Questions for Oncologist

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Jerry1
Regular Member


Date Joined Mar 2007
Total Posts : 460
   Posted 12/19/2009 5:57 PM (GMT -6)   
 
I have an appointment on Tuesday with the Radiation Oncologist and was wondering if anyone can tell me what kind of questions to ask, I believe they will be suggesting IMRT but at this point I cannot think anymore and just want to be sure I cover everything.  I know I will ask does this have a chance of working.  Since MJ still cannot find any info on a Gleason 8
with negative margins, and fast doubling time, and recurrance in less then a year benfiting from radiation I sure hope they are wrong.  Even Patrick Walsh says no benefi with my stats.  Still very confused but hopefully doctor will help just need to know the right questions.  I have been trying to go back to old posts to see if I can find some info but no luck.  Just need what you guys who have been through it think are inportant questions to ask.
 
Thanks for your help getting a little crazy.
 
Jerry1
Age 70
DX 8/13/08 , PSA 4.0, Biopsy 14 samples 1 positive 12% of sample,
Gleason Score 4+4 =8  Bone scan and MRI negative
Da Vince surgery on Oct 17, 08 Florida Hospital Dr Vipul Patel
Post Gleason report  4+4 = 8 Lymph nodes on both sides negative
margins Negative  Stage II (pt2a) 
Cath out on October 29th left in longer due to small leak.
11/19/08 dry no more pads
12/2/08 first PSA <0.1
 3/6/09 6 Month PSA 0.0
6/3/09 9 month  PSA 0.1
7/14/09  PSA still 0.1
10/15/09 PSA 0.3
10/26/09 surgery to remove 3 clips in bladder neck  
11/16/09 PSA 0.3
12/14/09 PSA 0.4 


don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 12/19/2009 7:45 PM (GMT -6)   
Hi Jerry,

The list below is the one I used when I spoke with the oncologist prior to beginning treatment. The difference is mine was as a primary treatment so you may want to edit the list. Your post surgery pathology would suggest that your PCa is still localized. Good chance that the IMRT will finish the bugger off.

Take a deep breath. You sound like you could use a breather. I know it easier said than done at times but try to keep a positive attitude.

Questions regarding radiation therapy
1 What is the primary goal of the recommended radiation therapy?
a. Suppression of disease
b. Slow progression of disease to other parts of the body
c. Curative
d. Does the radiation kill all of the cancer cells in the prostate and surrounding area?

2. What makes me a good or bad candidate for this particular treatment?
a. In favor
b. Against

3. Are there any additional tests that might change or improve the planned treatment?
a. Prosta Scint Scan
b. Lymph node biopsy
c. Determination of ploidy (diploid or aneuploid)

4. Forty five sessions have been recommended. Why so many?

5. What is the duration of each session?

6. What areas will be treated?

7. Are there any drugs administered or required during the radiation therapy?

8. Do I need to do any special preparation prior to each treatement?
a. Enema
b. Water consumption
c. Fasting

9. Are there risks of radiation induced cancers to nearby organs?
a. Bladder
b. Colon
c. Testicles
d. Kidneys

10. How does the radiation affect ones quality of life during treatment?
a. Impact on physical activity. (Biking, running, weight lifting, gardening)
b. Impact on sexual function.

11. How does the radiation affect ones quality of life after treatment?
a. Impact on physical activity. (Biking, running, weight lifting, gardening)
b. Impact on sexual function.

12. How long after completing radiation before things start returning to the new normal?

13. How do the radiation treatments affect ones general health?
a. Heart function.
b. Liver function
c. Bones
d. Weight gain or loss
e. Strength

14. What are the lasting effects of the radiation treatment?
a. Incontinence Urinary and Ailementary
b. Sexual function

15. Are there treatments available to manage the severity and duration of side effects from the radiation treatment?

16. How long do patients treated by this mean typically survive in cases similar to mine?

17. What is the measure of success?
a. PSA
b. Gleason Score
c. Tumor size

18. Are there any other follow up tests that will indicated the success or failure of the treatment?

Best of luck to you,
Don
Diagnosed 04/10/08 Age 58 at the time
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear and chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
Started Casodex on May 2 and stopped on June 1, 2008
Lupron injection on May 15 and every four months for next two years
Started IMRT/IGRT on July 10, 2008. 45 treatments scheduled
First 25 to be full pelvic for a total dose of 45 Gray to lymph nodes.
Last 20 to prostate only. Total dose to prostate 81 Gray.
Completed IMRT/IGRT 09/11/08.
PSA 02/08 21.5 at diagnosis
PSA 07/08 .82 after 8 wks of hormones
PSA 10/08 .642 one month after completion of IMRT, 6 months hormone
PSA 03/09 .38 six months post radiation and nine months into hormones 
PSA 06/09 .36 or .30 depending on who did the test
PSA 09/09 .33 one year after IMRT and 16 months into hormone
 
 
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 12/19/2009 7:47 PM (GMT -6)   
Jerry,

You and I had similar surgery dates and similar recurrance time, you are Gleason 8, me a 7. My salvage radiation just ended 3 weeks ago, my radiation doc gives it a 30% range to work, and this is assuming the recurrance is local. That is the big unknown in situations like ours.

Do remember, the radiation for you at this point is the last chance for a curative solution for your remaning cancer. This is why I agreed to do it myself. I was willing to endure what I did in hopes of being in that 30% group that it works. If it doesnt, then I will feel I did all I could on my end.

For those of us with PSA velocity and doubling time issues, both pre and post surgery, its our best shot. Your current PSA is much higher than mine was when I started salvage, my only advice is not to delay much more, it would have its best shot of working the lower that number is.

If you have any other direct questions to the entire Salvage RT process, please post again here or email if you wish.

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
Post SRT PSA:
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


Jerry1
Regular Member


Date Joined Mar 2007
Total Posts : 460
   Posted 12/19/2009 8:22 PM (GMT -6)   
 
Don826
Thank you so much for the information your questions are just the kind of information I needed.
 
David, you are right the only difference we have is you had a postive margin which changes the chance of local recurrance.  I can only hope mine is local but need to know the odds before I undergo this type of treatment at my age.  You are much younger and he your position and your state I would denifinity go for the radiation.
 
Jerry1
Age 70
DX 8/13/08 , PSA 4.0, Biopsy 14 samples 1 positive 12% of sample,
Gleason Score 4+4 =8  Bone scan and MRI negative
Da Vince surgery on Oct 17, 08 Florida Hospital Dr Vipul Patel
Post Gleason report  4+4 = 8 Lymph nodes on both sides negative
margins Negative  Stage II (pt2a) 
Cath out on October 29th left in longer due to small leak.
11/19/08 dry no more pads
12/2/08 first PSA <0.1
 3/6/09 6 Month PSA 0.0
6/3/09 9 month  PSA 0.1
7/14/09  PSA still 0.1
10/15/09 PSA 0.3
10/26/09 surgery to remove 3 clips in bladder neck  
11/16/09 PSA 0.3
12/14/09 PSA 0.4 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 12/19/2009 8:59 PM (GMT -6)   
Jerry, if I were your age, and assuming the rest of my general health was pretty decent age factored, I would still go for the salvage radiation, as it is still possibly curative for you. Just my take, you still have a good window of opportunity for it.

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
Post SRT PSA:
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


Jim B
Regular Member


Date Joined Mar 2009
Total Posts : 45
   Posted 12/20/2009 1:09 AM (GMT -6)   
Jerry,

I wish that I had asked the same questions as Don. He was much more prepared than I. I also agree with David. This is still curable for you and I certainly hope this treatment works. Everyone tolerates radiation differently, I really didn't have too many problems. Hope yours goes as well.

Jim
Dx age 48 PSA 11.58
Biopsy Nov 04
4 of 6 specimens positive
gleason 4+5=9
Perineural invasion at two locations
40 radiation treatments Jan-Mar 05
PSA May 05 0.07
Aug 05 - 0.15; Feb 06- 0.92; Oct 06- 0.55; Sep 07-0.42; Mar 08-1.13 Aug 08-2.26
Nov 08-3.98; Jan 09-5.81; Mar 09-9.02
Bone scan in Nov 08- one spot in pelvic region 1.9cm with SUV of 11
Bone scan in Mar 09-two spots. Original now 2.5cm with SUV of 22 and 2nd spot less than 1cm with SUV of 7.8
Bone scan in Nov 09 - NO CHANGE WOO HOO!

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