Post Surgery IMRT Decision

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Regular Member

Date Joined Oct 2009
Total Posts : 252
   Posted 12/16/2009 1:09 PM (GMT -6)   
I had open surgery in October.  Seminal vessels and lymph nodes clear, two small positive margins and a PSA of .07 done with ultra-sensitive method.  Urologist referred me to radiology oncologist who will talk to me again after 90 day PSA test result in January. He stated that current feeling is that post surgery IMRT should be done no later than the 6 month mark for best results.  It seems like most men and their doctors are happy with a PSA of <.10.  I brought that up to my urologist in latest meeting and he said that it was confusing and that my hospital lab will no longer be using the ultra-sensitive test.  So I would assume that my 90 day PSA will be <.10 (hopefully).  Unfortunately that will not tell me if there was a rise in PSA from the 30 day result.  I really don't want to do IMRT and deal with susequent side effects if I don't have to because I am still dealing with mild incontinence and hard core ED from the surgery.  My question is for those of you who chose to have IMRT after surgery, was your decison based on a rising PSA (>1.5) or was it based on positive margins being present.  My urologist is leaving the decision up to me and the radiology oncologist seems to be inclined to do the IMRT no matter what. 
Age 63, PSA 2009 5.66
Diagnosed July 2009, Biopsy: 2 of 12 cores positive, Gleason 3 + 5 = 8
MRI and Bone Scan Negative.
Open Surgey  October 22, 2009
Post surgery Biopsy, Gleason 4 + 3; 2 positive margins
Incontinance after 8 weeks - 2 pads per day.
ED - Yes (will start Levitra in January)
30 day PSA (ultra-sensitive) .07

James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4463
   Posted 12/16/2009 1:22 PM (GMT -6)   
Subicsquid (Navy guy, huh) Welcome to the Forum. I will let the guys more familiar with your questions answer you, but do hope you will stay with us and continue sharing your journey with us.
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
24 mts: PSA's: .04 each test since surgery, Bimix .3ml PRN or Trimix .15ml PRN

Regular Member

Date Joined Oct 2009
Total Posts : 252
   Posted 12/16/2009 1:32 PM (GMT -6)   
Thanks.  Definately a retired squid.  Was really shocked with PC diagnosis because over the years I believed that San Miguel beer consumed in large quantities prevented all diseases!!!!

Age 63, PSA 2009 5.66
Diagnosed July 2009, Biopsy: 2 of 12 cores positive, Gleason 3 + 5 = 8
MRI and Bone Scan Negative.
Open Surgey  October 22, 2009
Post surgery Biopsy, Gleason 4 + 3; 2 positive margins
Incontinance after 8 weeks - 2 pads per day.
ED - Yes (will start Levitra in January)
30 day PSA (ultra-sensitive) .07

Regular Member

Date Joined Dec 2009
Total Posts : 97
   Posted 12/16/2009 1:41 PM (GMT -6)   
Squid,Mine was based on my psa being so high right after surgery.My first psa after surgery went up to 2.2 I just did'nt want to take any chances.I will start my imrt jan. 6th. I will keep everyone posted as I go.Take care.

age 55dx 12-2008,psa at biopsy 8.6
biopsy 12/12 gleason 3+4=7
da vinci surgery 6-09 nerve sparing by DR. John W. Scott (my hero)
Hospital 3 days cath 7days still leaking from cough(bad lungs)
still have ed may be the hormones.
9-09 psa 2.2 hormone inj
10-09 nuclear bone scan no results yet I will have gold markers placed 12-29-09
start rad 1-10-10
organ confined
extracapsular seminal vesicle involvement
lymph node involvement

Veteran Member

Date Joined Oct 2006
Total Posts : 1211
   Posted 12/16/2009 1:51 PM (GMT -6)   
The issues about ART or/and SRT are a little everything else about this darn cancer. In my case, the PSA numbers started to creep up about one year after my open RRP. At the two year mark post RRP, it was about 0.08 and at SRT start had risen to 0.1. It is my understanding that the chance of success is best when RT is started very early. My Surgeon, my Onc and myself agreed that to start SRT at 0.1 was my best and only chance of beating the beast. My side effects from the RT were minimal and early indications are that it may have been successful. Time will tell.
Wishing you all the best in your journey.

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

Veteran Member

Date Joined May 2009
Total Posts : 2692
   Posted 12/16/2009 1:54 PM (GMT -6)   
There are several schools of thought on this topic.

If you begin adjuvant radiation, ( don't wait for high PSA ), within 4 months of surgery, the odds of good results go up significantly. Most likely, becasue the PC is still in the protate bed.

If you wait until it hits .5, which is then referred to as salvage radiation, the success rate is around 30 %.

Obviously, if the PC has ventured outside of the prostate bed, then you will most likely not be successful with radiation alone.

In my own case, with a Gleason 9, I have decided to wait for the .5 PSA because at 4 months I wasn't continent, and most likely, the IMRT will freeze your continence levels where they are. So far, my PSA's have been great, so maybe I will buy a few years here.

Good luck.

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

Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 12/16/2009 1:56 PM (GMT -6)   
Squid, another ex navy guy here. Drank my share of San Miguel in the PI back in the days.

I just went through salvage IMRT. Mine was based on 3 consecutive rises in PSA post surgery and the fact that I had one positive margin, and due to my high velocity PSA pre-surgery.

Of course the radiation clinic would like to have you, they make a lot of money off those long treatments. Mine ran close to 3,000 a day for 39 days.

I would make sure you have bonifide reaccourance first, before taking that next step.

If you are <.10, wouldn't give it a thought.

David in SC (formerly with VP-17 and DEG-6)
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 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 in place

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