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gregory m helman
New Member


Date Joined Oct 2009
Total Posts : 16
   Posted 1/21/2010 8:37 PM (GMT -6)   
well i talked to my radation oncologist and he wants me to start hormone thearpy and radiation therapy.
if i don't get the hormone thearpy,then no waiting and start radiation . i just don't know what to do, i keep reading all the side effects from hormone thearpy.
he insists on hormone thearpy, after half hour talking to him, i said yes, but now i have second thoughts. i just had a prostascient scan and he said it looks like they saw something in the prostate bed. now they think they saw something or not. i like get the copy of the report and see myself. because of the scan are not very accurate. my psa right now is 0.45 thats  was in october of 2009.post surgery was 0.59 , and then 0.39. now back up to 0.45. anyone else has had the hormone therapy and what side effects and how did you tolorate them?. my surgeon says no studies are not done yet . and probably never.
  age 52
 
post op pathology report
 
comment
Macroscopic
specimen type - radical perineal prostatectomy
specimen is intact
pre op psa level 0.97/ng/ml
other organs-seminal vesicle(s)
microscopic --tumor site-1 nodule
nodule#1- involves left lateral mid and left lateral
dimensions--0.6 x 0.2 x 0.6 cm
Histologic type------ Adenocarinoma
histologic grade---gleason
primary pattern is-grade 3 : single acini of variable size and seperation , cribriform and papillary patterns
Secondary pattern is: grade 4 : irregular masses of acini and fused epithelium , can show clear cells
gleason score (primary + secondary)  = 7 : Moderately poorly differentiated
 
Tumor Quantitation:
preportion of prostrate involved by tumor =<1 %
estimated tumor volume(% involved by tumor x prifixation vol) =< 1 ml
 
extraprostaic extention - absent
seminal vesicle invasion- absent
perineural invasion - absent
blood /lymphatic vessel invasion --absent
extent of invasion : pT2a: tumor involves < one half of one lobe
regional lyph nodes: NX; cannot be assessed
 
margins :
 
margins involved by tumor : anterior left lateral mid
margin involvement is extensive (> 1 HPF)
beingn prostatc acini are present at margins , not in area of tumor
 
 
 
 
 
 
 
 
 


SubicSquid
Regular Member


Date Joined Oct 2009
Total Posts : 252
   Posted 1/21/2010 8:43 PM (GMT -6)   
During my first consult with radiation oncologist, hormone therapy was not mentioned. Now that I know my PSA is rising and I will need IMRT, if he does recommend HT in addition I will accept it. I will do anything to try and kill off the cancer. I'm tired of side effects, but if the treatment will work I can accept them. All of these decisions are hard. No matter what, there is plenty of suppoprt here.
Age 63, PSA July 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 (6 hours on table; 2 units blood)
Small part of incision infected (2 staples removed); finally healed at 3 month mark.
Prostate, both nerve bundles, seminal vessels, and two lymph nodes removed during surgery.
Post surgery Biopsy, Gleason 4 + 3; 2 positive margins
Returned to work after 6 weeks.  First week worked only half days because of pain from sitting for long periods.
Still slightly incontinant after 12 weeks - 2 pads per day (light). Dry at night. 1-2 trips to toilet.
ED - Yes (will start Levitra possibly in January)
30 day PSA (ultra-sensitive) .07
90 dat PSA (standard) .15


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/21/2010 8:53 PM (GMT -6)   
Recently completed SRT without HT. I met with 3 different radiation oncologists before picking one. 2 of them strongly said to just do the IMRT without radiation, and 1 tried to make a case for doing HT plus the radiation, but when he was pushed for proof, he admitted that he didn't know if it would help me, and he admitted that he didn't know for sure if I needed the HT or not. He gave me 2 reasons not to do it along with the 2 doctors that also said not to do it at that time. That was good enough for me.

A case can be made for and against including HT with radiation, and both make good arguments. Like all the other tough decisions we have to make with our PC journeys, this will be another one you are going to have to make on your own.

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: 1/10 .12
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 43 days, 1/10 - Corrective Surgery #4, and Caths #11 and #12 in at the same time


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 1/21/2010 11:57 PM (GMT -6)   
My rad onc at Sloan quotes a few studies that show significant survival benefit for RT plus HT. However, these studies are for RT as a primary treatment. My onc at Duke agrees, he beleives that you can use those studies in salvage setting.

Like many, I first was looking at radiation only. Then was convinced to just do it for six months. Now he is talking three years.

The side effects are no picnic, but you get used to it. I have gone 8 months now. Just got latest shot today.
Father died from poorly differentiated PCa @ 78 - normal PSA and DRE
5 biopsies over 4 years negative while PSA going from 3.8 to 28
Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8
Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere + Avastin)
PSA prior to treatment 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60
RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins
PSA undetectable for 8 months, then 2/6/2009 0.10, 4/26/2009 0.17, 5/22/2009 0.20, 6/11/2009 0.27
ADT (ongoing, duration TBD): Lupron started 6/22/2009
Salvage IMRT to prostate bed and pelvis - 72gy over 40 treatments finished 10/21/2009
PSA 6/25/2009 0.1, T=516, 7/23/2009 <0.05, T<10, 10/21/2009 <0.05, T<10


don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 1/23/2010 8:51 PM (GMT -6)   
Hello Greg,
 
I had IMRT as a primary treatment with adjunct HT. I just had my 6th Lupron shot this week. It will be two years when this wears off in May. When I was diagnosed I found several studies that indicated anywhere from six months to two year HT therapy in conjunction with radiation gave very good long term results. My uro has suggested that I go a third year on the HT as there is some evidence of a bit more improvement in results. The side effects of the HT have been tolerable. No libido, lost my body hair, gained about 10 lbs, lost some strength (still able to do what I want), and that all time favorite hot flashes. In fact it seems like I am either cold or in a sweat most of the time. turn However, it has not been so bad that I would stop the therapy. It seems that the longer I am on it the easier it is to deal with.
 
Search the Bolla study. I think that is right. It is the one that is most often cited as an example of combined therapy and good results.
 
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
 
 
 

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