IMRT: How many ?

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JB71
Regular Member


Date Joined Nov 2009
Total Posts : 206
   Posted 2/27/2010 12:31 PM (GMT -6)   
My radiation oncologist has suggested 35 sessions or
5 days per week for 7 weeks.
 
Reading here, I see that sme of you get either more or fewer treatments, i.e. Opa had 32, while someone else got as many as 39.
 
Any reasoning to this that someone might explain?
 
Also he suggested we hold off a bit and hope my incontenence will improve over say, the next 8 weeks.
He claims that at whatever level my incontenence is on the FIRST day of the radiation treatment, it will always stay the same and never improve and that I definately would NOT want!
Age, only 71.
 
July 2009, PSA 9.1, free ratio 0.16
September GLEASON 4+4=8, T2A
Prostate 44cc.
 
Calcium: 2.46  (range: 2.20 - 2.65 mmol/L)
25 Hydroxy Vitamin D: 102 (range: sufficiency:
76 - 250 nmol/L)
 
Bone Scan: Negative
CT Scan scheduled for Dec. 1st. Negative.
 
Started Casodex 50mg. on Nov. 6, first pill of 30.
Got Lupron 22.5mg ( 90 day ) on  November 19.
 
No real side effects as of Dec. 15 except dry skin and hair but getting quite 'porky' in the belt area even though now I go to the gym, three times a week. Also I dont have a need to shave anymore so now I can save my 'shaving' allowance and direct it to my stash of Depends !
 
Christmas Day got my first hot flashes. Thanks Santa!
 
Open surgery scheduled for Jan. 22 by Dr. J. Chen
 
Open surgery done on Jan. 20th. by Dr. J. Chin at London's University Hospital.
 
Cath removel scheduled for Feb. 8th. Yes, I know,
that will be 19 days. Dr. is out of country until then.
====================================
Pathology Report:
 
Gleason Score: cannot be determined due to therapy effects.
 
Extraprostatic Extension:
present, left radial, multifocal
present, left basal, multifocal
 
Resection Margins:
Apical: involved by invasive carcinoma, multifocal
Bladder Neck: involved by invasive carcinoma, unifocal on left side.Other: non-tumoural prostatic present at resection margin.
 
Perineural Invasion: present.
Seminal Vesicle Invasion: absent
Lymphovascular Invasion: absent
Lymph Node Status: no malignancy in regional lymph nodes
 
Additional path. findings:
high grade prostatic intraepithelial neoplasia
 
Pathology Stage: yp T3a NO MX
==================================
Radialogist appointment is on Friday Feb. 26 with
Dr. Glenn Bauman in London.
 
First PSA test since surgery on March 30th.
 
Next appointment with the surgery Doc is April 13.
 
.


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 2/27/2010 12:54 PM (GMT -6)   
Alot of variables in IMRT, dosemetrics- the level of exposures in grey scale, mapping area decided upon, type of machinery and its delivery systems, there are even threshold limits of how much is considered 'safe' radiation and some patients opt if they know of such for heavier duty program and you can sign off as getting such, I did but I also got a way different radiation method combined which is very rare as you need a Cyclotron to do that only 2-3 of these in the USA from what I know, also Neutron ray is most potent ray available and is used sparing and hopefully by highly qualified rad-doc so I got the Neutron(10sessions) & Photon(25 sessions) using 2 machines). Went well and I have no complaints, and I am 7+ years since doing this radiation, 8 yrs. since diagnosis. This along with ADT3 was my primary treatment...I was not a reasonable candidate for curative surgery.

Usually IMRT is around 35-37+ sessions from other patients chiming in. Should go very well and not often do we see people with horrible side effects, alot of variables including the equipment maintenance and whom is at the helm and doing the planning and work. Around 30-40 yrs. ago technology was bad on radiation and burn and issues were common then (called Box radiation and some other names).

Why rush into radiation, let the gland issues heal the best they can sounds very reasonable. It is not as scary to get radiation as you may first perceive, this is why you get all these mini sessions and weekends to build up your system, while doing this. Other guys can mention how it went for them or their doseage levels and details, all worth learning about.

Post Edited (zufus) : 2/27/2010 11:57:59 AM (GMT-7)


pasayten
Regular Member


Date Joined Mar 2007
Total Posts : 437
   Posted 2/27/2010 2:26 PM (GMT -6)   
Zufus is right...   Many variables to consider.
 
You can look at my signature for my pathology and rising psa...
 
I have been set up for 32 sessions of IMRT with 2 gys per session for a 64 gys total dose.  I have just completed the 22 treatment and have 10 to go...   No significant side effects have been felt to date.  
 
pasayten
After 3-4 years of annual PSA 4-6, biopsy recommended
3/13/2007 - 12 point biopsy - Left 0/6  Right 1/6 Gleason 3+3 T1c
4/24/2007 - DaVinci performed at Virginia Mason hospital in Seattle
5/2/2007 - Catheter Out! Final pathology of Gleason 6  T2c Nx Mx, approx 20% of prostate involved, positive margin, but only at 2 focal points.  
6/28/2007 9 weeks incontinance... Overnite, went from 4-6 soaked pads a day from prev 8 weeks to 2 barely wet pads a day.
7/12/2007 11 weeks post-op  Minimal leakage...  one small pad a day
7/18/2007 First Post-Op PSA...  0.01 !!! 
9/10/2007 Pad free and ED at 75% with 100mg Viagra generic
6/26/2008 2nd Post-OP PSA at 14 months...  0.02 
12/2/2008 3rd Post-OP PSA at 20 months...   0.03
10/30/2009 4th Post-OP PSA at 31 months...   0.13 (moved and diff lab)
11/3/2009 Retest at my original lab...  0.11  (followup with Doc sched 11/10)
11/10/2009 Discussion indicated biochemical reccurrence and need for salvage radiation treatment. 
1/21/2010 Another PSA test at 34 months...  0.14
1/26/2010 IMRT Salvage Radiation Treatment started
                  32 sessions for 64 gys total.
2/26/2010 22 down and 10 to go...  No side effects to date except a little
tiredness.  Sometimes feel like a slight sunburn on the inside for a few hours after treatment.
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/27/2010 3:02 PM (GMT -6)   
My Salvage IMRT ended after Thanksgiving day. I had 39 treatments for a total of 72 gys, which is quite a load for a secondary treatment. There are just so many factors for your radiation oncologist to consider when they come up with a person's "plan". So you will see quite a range of sessions numbers and gys. Where I had mine done, the longest possible regiment is 45 days.

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, 1/19 - Corr Surgery #4,  Caths #11 and #12 in at the same time, 2/8-Cath #11 out - 21 days


Jakester
Regular Member


Date Joined Aug 2009
Total Posts : 285
   Posted 2/27/2010 3:10 PM (GMT -6)   
JB, I'm undergoing salvage IMRT (usually 6+ months after surgery and after the psa testing has signaled probable cancer remaining) and it may differ from the protocol used for adjunctive radiation given not long after surgery but.... originally I was planned for 35 sessions for a total of 70.2 gys. The radiation oncologist changed it to 39 sessions but still for a total of 70.2 gys but at a slightly lower dosage per treatment. When I asked why, he thought in my situation it would lower the side effects.

So far through 26 sessions, the side effects have been very tolerable. It may have been the same spread over fewer sessions since it really doesn't seem like much of a change each session.

I had my continence under control with the exception of a few unexpected drops. The few drops still occur after start of radiations but once again mine being salvage radiation I had plenty of time to recover from incontinence. I have heard that ideally you want to wait until you have as much control as possible.

Good luck and best wishes,
Jake
Diagnosed 8/2008 Pre-op psa 4.2, Age 60 at dx
7 of 12 biopsies positive 3+3
DaVinci LRP 11/08
Post Op pathology clear margins, confined to prostate, absent extraprostatic extension, vascular or perineural. Gleason 3+4=7, 5-10% of 4 and location in right mid-gland.
3 month psa .1 2/09, 6 month .1 5/09, 9 month .2 8/09
broke ankle bones 6/09
9/21/09 Bone scan clear, psa still .2
11/12/09 chest xray was clear, psa however up to .3,
01/05/10 psa still .3, radiation setup done with tats, 01/19/10 started 39 sessions 70.2gy, psa at 6th week salvage IMRT up to .4


bemis
Regular Member


Date Joined Feb 2010
Total Posts : 38
   Posted 2/27/2010 3:58 PM (GMT -6)   
J B I'm starting adjunct radiation on April 13 which is about 11 weeks after surgery.I'm getting 68 gys over 38 days, my onocologest said he could do it over a little shorter period of time if I wanted but I told him I didn't mind the extra days for the recomended protocol.The way I understand it, its the accumulated Grays that count.I hope its not cast in stone that your bladder control will not improve after radation starts.I'm leaking most of the day now ,6 pads a day so hopefully it will improve over the next 6 weeks DICK
age 55 /psa 10-09 5.4/biopsy 11-09 Gleson 3+3=6 3+4=7/ Radical prostateectomy 1/22/10/pathology positive margins and extraprostatic extension pY3a


Bootheel
Regular Member


Date Joined Oct 2007
Total Posts : 300
   Posted 2/27/2010 4:12 PM (GMT -6)   
I had 37 treatments for 66GY. you didn't mention your post surgery PSA. I would delay IMRT until the PSA reaches at least .1 to let your continence and ED clear up a little. You could possibly have some long term incontinence issues if it is started to soon. I was about 16 months out when I had IMRT. My continence is okay but I am almost back to square one on the ED. Just a suggestion.
Age 65
Diagnosed 10/12/07
PSA 6.3
Biopsy 18 core samples, 2 positive <5%
Stage T1a Gleason 6 (3+3)
LRP  1/29/08
Post-op
Gleason 7 (3+4)
1 positive margin (.3cm)
T2C
4/16/08- Started Bi-mix injections 
5/15/08- 1st Post-Op PSA 0.07 Undetectable
8/11/08 -2nd Post-OP PSA 0.02 Undetectable
8/15/08- No more pads as of today  Whoopee!!!
11/13/08- 3rd post-op PSA 0.02 Undetectable
03/02/09- 1 yr. post-op PSA .09 Undetectable
05/13/09   PSA .18 (ouch)
Started IMRT June 13, 2009
Completed 37 treatments July 31, 2009 (66.6gy)
11/23/09 Post IMRT PSA .18
2/12/10   Post IMRT PSA 0.00


Opa N
Regular Member


Date Joined Sep 2009
Total Posts : 150
   Posted 2/27/2010 4:38 PM (GMT -6)   
You began your journey riding the Lupron train. Lupron will knock your psa readings right down to zero, and halt the advance of PCa. With a gleason score of 4+4=8, I totally understand your starting out on the HT path. Don't know enough to understand why you couldn't get a post-op gleason score (due to therapy effects?) In any case, the PCa is not going anywhere, so rest up and heal for as long as you can before starting RT. How about you asking for a psa test right now so you can confirm a zero? I was supposed to begin my RT on December 20, but the Rad Oco said that with my zero psa I could wait an extra month until after the holidays to begin. AND, he does NOT think I will have any long term continency problems. I wear a pad, for security, but probably could go without if I were brave enough.
All the best.
Roger

 Age 67 at diagnosis. Treated for coronary artery disease (CAD) since 1998, and under control with medications.

2/6/09              Routine physical, with DRE and PSA Test. PSA 4.02. Referred to Uro

4/20/09            TRUS  w/needle biopsy

4/23/09            Diagnosis PCa with Gleason 4+3 in 2/2 cores, Gleason 3+3 in 5/10 cores.

                        CT scan and Bone Scan both negative. Stage T2C.

8/27/09            DaVinci RP at WakeMed Cary NC with Dr. Tortora. Discharged 8/28.

9/8/09              Catheder removed. Path post-surgery confirms PCa, with Gleason 3+3 with scattering of 4. Positive margins in L & R posterior, R and L seminal vesicles, with perineural invasion.  Stage pT3b.

9/30/09            PSA Post-Op <0.01. Met w/Uro/Surgeon to review surgery and path report. Referred to Prostate Oncologist and Radiation Oncologist. Appointments set for 10/8.

10/8/09            Met w/ both oncologists. Adjuvant Combination Therapy to begin ASAP.

10/21/09          First Lupron injection. 30 mg dose (4 month)

11/2/09            PSA 2-month <0.01. Cystoscope w/calibration and dilation to remove scar tissue from urethra. Big relief.

12/18/09          psa 4-Month <0.01 undetectable. MRI/CT scan set for 1/5/10 for IMRT planning. RT to begin week of 1/11/09. Anticipate 64-66 grays over 32-33 treatments.

1/14/10            Start RT with 32 treatments # 2 gys per.

2/26/10            IMRT completed.

 

Initial incontinence pretty bad, starting w/6 Depends pants/day. Gradually getting better, with dramatic reduction in leakage around 9/20. Currently on 1 pad during the day and one at night (for security). Actually totally dry at night. After 1/16/10 down to a female regular pad. Barely felt.

 

 

 


Magaboo
Veteran Member


Date Joined Oct 2006
Total Posts : 1210
   Posted 2/27/2010 9:28 PM (GMT -6)   
Hi JB71, good question. I often wondered about the amount of greys(?) and number of sessions different guy are getting. I'm just guessing that the body mass of the patient and the distance that the rays have to travel to reach their intended target play some role in the differences. I would certainly welcome other explanations. In any case, I hope we all get enough of the stuff to stop the cancereyes .
All the best to you.
 
Magaboo

Born Sept 1936
PSA 7.9
-ve DRE
Gleason's Score 3+4=7, 2 of 8 positive
Open RP 28 Nov 06 (nerve sparing), Post op staging T3a
Gleasons still 3+4=7
Seminal vesicles and lymph nodes clear
Catheter out 15 Dec 06, Dry since 11 Feb 07
All PSA tests in 2007 (4) <.04
PSA tests in 2008: Mar.=.04; Jun.=.05; Sept.=.08; 3 days before Rad Start=0.1
Salvage RT completed (33 sessions - 66 Grays) on the 19th Dec., 08.
PSA in Jan., 09=0.05; July 09=<0.04; JAN 10=<0.04


medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1096
   Posted 2/27/2010 10:45 PM (GMT -6)   
Opa N -- I am interested in your treatment history, from your signature -- relatively low pre-op psa; Gleason 3+3 from path report, good post op psa, and post-RP treated with adjuvant LHRH agonist and IMRT without waiting for post op psa rise. Seems an agressive (though perhaps very prudent) course. Was this based solely on the existence of postitive margins? How long do they plan to keep you on the adjuvant hormone treatment? Past the end of IMRT? Just asking as part of my effort to learn more. Thanks.
Age 45.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5
 


pasayten
Regular Member


Date Joined Mar 2007
Total Posts : 437
   Posted 2/27/2010 11:13 PM (GMT -6)   
Medved,
 
I am sure OPa N can tell you for sure,  but his post op pathology was stage 3 (T3b) which I believe is one of the indicators for adjuvant treatments.
 
pasayten
After 3-4 years of annual PSA 4-6, biopsy recommended
3/13/2007 - 12 point biopsy - Left 0/6  Right 1/6 Gleason 3+3 T1c
4/24/2007 - DaVinci performed at Virginia Mason hospital in Seattle
5/2/2007 - Catheter Out! Final pathology of Gleason 6  T2c Nx Mx, approx 20% of prostate involved, positive margin, but only at 2 focal points.  
6/28/2007 9 weeks incontinance... Overnite, went from 4-6 soaked pads a day from prev 8 weeks to 2 barely wet pads a day.
7/12/2007 11 weeks post-op  Minimal leakage...  one small pad a day
7/18/2007 First Post-Op PSA...  0.01 !!! 
9/10/2007 Pad free and ED at 75% with 100mg Viagra generic
6/26/2008 2nd Post-OP PSA at 14 months...  0.02 
12/2/2008 3rd Post-OP PSA at 20 months...   0.03
10/30/2009 4th Post-OP PSA at 31 months...   0.13 (moved and diff lab)
11/3/2009 Retest at my original lab...  0.11  (followup with Doc sched 11/10)
11/10/2009 Discussion indicated biochemical reccurrence and need for salvage radiation treatment. 
1/21/2010 Another PSA test at 34 months...  0.14
1/26/2010 IMRT Salvage Radiation Treatment started
                  32 sessions for 64 gys total.
2/26/2010 22 down and 10 to go...  No side effects to date except a little
tiredness.  Sometimes feel like a slight sunburn on the inside for a few hours after treatment.
 


Opa N
Regular Member


Date Joined Sep 2009
Total Posts : 150
   Posted 2/28/2010 8:55 AM (GMT -6)   
Medved - We are veering slightly off-thread here, but I want to answer your inquiry. I was stupid and allowed 10 years to pass between psa tests (and annual physicals too for that matter.) I was seeing a cardiologist all that time, and believed that doing so was all I needed to look out for my health. Very wrong assumption. So, when I finally had a physical, the family doc drew blood for a psa, then did a DRE, then when the psa result came back slightly out of normal range, he passed me on the the Uro. If I had caught this PCa earlier, then I might not have had positive margins to the extent I did have (all over the place), nor seminal vesicle invasion. The path stage of T3b triggered the Uro to refer me out to both the Rad Onco and the Med Onco. I wrestled mightily over the HT part of all this; at first I objected strenuously to it, but eventually came around to realize that both HT and RT gave me the best shot of beating this thing. I have outlived all other males in my family by at least 5 years (they all died mostly of heart problems, by age 63), so I figured I was on "gain" time, and needed to make the most of it. All the docs considered me to be at high risk for spread/recurrence, EVEN THOUGH my psa tests were coming back undetectable. So there was the decision process. My treatment coursecalls for one more Lupron injection (30 mg, 4 mos), which I do tomorrow. Theoretically it will wear off starting in July, and we will be testing psa regularly after that. With God's help, it will be all I need. I have to give thanks out to TC-Las Vegas, Doting Daughter, and Zufus, all of whom offered great advice to me while I was wrestling with my decision. Agressive? Yes. Prudent? I believe so.
All the best.
Roger

 Age 67 at diagnosis. Treated for coronary artery disease (CAD) since 1998, and under control with medications.

2/6/09              Routine physical, with DRE and PSA Test. PSA 4.02. Referred to Uro

4/20/09            TRUS  w/needle biopsy

4/23/09            Diagnosis PCa with Gleason 4+3 in 2/2 cores, Gleason 3+3 in 5/10 cores.

                        CT scan and Bone Scan both negative. Stage T2C.

8/27/09            DaVinci RP at WakeMed Cary NC with Dr. Tortora. Discharged 8/28.

9/8/09              Catheder removed. Path post-surgery confirms PCa, with Gleason 3+3 with scattering of 4. Positive margins in L & R posterior, R and L seminal vesicles, with perineural invasion.  Stage pT3b.

9/30/09            PSA Post-Op <0.01. Met w/Uro/Surgeon to review surgery and path report. Referred to Prostate Oncologist and Radiation Oncologist. Appointments set for 10/8.

10/8/09            Met w/ both oncologists. Adjuvant Combination Therapy to begin ASAP.

10/21/09          First Lupron injection. 30 mg dose (4 month)

11/2/09            PSA 2-month <0.01. Cystoscope w/calibration and dilation to remove scar tissue from urethra. Big relief.

12/18/09          psa 4-Month <0.01 undetectable. MRI/CT scan set for 1/5/10 for IMRT planning. RT to begin week of 1/11/09. Anticipate 64-66 grays over 32-33 treatments.

1/14/10            Start RT with 32 treatments # 2 gys per.

2/26/10            IMRT completed.

 

Initial incontinence pretty bad, starting w/6 Depends pants/day. Gradually getting better, with dramatic reduction in leakage around 9/20. Currently on 1 pad during the day and one at night (for security). Actually totally dry at night. After 1/16/10 down to a female regular pad. Barely felt.

 

 

 


JB71
Regular Member


Date Joined Nov 2009
Total Posts : 206
   Posted 3/1/2010 12:44 PM (GMT -6)   
Thanks all for your always valuable input.

I'll be doing the planning/ct scan/measuring session in about 3 weeks. I'm guessing that following that, my oncologist will decide and how many sessions and at what dosage. The treatment will be IMRT with IGRT

I would like to finish all my radiation sessions before the last week in June, for what is likely a very selfish reason:
It's summer time and my wife starts her two months of holidays from her school board job. Can't have this friggen prostate annoyance interfere with our fun times!

I asked my surgion doc about a PSA and he said that if we did one ( 3 weeks ago, plus 3 weeks post surgery) and since I had already been on Casodex plus Lupron, he would guarantee a big zero. I'm now scheduled for the PSA on March 25th. about 9 weeks post surgery.
 
My start up radiation date would be around 14 weeks post surgery.

I'm also to continue HT for at least awhile. Got another 90 day Lupron dose during the Feb. 26. appointment. Did notice it was $ 200.00 cheaper at the hospital than the earlier Lupron, which was priced at $ 1166.00 but fully covered by our OHIP coverage.
 
Thanks to Buddha we live in Canada!
.


Age, only 71.
 
July 2009, PSA 9.1, free ratio 0.16
September GLEASON 4+4=8, T2A
Prostate 44cc.
 
Calcium: 2.46  (range: 2.20 - 2.65 mmol/L)
25 Hydroxy Vitamin D: 102 (range: sufficiency:
76 - 250 nmol/L)
 
Bone Scan: Negative
CT Scan scheduled for Dec. 1st. Negative.
 
Started Casodex 50mg. on Nov. 6, first pill of 30.
Got Lupron 22.5mg ( 90 day ) on  November 19.
 
No real side effects as of Dec. 15 except dry skin and hair but getting quite 'porky' in the belt area even though now I go to the gym, three times a week. Also I dont have a need to shave anymore so now I can save my 'shaving' allowance and direct it to my stash of Depends !
 
Christmas Day got my first hot flashes. Thanks Santa!
 
Open surgery scheduled for Jan. 22 by Dr. J. Chen
 
Open surgery done on Jan. 20th. by Dr. J. Chin at London's University Hospital.
 
Cath removel scheduled for Feb. 8th. Yes, I know,
that will be 19 days. Dr. is out of country until then.
====================================
Pathology Report:
 
Gleason Score: cannot be determined due to hormone therapy effects. ???????
 
Extraprostatic Extension:
present, left radial, multifocal
present, left basal, multifocal
 
Resection Margins:
Apical: involved by invasive carcinoma, multifocal
Bladder Neck: involved by invasive carcinoma, unifocal on left side.Other: non-tumoural prostatic present at resection margin.
 
Perineural Invasion: present.
Seminal Vesicle Invasion: absent
Lymphovascular Invasion: absent
Lymph Node Status: no malignancy in regional lymph nodes
 
Additional path. findings:
high grade prostatic intraepithelial neoplasia
 
Pathology Stage: yp T3a NO MX
==================================
Radialogist appointment was on Friday Feb. 26 with Dr. Glenn Bauman in London.
 
Got another Lupron 90 day shot today and he wants to start IMRT soon. CT Scan plus measure scheduled in about 3 weeks.
 
First PSA test since surgery on March 30th.
 
Next appointment with the surgery Doc is April 13.
 
.

Post Edited (JB71) : 3/2/2010 8:18:42 AM (GMT-7)


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 3/2/2010 5:29 AM (GMT -6)   
Looks like probably you got the zoladex it is usually cheaper and is given in the stomach area as opposed to Lupron usually in the rump-end area. With zoladex you have a nice black n blue mark that lasts a while and eventually goes away. They basically work the about the same, both are LHRH type drugs. Back when I got it the Lupron, was about $500-600 more in cost over zoladex (2002-2003-2004). Taking these would mask any natural or real psa number you might actually have, so when you go off these and months go by one should get psa tests to know where you are in the psa world.

Best to you in the journey.


JB71
Regular Member


Date Joined Nov 2009
Total Posts : 206
   Posted 3/2/2010 9:24 AM (GMT -6)   
Zufus: Did find the receipt and it says the same as the previous Lupron: Leuprolide Acetate 22.5mg.

However, this time it went in the stomach area, the first one in a muscle area in the upper leg.

And as you said, the PSA to be done on March 25th. is likely a waste of time (and at someones expense) but perhaps done to make me feel good about having a ZERO reading.
Age, only 71.
 
July 2009, PSA 9.1, free ratio 0.16
September GLEASON 4+4=8, T2A
Prostate 44cc.
 
Calcium: 2.46  (range: 2.20 - 2.65 mmol/L)
25 Hydroxy Vitamin D: 102 (range: sufficiency:
76 - 250 nmol/L)
 
Bone Scan: Negative
CT Scan scheduled for Dec. 1st. Negative.
 
Started Casodex 50mg. on Nov. 6, first pill of 30.
Got Lupron 22.5mg ( 90 day ) on  November 19.
 
No real side effects as of Dec. 15 except dry skin and hair but getting quite 'porky' in the belt area even though now I go to the gym, three times a week. Also I dont have a need to shave anymore so now I can save my 'shaving' allowance and direct it to my stash of Depends !
 
Christmas Day got my first hot flashes. Thanks Santa!
 
Open surgery scheduled for Jan. 22 by Dr. J. Chen
 
Open surgery done on Jan. 20th. by Dr. J. Chin at London's University Hospital.
 
Cath removel scheduled for Feb. 8th. Yes, I know,
that will be 19 days. Dr. is out of country until then.
====================================
Pathology Report:
 
Gleason Score: cannot be determined due to hormone therapy effects. ???????
 
Extraprostatic Extension:
present, left radial, multifocal
present, left basal, multifocal
 
Resection Margins:
Apical: involved by invasive carcinoma, multifocal
Bladder Neck: involved by invasive carcinoma, unifocal on left side.Other: non-tumoural prostatic present at resection margin.
 
Perineural Invasion: present.
Seminal Vesicle Invasion: absent
Lymphovascular Invasion: absent
Lymph Node Status: no malignancy in regional lymph nodes
 
Additional path. findings:
high grade prostatic intraepithelial neoplasia
 
Pathology Stage: yp T3a NO MX
==================================
Radialogist appointment was on Friday Feb. 26 with Dr. Glenn Bauman in London.
 
Got another Lupron 90 day shot today and he wants to start IMRT soon. CT Scan plus measure scheduled in about 3 weeks.
 
First PSA test since surgery on March 30th.
 
Next appointment with the surgery Doc is April 13.
 
.

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