-scopic levels it also could be anywhere. If the PSA tests are done from blood that is coursing through the body, it could mean that the PCa is to some degree in the blood stream as well. The blood runs through the prostate in many veins and so on, so the cancer could get out that way just as easily. This explains why the guys who have the greatest of post surgery path reports, no extension, no margin, no invasions, no anything, at some point down the road see a rise in PSA. It just means that some small amount of cells escaped into the body before the prostate was removed and it took that length of time for their little colony to grew to a point of detection.

At this point and at a such a small level it is not going to show up on any scans or surveys. But because of history and studies and so on, you radiate the prostate bed, because of the statistical likely-hood of that being where it is.

So we talked about my receiving radiation. As has been posted by others, many times there has been reference to numbers like .5 being the cutoff for SRT. BTW he explained to me the difference between Adjuvant and Salvage Radiation. Adjuvant is treatment following prostatectomy and there is NO DETECTABLE PSA. It is just a second course or additional form of treatment in an attempt to make sure we got the little bugers. If there is any detectable PSA it is therefore Salvage.

In his thinking there is no magic number for treatment with radiation. He has had success with numbers far higher and lower than .5.

We talked about side effects and so on. Most of you know them. One interesting point concerned Incontinence. He said that if you are continent, you will more likely than not remain continent. You may have a few issues like urgency, burning, etc. by these will pass. He went on to say that he will not do radiation on anyone that is not continent. If you are using multiple pads per day, he waits until you are down to 1 or none. The reasoning is that if you are Incontinent, radiation will exacerbate the situation, not help it.

I asked about the studies involving Hypofractionated IMRT. Giving the same amount of Gys in a lesser amount of time. He said that most of these were still trials, none were being done as a normal course of treatments and that all of them were being done in a Radiation First treatment regimen (no prostatectomy). So I will be getting the standard 30+ treatments at 70Gy and not the reduced 25 I was hoping for.

We also discussed Hormone Therapy. He started by saying that Surgery is curative, Radiation is curative and HT is not. It is abatement therapy, it is meant to prolong life and to allow the PCa brother to be able to live with PCa. Fairly harsh and straight forward. He went on to say that I am far too early in the process to think about HT or have to worry about decisions I might make about it in the future.

In a post the other day I told you about running Nomograms for SRT at varying levels of Gy. The higher the dose I out in, the lower the percentage I got back on progression free at 6 years. It didn't make sense and I showed them to him and asked him why.

He explained Nomograms. They are mathematical statistical analysis based on thousands of individual patient data. Those that received say 80Gy (a number I ran) were already in far worse shape than I was. The fewer number of patients with those sets of numbers skewed the data to their small subset. If they required 80Gy their results were not as good as someone's lesser aggressive cancer that only required 66 or 70Gy. The numbers can't work in a vacuum, there has to be real patients, with real outcomes, that have had their individual results put into the database.

So there is the most of it. At least what I can remember of the larger point of the discussion. I liked this guy, I felt comfortable and confident with him and I am going forward with radiation. I have an appointment Thursday for scans to begin the mapping. At the same time they will run another PSA test. It is not really to see if by some miracle my PSA has gone down, but rather to establish a baseline with his lab for consistency of further tests to be run down the road.

My guess is that I will begin treatment in a week or two, most likely the Monday after Thanksgiving.

I will of course for posterity and informational purpose for those that follow, post my daily journey down the path of SRT.

I hope you guys found this to be as interesting as I did,

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


60Michael
Veteran Member


Date Joined Jan 2009
Total Posts : 2222
   Posted 11/17/2009 8:10 PM (GMT -6)   
That much info helps me come to terms with why I am not a scientist. But it sounds like it went well Sonny and you have a good head on your shoulders and have done your homework beyond anything a lot of us would do. But that is the way to do it, and we will keep you and your family in our hearts and in our thoughts in this process.
Michael
Dx with PCA 12/08 2 out of 12 cores positive
59 yo when diagnosed
Robotic surgery 5/09 Atlanta, Ga
Catheter out after 10 days
Gleason upgraded to 3+5, volume less than 10%
Margins not involved
2 pads per day, 1 depends but getting better,
8/5 1 depend at night only
 started ED tx 7/17, slow go
Great family
Michael


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 11/17/2009 8:14 PM (GMT -6)   
Sonny, a very good and informative post. You covered a lot grounds and points on the subject. I was amazed at how much this doctor would have been in agreement with my own radiation oncologist. I think you got a good one there, one you should have confidence with.

I wish you weren't going down the same path, but since you must, I will be most interested in your own journey. I hope you will be in the majority with few side effects problems. I want you to be in the large percentage group that gets through it with perhaps fatigue issues only, and perhaps some short term urinary issues.

The problem I disussed with my dr. on the higher dose - shorter treatment plans is radiation tolerance. If one is sensitive to radiation, like i am obviously from both my bouts with RT, some of the shorter programs push up to 3 gy a day, which is a lot of radiation to absorb in one day. Side effects would be much worse for someone like me in that range. I have been getting less than 2 a day over the 30 days, and the side effects were there in the first week, and have built up over time.

Did you get to ask this doctor about vitamin supplements or any dietary issues? Be interesting to know since its been a topic of debate here lately.

I hope you do great, you know I am rooting for you. Give my best to Lynn, and I know she has her own RT fight ahead, that will be a difficult place to radiate with her, so I hope they work closely with her to make it as comfortable as possible.

Your friend,

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


Jakester
Regular Member


Date Joined Aug 2009
Total Posts : 285
   Posted 11/17/2009 8:19 PM (GMT -6)   
Wow Sonny, many thanks for the recap... I'm seeing my guy soon and your notes are helping me prepare.

Our best,
Jake
Diagnosed 8/2008 Pre-op psa 4.2, Age 60 at dx
7 of 12 biopsies positive 3+3
DaVinci LRP 11/08
Post Op pathology clear margins, confined to prostate, absent extraprostatic extension, vascular or perineural. Gleason 3+4=7, 5-10% of 4 and location in right mid-gland.
3 month psa .1 2/09, 6 month .1 5/09, 9 month .2 8/09
broke ankle bones 6/09
9/21/09 Bone scan clear, psa still .2
11/12/09 chest xray was clear, psa however up to .3, being referred to radiation next week


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 11/17/2009 8:32 PM (GMT -6)   
David,

I did ask and discuss the subject of vitamins and supplements with the doctor. There has been a lot of discussion about this here at HW lately and I was hesitant to post the discussion for fear of raising it from the dearly departed.

I asked about accompanying radiation with supplements and vitamins. He said that there have been a lot of studies and a few trials about the subject lately. However, there has been no conclusive evidence one way or the other that they have any bearing on the success or failure of treatment as an additive.

He said that if I presently took supplements and felt that I was getting benefit from them, I don't have to stop, they won't hurt anything.

If I wasn't now taking them but wanted to try, to go ahead they wouldn't hurt anything.

And if I wasn't taking them and didn't want to, I wouldn't be losing anything.

HEY GUYS, HIS WORDS, NOT MINE, DON'T SHOOT THE MESSENGER.

As with everything else he had to say today, I felt he was giving me an honest answer based upon his knowledge and experience.

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


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4223
   Posted 11/17/2009 8:41 PM (GMT -6)   
Sonny,

It looks like you have found an excellent radiologist that knows what he's talking about and is wlling to answer all of your questions in a straight forward manner. Good luck with your treatments.
JT

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


Ralph Alfalfa
Regular Member


Date Joined Nov 2008
Total Posts : 469
   Posted 11/17/2009 8:43 PM (GMT -6)   
Hi Sonny,
Seems you asked the same questions I did and got the same answers. It's either an RO conspiracy, or perhaps they're telling the truth on what they know. I'm hoping it's the truth. Maybe 25 years down the line they will know something better and different. I, and I'm sure you, don't want to wait that long. We do what we do and that's all we can do. Best of luck going forward. I'll be watching. Today was No. 15...can't wait until it's over.

Bob
 AGE:57
 Dx: October,27(the day after my birthday)
 Psa 14.5
 Gleason:(4+3) 7 T1c
 Bone scan:Negative
 Cat scan: Negative
 Biopsy: 4 of 12 positive, left side, pre-cancerous on the right.
 Confined to prostate.
 DaVinci Jan. 19th, No lymph node involvement, all margins clear.
 8 week PSa <0.01
 Gleason downgraded to (3+4)7
 6 month Psa , 0.1 
 9 month Psa,  0.2  Doubled! Criminy!
 Started RT 10/28...one year since diagnosis.


Rolerbe
Regular Member


Date Joined Dec 2008
Total Posts : 235
   Posted 11/17/2009 10:04 PM (GMT -6)   
Sounds like you got a good and thorough discussion with a knowledgeable and confident expert. Thanks for the recap. It all made sense.
51 YO
PSA at Dx: 8.2
DaVinci RALP: 10/31/08 -- Great MD in New Haven, CT
Negative margins, no extra-capsular involvement
One nerve spared
PSA at 0 for just over a year now.
 
 


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 11/17/2009 10:09 PM (GMT -6)   
Sonny,

Thanks for the info. I am watching you guys carefully, as I expect to follow because of my G9.

So glad you found a Dr. you could relate to and feel comfortable with. That makes it a whole lot easier.

My best to Lynn as well.

Onward in our journey my brother !
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


Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4106
   Posted 11/17/2009 10:17 PM (GMT -6)   
Sonny, I shot you an e-mail...Disregard. Found your post after my note to you. Sounds like this Guy Shoots from the hip. Honest, and direct.. That is what I like best of all. Don't keep me guessing. Tell me what you know and think....Then I have a better direction of where we are going.

I am excited to know you are on the move.

Your brother in PC

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.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 11/17/2009 10:31 PM (GMT -6)   
Thanks for the follow up on the vitamin bit, that is definitely the same message as my doctor
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
Incontinence:  1 Month     ED:  Non issue at any point post surgery
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


Magaboo
Veteran Member


Date Joined Oct 2006
Total Posts : 1210
   Posted 11/18/2009 12:37 AM (GMT -6)   
Hi Sonny,
 
Thanks for passing along all the info you got from your Dr.. It all sounds very similar to what I was told by my Onc when I had my SRT about a year ago. Looks like you've found an excellent Oncologist to handle your RT. I'm hoping that you'll have an easy time with it with few or no side effects. Please stay in touch.
Wishing you all the best.
 
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


wesd40
Regular Member


Date Joined Sep 2009
Total Posts : 41
   Posted 11/18/2009 5:02 AM (GMT -6)   

sonny 3,

thank you so much for all of the good info. My first post op psa test is going to be Dec.11th and all of your info will help me. Wes


Modelshipwright
Regular Member


Date Joined May 2009
Total Posts : 215
   Posted 11/18/2009 7:56 AM (GMT -6)   
Hey Sonny,


Many thanks for a well written summary of your talk with him. I am impressed that you can retain that much detail of what must have been a lengthy conversation. Good luck on your journey and I hope it all goes by without incident.



Regards,

Bill

Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 11/18/2009 10:43 AM (GMT -6)   
It would appear that there is a general agreement that I have found a good doc for my RT. I really felt comfortable with him and liked his approach. His answers and discussions really seemed to be based on clinical fact and experience, but he did not sugar coat anything.

I didn't post earlier but we even had a lengthy discussion about the effects of my not doing anything. He stated that these levels at this time would not kill me. It would cause me QoL issues in the future and at some time the levels would grow to a point that RT would not be beneficial, however that may be many years from now. His experience is that most guys who have PCa just want it out or killed, rather than living with the knowledge that it is there and growing.

I figured that my decision process in the beginning to have surgery to get it out hasn't really changed, therefore there is no reason to forestall my efforts to see that it is done.

I really thank you all for weighing in. No matter how much any of us has learned or studied, there is always comfort in discussing it with those whose opinions we value. A little discussion is always good and it may open our eyes to information unknown at any point in time. This just allows for further research and DD.

So thanks folks for participating in my process,

Sonny

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 11/18/2009 10:52 AM (GMT -6)   
Sonny, I think you are making a wise decision, even though it is one that I wish you didn't need to make. Just consider it part "B" of your original plan. That is how I had to rationalize what I am going through right now. Without the part "B", wasn't a whole lot of point going through what we went through with part "A", our surgeries.

With a good doctor and a good clinic, they should be able to make it as smooth as possible for you.

I am on your side and rooting for you.

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
Incontinence:  1 Month     ED:  Non issue at any point post surgery
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


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 11/18/2009 12:44 PM (GMT -6)   
Thank you Sonny...very informative

Best of luck moving forward to you.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month Apr 2009 .06
                   9 month Jul  2009 .08
                 12 month Oct 2009 .09 


dsmc
Regular Member


Date Joined Jul 2008
Total Posts : 149
   Posted 11/18/2009 1:24 PM (GMT -6)   
Sonny,
Excellent post. Very informative for old as well as new members. The best of luck to you.

David
Age 54
Pre-op PSA 4.3
Surgery Feb. 17 2005
Post-op Path : Gleason 3+3=6
Right pelvic lymph nodes: negative for metastatic carcinoma
Left pelvic lymph nodes: negative for metastatic carcinoma
extent: right lobe 40% left lobe 10%
capsular penetration: Absent
Seminal vesicles and vasa differentia: Uninvolved
Prostate: 26 grams
Post-op PSA's <0.04 for 3 years
Feb. 08: 0.07, March 08: 0.08, June 08: 0.09 and Sept. 08: 0.1
IGRT scheduled.....November 17th....
FINISHED 01/14/09 YEA!
05/14/09
1st PSA after Salvage RT <0.04..... Another YEA!


RonE
New Member


Date Joined May 2009
Total Posts : 12
   Posted 11/18/2009 10:10 PM (GMT -6)   
Sonny:

I think you are in good hands with Dr. K.

I met with him twice. The first time was about 2 years ago, before my surgery. The second time was after surgery concerning possible adjuvant radiation. My PSA is still undetectable and I opted to wait for biochemical recurrence (if it happens) before I start salvage radiation.

If Dr. K. is leaving the area, I will be sorry to see him go.

Good Luck!
Oct 2007 - Family doctor checkup at age 53
PSA 2.4, ~10% increase from 6 months previous
Nov 2007 - Consult with urologist
Biopsy 1/12 cores positive 1% Gleason 6=3+3
Jan 2008 - DaVinci radical prostatectomy
Hospital stay of 3 days, JP drain in 1 week and catheter 10 days
Gleason 7=3+4 with early foci extracapular extension
Surgical margins clear, prostate 5x4x4cm & 43g, involvement 3%
Mar 2009 - Consult with radiation oncologist about adjuvant radiation therapy
Decided to monitor PSA instead of doing adjuvant radiaition
Post surgery PSA undetectable thru Sept 2009

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