Got my second opinion--Another grey area--adjuvent radiation

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compiler
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Date Joined Nov 2009
Total Posts : 7270
   Posted 3/8/2010 11:57 AM (GMT -6)   
Well, I spoke today with Dr. Jon Epstein. We sent him the pathology slides.
 
His conclusion appears to be identical to the original opinion.
 
But...sigh... he recommends doing adjuvent radiation due to the Gleason 4+3. (I have one small focally positive margin with no lymph nor seminal vessicle involvement) But he also readily admits that others would disagree (including my Ford doctors and I think Dr. Strum)). He says the recent data supports doing the radiation. But he also points out that I certainly could just monitor the PSA and I might end up saving myself the radiation process.
 
Frankly, my emotions tell me to wait and certainly one can argue either way. But with my current urinary problems and the emotional toll this has taken, I'm going to wait. But I'd like to hear what others have done in similar situation.
 
Mel
 

63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms. 

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry, was  using 1 pad at night for security, but pretty much dispensed with that most nights. Update: no pads at night. No pads while at home, but still very uncomfortable. Use 1 pad for out-of-house activities.

Next Event: First post-op PSA on 3/9/10


Purgatory
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Date Joined Oct 2008
Total Posts : 25393
   Posted 3/8/2010 12:19 PM (GMT -6)   
Not telling you what to do, but I would wait until there is proof of recurrance. With your pathology report, recurrance may very well happen, but it's not guaranteed to happen. More and more doctors are not doing adjuvent radiation, as they want to see evidence that it is needed. Definitely need to see what this first PSA of yours reads. It may be a super low zero. If you ultimately need radiation, call it adjuvent or salvage, it will be there for you. Using Bro. Sonny as an example, his recurrance was instant and strong, and doing his radiation so fast and strong only made sense, in his case, it would not have made any sense to delay or wait.

Just my take.

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, no problem post SRT
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  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, Caths #13 & #14 same time, 3/6 Cath #13 out - 4 days


compiler
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Date Joined Nov 2009
Total Posts : 7270
   Posted 3/8/2010 12:57 PM (GMT -6)   

David:

My take agrees with your take!

Mel


Ed C. (Old67)
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Date Joined Jan 2009
Total Posts : 2461
   Posted 3/8/2010 2:52 PM (GMT -6)   
Mel,
I agree with you on waiting. You are still recovering from surgery. Waiting for your first PSA test is a smart thing to do. I'm hoping for a zero. If the PSA rises on a subsequent test ( I hope not) then you can take the next step.
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 in circumference.
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
11.5 months test 1/21/10 result 0.004


Herophilus
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Date Joined Sep 2009
Total Posts : 664
   Posted 3/8/2010 3:56 PM (GMT -6)   

My younger brother got his pathology back Thursday in the form of a phone call from the surgeon.  He has a positive surgical margin.  His surgeon called back today to reiterate the disappointment he has and that all options will be discussed at a visit next week.

 

It’s “only a small” positive margin…It’s only "prostate cancer"…this is an immensely frustrating disease!

 

Hero


Age 51, PSA 08/31/2009= 6.8, DRE Neg.
Biopsy 9/24/09 =10 of 12 positive. Gleason 6. involving up to 75%
da Vinci at Wash U, Barnes on 11/02/09
Modified Pathology, Gleason 4 + 3 = 7. Gleason 7 present throughout Prostate.  Negative surgical margins
4 of 4 periprostatic Lymph Nodes Negative, 10 of 10 pelvic Lymph Nodes Negative. Seminal Vesicles tumor free. No prostate extension
Post-op PSA 12/10/2009, Undetectable
12/12/2009, Pad Free and Started jogging.


Ken S
Regular Member


Date Joined Nov 2006
Total Posts : 120
   Posted 3/8/2010 3:56 PM (GMT -6)   
Mel,

My pathology report was very similar to yours. Even though my first PSA was 0.01 my Uro suggested I see an Oncologist and a Radiologist and all three thought adjuvant therapy would be a good idea.

After a little sidetrack (taking care of a tumor in my kidney 3 yrs. ago tomorrow) I started radiation treatments just two weeks after putting the pads away. A few weeks into treatments stress incontinence rears it's ugly head, the pads came off the shelf and unfortunately they're still a part of my life, one a day. ED has remained the same as it was after the RP, about a 75% erection without any aids.

The many reports I've read (UroToday) the past three years indicate that chances of a recurrence are slightly less if you opt for adjuvant therapy rather than salvage therapy. But quite a few reports say that many men may be unnecessarily getting treatments.

My thinking was to do all I could to give me a better chance of beating this. Us positive margin guys have a higher chance of recurrence and with adjuvant therapy the odds are more in our favor. Perhaps it wouldn't hurt to talk to an Oncologist.

Ken
Age 54 (2006) PSA: 2005 - 3.2, 2006 - 3.7
Biopsy 8/06, Gleason 6 (3+3), T1c
Radical Retropubic Prostatectomy 11/3/06 Post-Op Biopsy, Gleason 6 (3+3), T2c, right apical margin positive
CT Scan 1/07, tumor discovered on right kidney (unrelated to PCa) Partial Nephrectomy 3/9/07
IMRT (37 Treatments) 4/23/07 - 6/14/07
PSA: 11/09 - 0.01


Piano
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Date Joined Apr 2008
Total Posts : 847
   Posted 3/8/2010 4:10 PM (GMT -6)   
I am in a similar situation (high Gleason with slowly rising PSA), but have decided to wait until the 0.2 level. Even then, I may not be a suitable candidate for radiation.

Why subject your body to more potentially harsh treatment when the treatment may not actually be necessary? And when the doctors are far from unanimous? We each have to take our own approach to this, and bear the consequences -- but that is my choice.
Pre-op:
Age 63 at diagnosis, now 64.
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores.
Operation:
Non-nerve sparing RRP on 7 March 2008.
Two nights in hospital; catheter out after 7 days.
Post-op:
Continent; no pads needed from the get-go.
Pathology showed organ confined and negative margins. Gleason downgraded to 4+4=8.
PSAs:
6-week : <0.05
7-month: <0.05
13-month: 0.07 (start of a trend?)
19-month: 0.09 (maybe)
ED:
After a learning curve, Bimix injections (0.2ml) worked well. From 14 months, occasional nocturnal erections. Have "graduated" to just the pump.


zampilot
Regular Member


Date Joined Aug 2009
Total Posts : 152
   Posted 3/8/2010 5:44 PM (GMT -6)   
You are where I was last fall but I was 3+4, with a slim possibility that a cell may have escaped the scalpel. The study my Rad Doc showed me was 40% recurrence vs <5%, with a positive margin. Note that some Doc's may call a 'close' margin a positive. I did the Rad, 35 zaps, no major side effects.

BillyMac
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Date Joined Feb 2008
Total Posts : 1858
   Posted 3/8/2010 6:28 PM (GMT -6)   

Mel,

Our presurgery and biopsy stats are quite similar as is the post surgery pathology with the exception that due to extent it was too risky to attempt nerve sparing in my case. My gland was about 32 cc and the tumour was more extensive including a focal extention. I investigated the post surgery radiation and found the same divided opinions. I waited. I have tracked my PSA at the ultrasensitive level over this time. It still comes in undectectable after 2-1/2 years (ie<0.01). If you elect to wait I would recommend doing the ultrasensitive  test and watching carefully for a definite trend ie say 3  consecutive upward movements even at these  low levels. (without worrying of coursetongue)

Bill



1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)
PSA February 09 <0.01
PSA August 09 (2 year mark), <0.01
PSA December 09 <0.01

My Journey: www.yananow.net/Mentors/BillM2.htm

Post Edited (BillyMac) : 3/8/2010 4:46:44 PM (GMT-7)


Sonny3
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Date Joined Aug 2009
Total Posts : 2448
   Posted 3/8/2010 6:38 PM (GMT -6)   
Mel,

As David pointed out, my PSA rise was immediate and pronounced. That is why I elected to go ahead with the IMRT at only 74 days post surgery.

If mine had come back lower and remained that way I would have saved the IMRT for another day.

In your shoes I would wait just a tad and let the next PSA test come in. It will be what it is in a month or two and IMRT is still viable at that point. You have drained yourself about as much as possible emotionally, so take a break from this carp.

Just sticking my two cents in,

Sonny
60 years old when diagnosed
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
Gleason Score (3+4) 7 in all positive cores
da Vinci 9/17/09
Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5%
positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT completed 1/15/10 35 treatments- 70Gy


goodlife
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Date Joined May 2009
Total Posts : 2692
   Posted 3/8/2010 8:02 PM (GMT -6)   
Mel,

If this was some kind of poll, it would appear that the waiters outnumber the non-waiters. I also with a Gleason 9 was advised to have adjuvant even tho I had negative margins by U of M. Their study said that adjuvant should be started within 4 months of surgery. I was stilll riding the white pads, and my PSA was still undetectable. At 9 months, I am still undetectable.

The poster who mentioned the study of 40 % vs <5 % doesn't sound correct to me. I don't believe the odds are that good.

So, put me in the waither category. PSA's every 3 months for the next several years for me.
Goodlife
 
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 injection
No pads, 1/1/10,  9 month PSA < .01


bemis
Regular Member


Date Joined Feb 2010
Total Posts : 38
   Posted 3/8/2010 8:11 PM (GMT -6)   
Mel I have the same report as you, gleason 3+4=7 and focal positive margins.I've decided to go with the adjunct radiation at 3 mths.[april 13]I just want to be done with it.So far it hasn't been to bad except for the serious leaking which I hope improves soon. I too saw the stats that adjunct might be more effective than salvage, but so far I don't think there has been a double blind study done and who knows how many men who opted for adjunct actually would have needed it.Well at this point I don't mind investing another 4 months to the process as it seems the sooner you start killing the cancer cells the better. 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


Doting Daughter
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Date Joined Aug 2007
Total Posts : 1064
   Posted 3/9/2010 2:37 PM (GMT -6)   
I will preface my response with a disclaimer: I am a little jaded. As you can see from my father's stats below my signature, he too "only" had a focally positive margin. The million dollar question is: how did he have a positive lymph node if there was only one focally positive margin? I have found that cancer doesn't make any sense. My father underwent adjuvant radiation because of his lymph node invovlement, which was also controversial. I have come to believe that everything associated with PC is "controversial". I won't get started on that :) Anyways, in my opinion, cancer is like ants. They are a nightmare to get rid of and if you leave one behind, they multiply like crazy, so I always blast the heck out of them. My philosophy with cancer is the same: blast the heck out of it.
Thankfully, my father tolerated IMRT well and I hope and pray it got rid of any straggler cancer cells. At the end of the day, we just don't know whose cancer has spread and if it were me, I would take my chances of radiating nothing vs.choosing not to radiate and having the cancer spread. Again, just my opinion and that is all that it is. Best of luck in your extremely difficult decision and may you have peace with whatever decision you come to.
Father's Age DX 62 (now 64)
Original Gleason 3+4=7, Post-Op Gleason- 4+3=7,
DaVinci Surgery Aug 31, 2007
Focally Positive Right Margin, One positive node. T3a N1 M0.
Bone Scan/CT Negative (Sept. 10, 2007)
Oct. 17 PSA 0.07
Nov. 13 PSA 0.05
Casodex adm. Nov 07, Lupron beg. Dec 03, 2007 2 yrs
Radiation March 03-April 22, 2008- 8 weeks 5x a week
July 2, 08 PSA <.02
Oct. 10, 08 PSA <.02
Oct. 9, 09 PSA <.01 Last Lupron Shot
Praying for a cured dad.

Co-Moderator Prostate Cancer Forum


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 3/9/2010 4:53 PM (GMT -6)   
Daughter,

Great analogy about the "ants", never thought of it that way before, I will have to remember that one.

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, no problem post SRT
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  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, Caths #13 & #14 same time, 3/6 Cath #13 out - 4 days


deer hunter
Regular Member


Date Joined Jan 2010
Total Posts : 250
   Posted 3/9/2010 6:26 PM (GMT -6)   
This is one of these decision that is complciated some say no wait and some say go ahead thats the 64 dollar question I can't anwser as for myself I waited 3yrs after surgery i don;t know if that was good thing or not only time will tell!!!!!! My first PSA was .05 after 4o treaments is was .5 before treatements finish srt 12-12-09 first test 3-3-10 the report reads as follows PSA o.05-- normal high 4.00 but i'm not normal i don't have a prostate i have pc so answer that one
DEERHUNTER
dx age 57 01/06 open RP 4/06 psa in 01/06 8.1  surgery path report Gleason 3+4=7 poorly differentiated  tumor was 90%involved in both lobes surgical margins postive. in the right apex and right radial margins tumor grade G3  perineural invasion present high grade of PIN found  T2c NX MX PSA 0706  .01 10/06 .02 01/07 .03 04/07 .04  06/07 .05  07/07 .08 07/07 bone scans pelvic ct neg. 08/07 proscintic scan neg.9/07 psa.10 net with rad onc. wanted to do SRT but i did not do it 10/07  saw a new dr at Emory University [my old dr urg. suggested second opinion ]  bone scans negs ct scans pelvics neg. biopies of the bladder and adrinal glands neg.another proscintic scan neg.12/07 Psa .11 clinial trial Emory injected with protons to try and find the cancer cells no luck 3/08 psa .17 06/08 psa .23 psa 09/08 psa .32 12/08 psa .39 3/09 psa .39 6/09 psa .43  meet with medical onc. he said  i might have waited to long to start SRT 7/09 psa .50  another bone scan ct scan all neg.MRI neg. meet rad. onc. 7/09 started casdex 50mg 1 day for 30 days 2 shots of lupron started rad treament 10/09 40 treatments 75 gm 12 shots each time all aroud pelvic finished 12/09  psa .07 and psa 01/10.05 next dr visit 03/10 wait and see!!!!!!


zampilot
Regular Member


Date Joined Aug 2009
Total Posts : 152
   Posted 3/9/2010 6:48 PM (GMT -6)   
"The poster who mentioned the study of 40 % vs <5 % doesn't sound correct to me. I don't believe the odds are that good"

Goodlife, please explain your doubts about Dr. Dickson's info. It may make a difference in the original poster's options.

goodlife
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Date Joined May 2009
Total Posts : 2692
   Posted 3/9/2010 7:13 PM (GMT -6)   
The way it was stated is that if we had adjuvant therapy, we have less than a 5 % chance of reocurrence, or at least that is the way I interpreted it.

If the PC is ouside of the prostate bed, or systemic, then no amount of radiation will stop reoccurence. If, because of a positive margin, the PC is still laying in the prostate bed, then of course it will help. But if there is peineural invasion, or some cells have escaped into the lymph system, then the radiation may slow down the reoccurence .

Men with an EPE have about and a 10 to 25 percent chance of reoccurence according to the nomograms. I believe that most of the numbers I have seen give radiation about a 30 to 40 % chance of stopping reoccurnce, depending on who you read. I have never heard or read of adjuvant radiation giving a less than 5 % chance of reccurence. University of Michigan is saying adjuvant begun within 4 months shows about a 40 % chance of a cure, or about 5 to 10 % greater than salvage radiation.

I may have misundrestood the numbers, so that is why I said I don't believe. It sounds too good to be true.

I stand to be corrected if wrong.
Goodlife
 
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 injection
No pads, 1/1/10,  9 month PSA < .01


keysailfisher
Regular Member


Date Joined Dec 2009
Total Posts : 347
   Posted 3/9/2010 7:31 PM (GMT -6)   
I'll be interested in what you decide Mel, my uro also wants to do radiation.
 
Neal
age 45
psa 3.09
Biopsy results 12/9
Left side base 3+3=6 21% 2/2 cores positive
Left side mid  3+3=6 100% 2/2 cores positive
Left side apex 3+4=7 88% 2/2 cores positive
Right side - 0/6
CT & Bone scan negative
Davinci Feb. 5th 2010/ cath removal 2/16
 
Gleason-3+4=7
Extent of tumor-Bilateral
Extraprostatic Extension-Absent
Seminal Vesicles-Negative for tumor
Surgical Margins-Rt apical margin focally positive
lymphovascular invasion-Suspicious in areas of capsular involvement
Regional lymph nodes-One node negative
Stage-T2c NO Mx
Incontinence-yes


compiler
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Date Joined Nov 2009
Total Posts : 7270
   Posted 3/9/2010 10:11 PM (GMT -6)   

Neal:

Don't base your decision on what I decide!

At this point, I will be getting my first post-op PSA this week.

I have decided to wait. Now, if the first post-op PSA is bad (ala Sonny's) then I might have to rethink matters.

But, this is still an area of controversy. My doctors at Ford recommend I wait as many patients never need the radiation. Also, I am having plenty of urinary drip issues and I would like to give that a chance to get better. Also, I have to admit that I have not handled things all that well. I did a good job researching possibilities and making informed, intelligent treatment choices. But, emotionally, it has been a tremendous roller coaster for me. I have always been the relaxed even personality type so this reaction is unusual for me (but PC is not a usual occurrence).

OTOH, I am a rational person (I am a mathematician). Basically, it is not sufficient to just say adjuvent radiation has a 5%-10% advantage over salvage radiation. If I KNEW I'd have to undergo radiation, then it is a clearer decision (although the urinary QOL issue still needs to be thought about; my understanding is that radiation will permanently cement your current urinary situation -- am I correct about that?). Anyway, I am factoring in the probability that I will NOT need further tx. based on PSA readings. When I factor that in, my conclusion is to wait.

I hope I get a good first PSA; otherwise,  I will reconsider!

 

Mel

 


63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms. 

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry, was  using 1 pad at night for security, but pretty much dispensed with that most nights. Update: no pads at night. No pads while at home, but still very uncomfortable. Use 1 pad for out-of-house activities.

Next Event: First post-op PSA on 3/9/10


keysailfisher
Regular Member


Date Joined Dec 2009
Total Posts : 347
   Posted 3/9/2010 10:23 PM (GMT -6)   
I'm not basing my decision on what you do. I have not had my first psa either that will be on 3/29. I know some say wait on psa to rise and some say do it now. I'm still undecided on what to do. I hope you get undetectable results.
 
Neal
age 45
psa 3.09
Biopsy results 12/9
Left side base 3+3=6 21% 2/2 cores positive
Left side mid  3+3=6 100% 2/2 cores positive
Left side apex 3+4=7 88% 2/2 cores positive
Right side - 0/6
CT & Bone scan negative
Davinci Feb. 5th 2010/ cath removal 2/16
 
Gleason-3+4=7
Extent of tumor-Bilateral
Extraprostatic Extension-Absent
Seminal Vesicles-Negative for tumor
Surgical Margins-Rt apical margin focally positive
lymphovascular invasion-Suspicious in areas of capsular involvement
Regional lymph nodes-One node negative
Stage-T2c NO Mx
Incontinence-yes


compiler
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Date Joined Nov 2009
Total Posts : 7270
   Posted 3/9/2010 10:27 PM (GMT -6)   

Neal:

 

I don't know why you get so hung up on such unimportant little decisions!

 

Mel


63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms. 

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry, was  using 1 pad at night for security, but pretty much dispensed with that most nights. Update: no pads at night. No pads while at home, but still very uncomfortable. Use 1 pad for out-of-house activities.

Next Event: First post-op PSA on 3/9/10


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 3/9/2010 10:43 PM (GMT -6)   
Mel,

As a postscript to part of my decison making process, the radiation oncologist added that there is a 1.5 to 2 % chance of radiation timors. I dodn't know how to factor that into the equation. Perhaps with your math skills, you would know how to do that.

If you add on some of the recent posts about side effects such as bladder damage, rectal issues, etc., I'm not sure the extra 5 % or 10 % is worth the risk. I think the odds may be better to wait for rising PSA, all facts considered.
Goodlife
 
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 injection
No pads, 1/1/10,  9 month PSA < .01


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 3/9/2010 11:13 PM (GMT -6)   
I am still of the opinion, that unless one has such a blatant post surgery PSA, as our beloved Sonny, it is best to wait. Neal, I know you well enough to know that you will wait and see what the numbers say, and will do what you think is best for you.

Even though Radiation Oncologists get paid the big bucks if they reel in a new customer, from the three that I interviewed, all of them now believe it is best to wait until there is real evidence of reccurance, with 3 consecutive rises in post PSA above .10, before engaging in radiation.

Invoking Sonny's name again, his post surgery PSA was so high out of the box, that it was the most sensible and prudent thing to do, by starting a pretty vigorous round of IMRT as he underwent.

In my case, some wonder at .16 what the big concern was, the decision I made was based on the concensus of opinion that with my pre-surgery PSA velocity, and recurrance at or before 9 months post surgery, even with a pretty clean pathology report, that it was in my best interest to undergo salvage surgery, which was the last thing I wanted to do.

Like all things PC, there is no one size, its still guy by guy, case by case.

If you are having incontinence problems, most doctors feel its best to get that under control before undergoing post surgery radiation, as it tends never to improve upon the point you begin, and in some cases, can get worse. But its important even on that point, that is not written in stone, and it varies of course, case by case.

It is also not written in stone, when is it best to start, what line in the sand with the post surgery PSA level, again, depends on the circumstances, my doctors agreed that I needed to stay way under .50. Again, it was because of my track record with the velocity issue. Other men here began radiation way beyond .50 and even over 1.0 in a couple of cases I seem to remember and are doing fine.

The decision is very important, and one has to factor in all the criteria for your own case and have excellent communication with your doctors, both urological and radiation.

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, no problem post SRT
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  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, Caths #13 & #14 same time, 3/6 Cath #13 out - 4 days

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