Pasayten has Questions that need answers

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Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 11/30/2009 7:29 AM (GMT -6)   
The following was posted as a reply on my thread about my upcoming IMRT. I am starting a new thread so that the folks at HW can answer the questions posed. I thought it would get lost if left where it was. He has some good questions and is looking for some guidance.

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)
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)


dsmc
Regular Member


Date Joined Jul 2008
Total Posts : 149
   Posted 11/30/2009 7:59 AM (GMT -6)   
Hi Sonny and pasayten,

Sonny I hope your SRT goes without a hitch. My main thing is getting there everyday as I continued to work. At that time I was replacing some rotten logs on a log home and replacing a deck and it did not slow me down a lot. I did experience some fatigue 3 or 4 week into it but it was during the Thanksgiving and Christmas holidays so I got some breaks.

I just got off the phone to make a lab appointment this week for my 2nd 6 month psa.....everyone keep their fingers crossed. I believe it will be fine since my psa bottomed out on my first one but I still get a little anxiety over it. My Doc said with 3 consecutive rises it constituted a recurrence and even at 0.1 that was all the better starting early and with my searches on the internet that seems to be the mindset with most Doc's. With that being said, pasayten, it is still your decision but I am glad I went ahead and got mine done at that point!

Good luck to both of you and keep us posted.

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!


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 11/30/2009 8:02 AM (GMT -6)   
There are no easy answers in fighting PCa too many unknowns, one has to realize that even the salvage radiation is basically a blind gamble, may well be worth taking, but you need to know just like surgery and other treatments, where is the guarantee???? You have not reached .2 range which is considered the threshold post surgery and such, guessing you can wait some as others seemed to have done and still had successes in treating this dragon. Thus another big decision when facing salvage therapies and your choices. Perhaps the Combidex scan is your best tool currently available, as to where is this PCa and can it be treated in that area??? Maybe get the color doppler ultrasound which is available in Michigan and California, to add to making your decision.

Some people opt towards hormone and drug therapies for control on PCa and at various stages even including primary treatment (e.g. Dr. Leibowitz protocols). All of us patients at any juncture and including post surgery and radiations, etc., needs to monitor your psa levels for years and years. Reoccurence is possible more so than many are lead to believe is the truth, as they don't know if it is outside the gland...they can assume and use averages from like Partin tables and such, but nothing is in stone or completely definitive. The low stats 'found' patients have the best chance for cures, even that can lack precise biopsy information and pathology findings, missed biopsy areas, undefined type of variant PCa or plodity analysis which could make a difference and like perinureal invasion (path to leave the gland) and such. Grey areas like you would not believe. This is why some low stats patients do have psa failure which is very sad, as they were lead to believe remove it and you are done with it, problem is that it is not the easy overall. In alot of cases that may be true or even majority of cases, but not all cases.

This is what my experience with PCa is telling me, perhaps it is not totally correct.... Maybe someone else has other information and experiences with this.

 

Post Edited (zufus) : 11/30/2009 8:10:43 AM (GMT-7)

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