Back-up treatment option question

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compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7204
   Posted 12/22/2009 10:58 PM (GMT -6)   
Suppose surgery doesn't work totally (ie: PSA rises).
 
Salvation Radiation (IMRT) might still be curative. But am I correct from my reading that your chances are now down to 30% (for a cure)?
 
Mel
 
 
63 years old
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro! DREs have always been normal.  
History of BPH/prostatitis. PCA-3 test: 75.9 (bad news, guaranteeing I have to do....): Biopsy on 11/30/09. Result of biopsy:

5 out of 12 cores positive. Gleason 4+3. More specifically: 2 cores were 3+3 (one 5% and the other 30%) on one side. On the other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C

 Latest: Surgery with Dr. Menon at Ford Hospital, set for 1/25/10

 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/22/2009 11:14 PM (GMT -6)   
Mel, that is generally a true statement. It all comes down to is the recurrance local or distant, or in some case, both can be going on at the same time.

I have seen stats that show as high as 40% for the secondary treatment of radiation as still being curative. There are other factors, including psa velocity both pre-surgery and post surgery that can dinimish those odds. My own radiation oncologist gives me a 30% chance for success at best for those very factors.

There was a recent study releaseddin the news that was showing a more positive spin on salvage radiation for us surgery guys, I will post the link as soon as I can find it, unless one of our other brothers don't beat me to it.

When you are in that situation, like I just was, and our brother Sonny, you usually go for it, because it will be the last curative chance you will get in fighting PC beyond your primary treatment. Whether that be 30 or 40%, it is still something you can be pro-active about, and something you can say you tried while you still had the opportunity.

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


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 12/23/2009 6:06 AM (GMT -6)   
Mel, the radiation oncologist we spoke with said that the success rate for SRT is high when the recurrence is confined to the prostate bed. The tricky thing is figuring out if that is the case or whether the disease has moved to more distant sites. There was a study published, I think, by Johns Hopkins within the past few months that showed salvage RT as having a good success record. Maybe a Google search will bring up the article - it was published around August or September of this year.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (single small EPE in posterior left). Perineural tumor infiltration present. Apex margin, bladder neck and SV negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009- 0.1, September 0.3, October back to 0.0, December 0.0. Thank you God!


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 12/23/2009 6:36 AM (GMT -6)   
Mel,

Recently I posted the results of a study that indicated that Adjuvant IMRT following surgery increased the chances of being cancer free considerably.

I can't lay my hands on the link right now, running off to IMRT treatment in a few minutes.

Wait, try this one: http://www.cancerconsultants.com/adjuvant-high-dose-intensity-modulated-radiotherapy-may-decrease-relapses-after-radical-prostatectomy/

There is another one. Can't find it now.

I will try to find it later today and post it. My own RO told me that in my case he felt that the chances of success were 50% for my treatments. I'll take those odds any day.

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)


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7204
   Posted 12/23/2009 1:15 PM (GMT -6)   

Sonny:

 

That's a good article. Basically it suggests doing the radiation if the pathology is bad (eg: positive margins, etc.)

That will be an important decision: to wait and monitor PSA in light of adverse post-surgical findings vs. going right to IMRT. It sounds like IMRT -- immediATELY-- is the advisable way to go.

 

Mel

 


63 years old
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro! DREs have always been normal.  
History of BPH/prostatitis. PCA-3 test: 75.9 (bad news, guaranteeing I have to do....): Biopsy on 11/30/09. Result of biopsy:

5 out of 12 cores positive. Gleason 4+3. More specifically: 2 cores were 3+3 (one 5% and the other 30%) on one side. On the other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C

REVISED BIOPSY REPORT: The previous was read by Umich. Slides were then sent to Dr. Menon at Ford Hospital. Here is their report (much better) -- changes in bold print below:

5 out of 12 cores positive. Gleason 3+4. More specifically: 2 cores were 3+3 (one 5% and the other 20%) on one side. On the other side, 3 cores were 3+4 (5%, 5%, 20%)

 Latest: Surgery with Dr. Menon at Ford Hospital, set for 1/25/10

 


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 12/23/2009 2:11 PM (GMT -6)   
Mel, there was another study recently (can't lay my hands on it right now) that finds doing IMRT following surgery within 18 weeks, (before rise in PSA) dramatically improves the statistics of going progression free for a much longer period of time. That is the main reason I jumped on the IMRT train so quickly following my initial PSA showing as detectable.

Soon as I find it again I'll post the link.

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 12/23/2009 5:57 PM (GMT -6)   
Mel,

I should have expected this post, but I was hoping you could rest a little until after the surgery. You just might drive yourself crazy on this stuff.

It's all a big crap shoot if the surgery doesn't work. It either has spread outside the prosate bed or it hasn't. Not really much we can do either way.

TC-Las Vegas took a real proactive solution and just hit it with everything they had from the get go based on his age, pathhology, etc.

Others, like myself, altho I have a very aggressive Gleason, have decided to wait it out and see if PSA rises, then decide. Studies show a higher cure rate for those that do adjuvant radiation within 4 months of surgery. The downside is that it may seal incontinence and/or ED at the postion at time of radiation.

I think the Brachy Boys postion is that if one is inclined to pursue the adjuvant therapy, based on pre-surgery testing, why not just do Brachy and IMRT and not surgery. I couldn't agree more.

That is why further testing with things such a Color Doppler now may help make that decsion.

Merry Christmas Mel, and hopefully, you can put this thing on the shelf for a day or two and enjoy the holidays.

Goodlfe
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

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