I am starting IMRT Monday - BUT WHAT IF

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Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 11/28/2009 7:55 AM (GMT -6)   
First off, I am not having seconds thoughts about undergoing IMRT. My surgery 10 weeks ago appears to have not gotten all of the little bastich PCa cells and logically IMRT seems to be the next step.

However, I am 61 years old, my wife also has cancer, ED is already an issue for the time being (but it's not bothering me or my wife as we still have a very enjoyable sex life) and so on.

There are a lot of you folks here that are much more knowledgeable about the various drugs that are taken in lieu of surgery or IMRT, so I throw this out there for discussion;

I know that any type of drug therapy is NOT CURABLE, but is there any reason the I should consider drugs like finasteride or dutasteride) at this time and put IMRT further down the road for a while or not at all.

From what little I have read and my acknowledged limited understanding, these drugs don't appear to have the stronger side effects of drugs whose purpose is to expressly stop the production of testosterone.

Anyway, I am putting this out there for discussion, as I explicitly trust the folks here at HW for a patient view on all things PCa.

Thanks for your input,

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
Post Surgery Pathology:
Gleason: Changed to (4+3) = 7
Stage: T3a
Tumor Volume 12.5%
NERVES SPARED-positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT scheduled to begin Nov 30,2009 (74 days post surgery)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 11/28/2009 8:15 AM (GMT -6)   
Sonny, I wanted to answer your quickly as soon as I saw this.

Before I give you my opinion, what are you thinking here? What would be any purpose of putting off the RT?

With your strong .6 so soon after surgery, and being that have been comfirmed a Stage 3 by surgery, you are sitting on the edge of your best window for the RT to work. Based on my own doctors, the very best shot is when reaccurance is at or under .5. You are already over that. The next best window is from .6 to 1.0. Beyond 1.0, my group feels it won't do much good.

You are set to do this thing Monday, you have a great doctor, and you are still in a good window of recovery. Unless you are holding back on something you know about your own case, it sounds incredibly risky to delay or not have the treatment. The other drugs at this time will give you a false sense of security by masking and lowering the numbers, for now.

Please tell me what you are thinking, or give me a phone call. Something diffferent is going on here, not sure what.

Deeply concerned,

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


KrisP
Regular Member


Date Joined Mar 2008
Total Posts : 162
   Posted 11/28/2009 8:59 AM (GMT -6)   
Hi Sonny3,
I cannot shed any information as I'm not knowledge is that area but I do want to wish you all the best and hope your treatment is successful.
Good Luck!!
Occupation: Mechanical Engineer

Biopsy: 3/5/2008; Pre surgery: Gleason 6 (3+3), involving left lobe
t2b. DaVinci Surgery on 4/21/2008 in Austin by Dr Randy Fagin.[/color]

Pathologist report upgraded to a Gleason 7 (3+4); Margins: Clear
ED back to 95%, Viagra o<SPAN style="FONT-SIZE: 9pt; FONT-FAMILY: Verdana">ccasionally

<SPAN style="FONT-SIZE: 9pt; FONT-FAMILY: Verdana"><?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p>
First PSA (06/17/08) = <0.04 Undetectable

Second PSA (10/27/08) = < 0.1 Undetectable

Third PSA (02/11/09) = < 0.1 Undetectable

Fourth PSA (05/13/09) = < 0.1 Undetectable

Fifth PSA (11/11/09) = < 0.1 Undetectable


Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4088
   Posted 11/28/2009 9:43 AM (GMT -6)   

Sonny,  Sounds like that mind in making you have all those What Ifs and Should Is.  Time to take a deep breath and get set for the race.  You will do fine.  Most have some side effects but nothing like our firend David had. 
 
Buddy I want you to know Pat and I will be thinking of both you and Lynn as to tow of you get this treatment.  I have told you this before.  If you need please do not hesitate to give me a call. 
 
Your Friend and Brother in PC
 
Jeff T
Cajun Country
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.


wesd40
Regular Member


Date Joined Sep 2009
Total Posts : 41
   Posted 11/28/2009 11:16 AM (GMT -6)   
Sonny,
My friend,Good luck with whatever you choose.i have to wait 2 more weeks before my first post op psa test. You and I STILL share the same Da Vince birthday and i will have a little relief once I know what my psa test is either way. I just want to know.Take care, Wes

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4188
   Posted 11/28/2009 11:51 AM (GMT -6)   
Sonny,
50 mg of Casodex should work to keep the PC in bay for at least 6 months to a year with very few side affects If you have a good reason for postphoning RT Casodex is probably your best bet.
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


Magaboo
Veteran Member


Date Joined Oct 2006
Total Posts : 1210
   Posted 11/28/2009 11:54 AM (GMT -6)   
Hi Sonny,
 
Please listen to David. The time to tackle your problem is NOW! Unfortunately, David had a tough time with his RT, but most of us have only minor side effects. Don't just walk to the RT clinic...RUN. I had my SRT when my PSA was only 0.1. Had minor side effects and my last PSA was <0.04. I don't know what's in my future, but I know I made the right decision. If you don't get the RT now, you may regret it for the rest of your life. There is no going back.
 I'm certainly not a medical expert and can only give you my own, personal opinion. The final decision, of cause, rests with you.
 
 
All the best to you.
Your friend,
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


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 11/28/2009 12:17 PM (GMT -6)   
Lots of choices in dealing with PCa, no easy answers, even just jumping into RT is not a guarantee or easy answer, not that it is bad or like Davids experience, but it also comes with no guarantee at all, maybe should try to read and find abstracts and data on the percentage of successes or failures on 'salvage radiation' and put that into your considerations basket.

It is in effect another gamble just like surgery and other treatments, is it the best gamble, maybe? IF you want more time to consider it all, you can do casodex and other drug protocols and avodart or proscar do work(maybe use with casodex=ADT2), without casodex(avodart or proscar)is used as maintenance therapy it is used after dropping ADT3 combo therapy....why because it does block/cancel dihydratestosterone which is the bigger/better fuel for PCa that normal testostorone, it is said to be atleast 10 times more potent form of 'testosterone' and your body makes this normally, makes sense to block it as docs are saying PCa prefers this fuel as first for fueling PCa. You can seek docs and others that might give you this information: www.pcref.org (Barken-donation basis), www.paactusa.org (likely free opinions), and other sources. If you had a super fast rising psa that could influence all this (like doubling in days or weeks), doesn't seem to be that...you probably have time to do alot of things, maybe get an opinion from a PCa type oncologist to perhaps see what that opinion is.
 
Alot of discussion on what is the window of opportunity on PCa, especially salvage treatments. Not against doing radiation or any treatments (fyi), patients should have the quantitative data they need in order to make "their" decision on when and what risks are included, then you need to decide what is right for you. I mentioned Rick K. herein a few times, low stats patient, did not do surgery or others, did ADT3 drugs 13 months then only on proscar, manhood returned to normal soon after quitting ADT3, went 12 yrs. clear biopsies and no problems, just recently(psa went up) and resumed 2nd round of ADT3 and will quit and go back on Proscar. Is he unpleased???? Not at all and fully normal functions, that is his choice and does not seem all that ridiculous...he can still have any normal treatment still also(he is around 67 now approx). Surgery would be harder but is still possible, too. It is car-razy in PCa twight zone world.

Post Edited (zufus) : 11/28/2009 11:48:05 AM (GMT-7)


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7197
   Posted 11/28/2009 12:47 PM (GMT -6)   

Hi Sonny:

You and I both have big days on Monday. This is no fun. I had more questions and was going to post a what if type thing, but the usual response is "take a deep breath," "you are running too far ahead," etc. etc. etc.

In my case, they may be correct. But, you have given me the courage to post another what if, which I'll do shortly.

I do think you have to decide on a treatment and go with it. It's getting late to change your mind. But, from my readings, it does seem like this is the next step in the attempt to beat this crap. Fortunately, most folks seem to have fewer problems than Dave.

 

Mel

 


PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro!
 
History of BPH/prostatitis.
 
Awaiting results of my PCA-3 test which will determine whether a biopsy is in my immediate future. Just in: BAD NEWS: PCA-3 = 75.9! Cut-off is 35. Biopsy scheduled for 11/30


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 11/28/2009 1:50 PM (GMT -6)   
I would hope to God that most men wouldn 't have all the side effect problems I went through, but a truthful report of the journal I took was what was requested, good or bad.
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


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 11/28/2009 3:43 PM (GMT -6)   
Sonny,

As I have said before on this forum, we must make our choice, and then live with it and the consequences.

You opened your post with something about being 61. I hope you aren't thinking that your age somehow is influencing your decision not to have RT. In my view, 61 is pretty young not to give it your best shot now. You still have a lot of years and a lot of golf to play.

But, whatever you decide, I for one will never second guess you because it is your choice, for your reasons. I think there is no doubt that HT could slow the progression for a while, but I think most believe it does not stop it.

Good luck Sonny to you and Lynn. These really are some tough positions we are put in, and require some tough choices.

Goodlife
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


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2457
   Posted 11/28/2009 5:16 PM (GMT -6)   
Sonny,
I'm not an expert on RT but if I have a recurrance (i hope I won't) I will definitely get IMRT. ADT is not a cure so why postpone? I'm 7 years older than you so your age and your wife's health should not stop you from getting the right treatment sooner rather than later. We will all be praying fro you and wishing you the best.
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Pathology report:
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 4 months
8 weeks PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1
8 months PSA test 10/9/09 result <0.1


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 11/29/2009 2:12 PM (GMT -6)   
To all of you that weighed in on this, thank you very much.

I had specific reasons for asking this, that I did not want to go into. It was more about dealing with some things that are occurring with my wife than with me. It was never about second guessing myself or having doubts about the radiation.

I have an appt tomorrow afternoon at 1:20pm and I will begin my IMRT. Unless there is something really noteworthy, I plan to post on Fridays about the treatments for the week. Hopefully it will be pretty much a non-event, just like my biopsy, surgery, and recovery. Sure would like to see that good luck streak continue.

Thanks again for responding,

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
Post Surgery Pathology:
Gleason: Changed to (4+3) = 7
Stage: T3a
Tumor Volume 12.5%
NERVES SPARED-positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT scheduled to begin Nov 30,2009 (74 days post surgery)


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 11/29/2009 4:10 PM (GMT -6)   
Break a leg Sonny (just an expression)  and give those little buggers what they deserve.  God Bless you and Lynn in the coming weeks !

pasayten
Regular Member


Date Joined Mar 2007
Total Posts : 428
   Posted 11/29/2009 10:24 PM (GMT -6)   
Hi All,
 
Looks like I an in a similar situation as after my davinci removal,  psa loooked ok for a year or 2...  Now at month 31,  it climbed to 0.13 (checked at another lab at 0.11) and visit with uro doctor, he suggested salvage radiation.  Talked with their oncologist and he wants to progress on treatment.  I never did have a ct scan/bone test and that is what they would like to schedule that soon (guess I did not have one as I was a gleason 6) and then start a 7 week radiation treatment.
 
My question is recurrence is not defined til 0.2...   I am not there yet... 
But is the need for speed required for best outcome?    Best chance to be localized...
 
And how are the psa doubling times calculated?     After you reach 0.2?  or any of the ones before also count in figuring doubling times...
 
Also, I am figuring if I am in the 0-3 year period...   or the greater than 3 yr period for recurrence...   it might not hit 0.2 til after the 36 month period.
 
My stats have more info...    but this has really freaked me out as I had thought I had beat this thing...  I am 62 y/o now...  and currently severely depressed...  this on top of other building new house/selling old house  factors pushed me over the edge....    and thinking about the 7 week treatment each day requiring a 1 1/2 hr commute each way...
 
On the positive side, I have a great understanding wife and she assures me that thru the doctors and our faith in Jesus we will get thru this...  
 
Thanks for letting me vent and ask a few questions...    I know there are many that are in a much more serious situation than I am...
 
pasayten
 
 

After 3-4 years of annual PSA 4-6, biopsy recommended
3/13/2007 - 12 point biopsy - Left 0/6  Right 1/6 Gleason 3+3 T1c
4/24/2007 - DaVinci performed at Virginia Mason hospital in Seattle
5/2/2007 - Catheter Out! Final pathology of Gleason 6  T2c Nx Mx, approx 20% of prostate involved, positive margin, but only at 2 focal points.  
6/28/2007 9 weeks incontinance... Overnite, went from 4-6 soaked pads a day from prev 8 weeks to 2 barely wet pads a day.
7/12/2007 11 weeks post-op  Minimal leakage...  one small pad a day
7/18/2007 First Post-Op PSA...  0.01 !!! 
9/10/2007 Pad free and ED at 75% with 100mg Viagra generic
6/26/2008 2nd Post-OP PSA at 14 months...  0.02 
12/2/2008 3rd Post-OP PSA at 20 months...   0.03
10/30/2009 4th Post-OP PSA at 31 months...   0.13 (moved and diff lab)
11/3/2009 Retest at my original lab...  0.11  (followup with Doc sched 11/10)


CPA
Veteran Member


Date Joined Feb 2008
Total Posts : 655
   Posted 11/30/2009 8:00 AM (GMT -6)   
Greetings, Brother Sonny.  Trust you will do well today and for the next few weeks of treatment.  You are doing the right thing!  David

Diagnosed Dec 2007 during annual routine physical at age 55
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 pos; 2 marginal
Gleason 3+3; upgraded to 4+3 post surgery
RRP 4 Feb 08; both nerves spared
Good pathology - no margins - all encapsulated
Catheter out Feb 13 - pad free Feb 16
PSA every 90 days - ZERO's everytime!
Great wife and family who take very good care of me


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 11/30/2009 9:08 AM (GMT -6)   
Sonny, if I could, I would sit in the waiting room with you, and root you through the days and weeks ahead. With you all the way on this one.

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

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