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orickster
Regular Member


Date Joined Dec 2009
Total Posts : 22
   Posted 12/22/2009 10:25 AM (GMT -6)   
I'm a 59 year old male, and live in Texas. In August, diagnosed with prostate cancer. My wife and I decided on the da Vinci procedure with Dr. Randy Fagin in Austin, Texas. Initial biopsy: LEFT PROSTATE BIOPSY SHOWED: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 5, INVOLVING APPROXIMATELY 25% OF THE SUBMITTED SPECIMEN. ALSO SEEN ARE NUMEROUS AREAS OF HIGH GRADE PIN AND A FOCUS OF PERINEURAL INVASION. RIGHT PROSTATE SHOWED: BENIGN PROSTATE TISSUE SHOWING ADENOMATOUS HYPERTROPHY. Dr. Fagin called and thought we caught it early enough and scheduled surgery for September 30th, 2009. Surgery was performed and released the following day with a followup in 8 weeks. Never had 1 day of problem with leakage and never wore a pad. Went through physical therapy to strengthen muscles. Then back to work. Post Biopsy report: DIAGNOSOS: PROSTATE AND SEMINAL VESICLES(RADICAL PROSTATECTOMY):
Histologic Type: Prostatic adenocarcinoma.
Histologic Grade: Gleason grade 3+4=7
Laterality: Bilateral, involving approximately 35% of left prostate and less than 5% of right prostate.
Margins: Focal involvement of peripheral surgical margin measuring 3mm in greatest dimension.
Extraprostatic Extension: Focally present
Seminal Vesicle Invasion: Not identified
Perineural Invasion: Present
Angiolympatic Invasion: Not identified
Lymph Nodes: Not identified
Stage (AJCC, 2002): pT3a, NX,MX

My eight week followup, with PSA bloodwork done the week before the visit showed 0.15. Dr. Fagin ordered another PSA in hopes of a false reading. This result showed 0.12. The number did go down. He expressed to me the number was real and suggested Radiation Therapy. He said this procedure would last Mon-Fri for 4 to 8 weeks, and suggested a radiation onogologist in Austin. The only problem with that is, it's a 2 hour drive one way for me. I told him of a cancer center in Brownwood, Texas, which is only 50 miles from where I live. I work in Brownwood, so I drive it everyday and have for the past 20 years. The facility (WALKER CANCER CENTER) is relatively new, been the since the late 80's, with one radiation onogoligist, Dr. Alan Cass. I scheduled an appointment with my Urologist, Dr. Daniel Allstatt, in Brownwood, Tx. He's the Dr. who performed the initial biopsy. We talked, and he as well suggested radition therapy, moreless to nip it in the bud, or wait a couple of months to perform another PSA test. The decision was entirely up to me as to what to do. Based on the initial biopsy and the post biopsy, and the agressiveness from 25% to 35% in a month, and not knowing how agressive the exsisting cells may be, I've scheduled an appointment with Dr. Cass for next Monday, the 28th of December. This option is clearly up to me as to where to have the treatments. Are all cancer centers the same when it comes to radiation therapy or are there some better than others? Is Proton therapy used to combat these exsisting cells? And if so, there is only one center in Texas that offers Proton therapy and that is MD Anderson, in Houston. As you can tell I'm a little concerned as to my choices. I definitely want to make the right decision. Should I wait a couple of months for another PSA or go ahead with the radiation? Any suggestions??? My wife and I are going to meet with the Dr. on Monday, feel him out, and ask questions about how many of these he does for prostate cancer, and the success rate to rid of this disease. I'm just hoping for some positive feedback on those of you who have had to do this, and the time frame to get it done. Needless to say my anxiety and stress level are high and just want to make the right choice. As far as ED goes, the pills did not work, never tried the pump, using the injection therapy with some results, not lasting that long after orgasm, may try the trimix next. The injection medication I'm now using is: C-ALP20MCG/PHEN1MG/PAV30MG/ML20MCG/1M. Any info on the trimix would be helpful as Dr. Allstatt suggested this to me as well. My fear is will this type of therapy work after radiation, and what other side effects could I encounter after radiation therapy.

Regards, orickster

Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4119
   Posted 12/22/2009 1:26 PM (GMT -6)   
Orickster, I am sorry that the PSA is moving up. Sound like it is mop-up time to clean thing up in the prostate bed. I do not have any more info in that area. I am sure others will jump in that have already been there. I know that is is stressful and I do hope you meeting the the Rediation onogoligist will answer some of your questions. As far as the ED. You Dr is a bit more help than mine in the ED area. I am a bit ahead of you in time. I am 14 months out and still fighting the ED battle. I am going to another Dr the first of the year to try the injections. I am hoping this is kick start things. Best of luck to you for the New Year.

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.


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2461
   Posted 12/22/2009 3:20 PM (GMT -6)   
Orickster,
I had my surgery with Dr. Fagin as well. My Gleason score was 4+4. I knew my cancer was aggressive from the biopsy report and told Dr. Fagin to remove the nerve bundles if he thought it will give me a better outcome. So far I've had undetectable PSA. I'm using trimix and the pump for the ED problem and it works for me every time. I started out at .10 which was too low a dosage, I gradually increased that to .30 which works.
As for radiation, I can't help you with the choices you have but I do think that you should go ahead and get it done.
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


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 12/22/2009 4:46 PM (GMT -6)   
Hello and welcome.

Your apperent recurannce path is similar to mine. I had open surgery, then at around 11 months post surgery, I had salvage radiation via IMRT. Just completed 39 treatments totallying 72 gys of radiation.

Your pathology was much more serious than mine, and I know you are a Gleason 7 also and a total of 40% of your prostate was involved with cancer. I would definitely be seeing the radiation oncologist as soon as possible, and I am certain that they will recommend you starting radiation as soon as possible. With your pathology, I wouldn't wait and watch the psa rise any more at this point then practical.

Good luck and keep me posted.

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


Tom2116
New Member


Date Joined Dec 2009
Total Posts : 3
   Posted 12/22/2009 7:13 PM (GMT -6)   
Oickster, Like the others I recommend you see your radiation oncologist ASAP and get the ball rolling on your therapy. I had IMRT therapy and had no side effects. I am over five years out from my radical and even though I had psitive margins I am beating the odds and glad I had radiation. Good luck and best wishes...Tom2116 in WI
 Age 64, unmarried, sexually active, over 5 years out from RRP, PSA prior to RRP 5.7, undetectable since. Nerve sparing radical retro pubic prostatectomy (RRP), 8/2004, Gleason 7=4-3, positive margins, radiation therapy thereafter as well as four surgeries for bladder neck constrictions over the next two years. Self cathed twice daily for one year, no further constrictions. Incontinent, (4 or more pads a day) and have ED thereafter.

 

ED and Incontinence:  Used pills, Muse and/or Caverjet injections (yuck!) with limited success until I found a Men’s Health Clinic in Las Vegas, thereafter used their injection formula with an auto injector until I found a formulary pharmacy near where I live. Would certainly recommend an auto injector for anyone doing injections. The pharmacy provided Tri-mix and Quad-mix which helped some but was still unable to achieve long lasting erections or penetration because I lost about 2 inches in length as a result of the RRP.

 

UAS/IPP: In 8/2009 I had an artificial urinary sphincter (UAS) and an inflatable penile prosthesis (IPP) surgically placed during the same procedure, which I would recommend to no one. One of the penile cylinders became dislodged upon activation and in 11/2009 they did a revision. The IPP works well but I am dissatisfied with the overall length and girth and still cannot achieve penetration. Still incontinent (stress incontinence) and require one pad a day sometimes more depending on level of activity. Open to any questions or comments.  I’ve been there, done that!


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 12/22/2009 8:21 PM (GMT -6)   
Just to add, the side effects of radiation are usually mild (but not always, as David, aka Purgatory, can testify to). Many Proton centers don't even do the salvage radiation. Photons are a standard treatment. The differences between centers are two fold. The doctors (and even more important the physicists) who plan your treatment and the equipment. Talk to local doc and ask him about the equipment (among other things). Then have a second opinion elsewhere. See who you trust more. Two hours is a hike, but I would rather do that, if I did not feel I can trust the local doc. Best of luck.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 12/22/2009 8:30 PM (GMT -6)   
With the difficulties I encountered with radiation, adding two hours for driving time would have been tough on me, I was fortunate that my rad center was only 13 easy miles away door to door.
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


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 12/22/2009 8:36 PM (GMT -6)   
I liked what Geebra mentioned, as being a more reasonable philosophy in PCa decisions. Also, all radiations are not alike or equal, nor is the machinery or planning and dosemetrics and the skill of the radiation onco-docs varies too.  There even are mutliple choices of possible treatments methodologies which many herein do not probably know about, including neutron rays or neutron & photon combinations treatments or differences(proton vs. photon) in the the others and differences in targeting methods, delivery and such, there is  a maximum threshold of sold called safe radiation (ask your doc if it is worth it or warranted in your case). Not positive which types of radiations are ruled out or used in salvage situations, you have to look into that yourself or ask someone with alot of background.
 
Not easy to find neutron radiation, it is either 2 or 3 place in the whole USA having such. In Dr. Strums book one can read about these radiations and some of the data, differences in more technical lingo...if you were interested enough.
 
 
 
 
Youth is wasted on the Young-(W.C. Fields)


orickster
Regular Member


Date Joined Dec 2009
Total Posts : 22
   Posted 12/23/2009 7:59 AM (GMT -6)   
corvetteman3 said...
Orickster, I am sorry that the PSA is moving up. Sound like it is mop-up time to clean thing up in the prostate bed. I do not have any more info in that area. I am sure others will jump in that have already been there. I know that is is stressful and I do hope you meeting the the Rediation onogoligist will answer some of your questions. As far as the ED. You Dr is a bit more help than mine in the ED area. I am a bit ahead of you in time. I am 14 months out and still fighting the ED battle. I am going to another Dr the first of the year to try the injections. I am hoping this is kick start things. Best of luck to you for the New Year.

Jeff T
Cajun Country

Thanks Jeff T for your reply. Regards Orickster


orickster
Regular Member


Date Joined Dec 2009
Total Posts : 22
   Posted 12/23/2009 8:01 AM (GMT -6)   
Ed C. said...
Orickster,
I had my surgery with Dr. Fagin as well. My Gleason score was 4+4. I knew my cancer was aggressive from the biopsy report and told Dr. Fagin to remove the nerve bundles if he thought it will give me a better outcome. So far I've had undetectable PSA. I'm using trimix and the pump for the ED problem and it works for me every time. I started out at .10 which was too low a dosage, I gradually increased that to .30 which works.
As for radiation, I can't help you with the choices you have but I do think that you should go ahead and get it done.

Thanks Ed C. for your input. Orickster


orickster
Regular Member


Date Joined Dec 2009
Total Posts : 22
   Posted 12/23/2009 8:03 AM (GMT -6)   
Tom2116 said...
Oickster, Like the others I recommend you see your radiation oncologist ASAP and get the ball rolling on your therapy. I had IMRT therapy and had no side effects. I am over five years out from my radical and even though I had psitive margins I am beating the odds and glad I had radiation. Good luck and best wishes...Tom2116 in WI

Thanks Tom2116  for your input. Orickster


orickster
Regular Member


Date Joined Dec 2009
Total Posts : 22
   Posted 12/23/2009 8:06 AM (GMT -6)   
Geebra said...
Just to add, the side effects of radiation are usually mild (but not always, as David, aka Purgatory, can testify to). Many Proton centers don't even do the salvage radiation. Photons are a standard treatment. The differences between centers are two fold. The doctors (and even more important the physicists) who plan your treatment and the equipment. Talk to local doc and ask him about the equipment (among other things). Then have a second opinion elsewhere. See who you trust more. Two hours is a hike, but I would rather do that, if I did not feel I can trust the local doc. Best of luck.
 
Thank you for your input.  Orickster

orickster
Regular Member


Date Joined Dec 2009
Total Posts : 22
   Posted 12/23/2009 8:06 AM (GMT -6)   
zufus said...
I liked what Geebra mentioned, as being a more reasonable philosophy in PCa decisions. Also, all radiations are not alike or equal, nor is the machinery or planning and dosemetrics and the skill of the radiation onco-docs varies too.  There even are mutliple choices of possible treatments methodologies which many herein do not probably know about, including neutron rays or neutron & photon combinations treatments or differences(proton vs. photon) in the the others and differences in targeting methods, delivery and such, there is  a maximum threshold of sold called safe radiation (ask your doc if it is worth it or warranted in your case). Not positive which types of radiations are ruled out or used in salvage situations, you have to look into that yourself or ask someone with alot of background.
 
Not easy to find neutron radiation, it is either 2 or 3 place in the whole USA having such. In Dr. Strums book one can read about these radiations and some of the data, differences in more technical lingo...if you were interested enough.
 
 
 
 Thank you for your input. Orickster


orickster
Regular Member


Date Joined Dec 2009
Total Posts : 22
   Posted 12/23/2009 8:13 AM (GMT -6)   
I think I hit the wrong icon in the upper right corner stating to ignore, it was by accident, don't want to ignore anyone, as this is a wonderful place to be to get information. Orickster

orickster
Regular Member


Date Joined Dec 2009
Total Posts : 22
   Posted 12/23/2009 8:16 AM (GMT -6)   
Purgatory said...
Hello and welcome.

Your apperent recurannce path is similar to mine. I had open surgery, then at around 11 months post surgery, I had salvage radiation via IMRT. Just completed 39 treatments totallying 72 gys of radiation.

Your pathology was much more serious than mine, and I know you are a Gleason 7 also and a total of 40% of your prostate was involved with cancer. I would definitely be seeing the radiation oncologist as soon as possible, and I am certain that they will recommend you starting radiation as soon as possible. With your pathology, I wouldn't wait and watch the psa rise any more at this point then practical.

Good luck and keep me posted.

David in SC

Thanks for your input and words of encouragement, will keep everyone posted. Orickster


orickster
Regular Member


Date Joined Dec 2009
Total Posts : 22
   Posted 12/23/2009 8:17 AM (GMT -6)   
I edited the button I accidently hit.
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