Met with Oncologist on salvage radiation

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Jerry1
Regular Member


Date Joined Mar 2007
Total Posts : 460
   Posted 12/23/2009 7:08 PM (GMT -6)   
 
Well my wife and I met with the radiation oncologist yesterday and went through all our questions and have to say he spent over an hour with us just answerning questions.  Thanks to your help in providing some of the questions.  He feels my only shot for a possible cure is radiation he also suggested hormone treatment starting 8 weeks before and continuing though the radiation my wife asked then how do you know if the radiation worked if the hormones are bringing down the PSA.  He said that is a very good question quess we would have to stop the hormones and see what happens.  Not to pleased with this answner and told him I prefer to do the radiation alone and if it does not work then do the hormones.  He said that it will be discussed at the council meeting on Jan 8th that will involve the other doctors in this field and all treatment opions will be disussed. 
 
I have an appointment on Dec 29 th for the cat scans and whatever else they do to get you ready for radiation and then depending on the results of the Jan 8th meeting I will probably start in Mid January.  He said 7 weeks 35 treatments.  Appartenly they have had some success with Gleason 8's that have negative margins.  All I can do is hope.
 
I wish you all a happy and very healty New Year and will keep in touch.
 
David good luck with your PSA results.
Jerry 1   
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 12/23/2009 7:15 PM (GMT -6)   
Jerry, thanks for the update on your situation, and on asking about me.

Your rad dr's answer to that last question about the hormone treatment and the radiation is exactly why I turned down a certain dr. He kept pushing the HT portion, and when I grilled him about it, he admitted to me that he wasn't sure I needed it and he wasn't sure it would help me. So in my mind, he gave me two reasons not to do that.

My rad. oncologist that I went with, and my former one from 10 years ago, would have agreed with what your wife said. they didn't want to mix the results of HT and RT at the same time. My dr. wants to see how the radiation works on its own. She told me to save the HT in case the salvage fails.

I did not get my PSA results today as expected, may now not get them till after Christmas. It's that lovely time of the year.

Please keep me posted, sounds to me like your head is in the right direction on the matter.

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


Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4119
   Posted 12/23/2009 10:00 PM (GMT -6)   
Jerry, Your wife had a great point and the answer was not helpful. Best of luck with the decision process and best wishes for the New Year.

Jeff T
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.


don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 12/23/2009 10:09 PM (GMT -6)   
Hi Jerry,

The reason your doc is suggesting the ADT concurrent with the radiation is that research indicates a better and more durable response for those who do the ADT and radiation together. That is the regimen I am on and yes it is a bit frustrating not knowing who is doing the work on the PCa.... hormone or radiation. Here is how I look at it. It does not matter at this point which one is doing the most work as long as both are working. I should have one last Lupron shot in Janaury and then see where it goes from there. The side effects of the hormone are uncomfortable initially but you will adapt.

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
 
 
 


bcc
Regular Member


Date Joined Oct 2009
Total Posts : 46
   Posted 12/23/2009 10:13 PM (GMT -6)   
hi guys sorry about this new member dont fully understand terms .talking abuot ed does not an issue after op mean no problem or that it wont work barry
PSA Aug 07 was 3, Mid 08, 3.5, mid 09, 7.27

First biopsy july 09 - t2a on left . 11 samples taken from 6 blocks. 4 blocks show positive for adenocarcinoma. 1 block 10%, 3 blocks 5%, overall gleason 3 plus 4. No perineural invasion seen. Seminal vesicles clear.

End Oct 2009, bone scan all clear, MRI shows 6mm lesion on bottom left and rest of gland diffused image. Late Nov 2009, a template biopsy of 32 from 20 sites adenocarcinoma, gleason 3 plus 4 at 10 sites; unfortunately spread over both left and right.


dkob131
Regular Member


Date Joined Apr 2008
Total Posts : 364
   Posted 12/24/2009 8:51 AM (GMT -6)   
Jerry:
As Don indicated most studies show that HT plus radiation is the way to go.  Google the two and you'll find the studies.  I'm in the middle of both and doing fine.  Whatever you decide Good Luck!
 
David
 54 y.o.
 Diagnosed 4/10/08
 DRE Normal
 PSA-5.5
 Biopsy- 12 cores, 4 positive highest 4+4=8
 Bone scan, CT scan and Chest X-ray clear 4/16/08
 Urologist suggested surgery 4/16/08
 MRI on 4/24/08 clear no suggestion of lymph node   involvement.
 4/24/08 -Started on Lupron and Casodex preparing for HDRT and IMRT in late July.  This treatment will not preclude me from surgery if I change my mind.
Decide to have DaVinci surgery after another consult with surgeon.
6/19/08- DaVinci surgery at University of Washington.
6/25/08- Path report, clear margins, no noted extension
9/12/08- PSA <0.02 
12/05/08-PSA <0.02 Six months after surgery 
3/02/09-PSA <0.02 Nine months after surgery
5/02/09-PSA .10
8/17/09-PSA .21 Begin HT and set up for SRT to begin in 2 months.
 


Carlos
Regular Member


Date Joined Nov 2009
Total Posts : 486
   Posted 12/24/2009 9:04 AM (GMT -6)   
Jerry, Take a look at the Sloan-Kettering prostate cancer nomogram for SRT. The nomogram suggests that for most men the use of neo-adjuvant HT almost doubles your chances of success. It certainly is something to talk to your doctor about.

Carlos
Diagnosed 2/2008 at age 71, PSA 9.1, Gleason 8 (5+3)and stage T1c.  CT and bone scan neg.
Robotic surgery 5/2008, nerves spared, bladder neck spared with pelvic floor reconstruction.
All margins, SV and lymph nodes were neg. 
Staged pT2c, Gleason sum 8 (5+3).
Continent at 6 weeks. 
PSA <0.1 at 18 months, Nov. 2009.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 12/24/2009 9:31 AM (GMT -6)   
And Jerry, I consulted with 3 diferent Radiation Oncologists before deciding to go with the salvage radiation, 2 of the 3 strongly disagreed about adding HT to the radiation, and the only one that suggested it is the one I talked about above. He even showed me a couple of studies he had printed out and admitted that they weren't conclusive.

You will have to do what you feel is right for you, and you will have to work with a radiation oncologist that you have a good level of trust and confidence with. That is very important.

Good luck as you continue to think through this important juncture in your journey.

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

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