Salvage or Adjuvant Radiation?

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JB71
Regular Member


Date Joined Nov 2009
Total Posts : 206
   Posted 3/14/2010 11:45 AM (GMT -6)   
My open surgery Dr. J. Chin is suggesting IMRT and I'm trying to decide between these two treatments. We do not have a post-op PSA untill early April but tomorrow I'm traveling to the hospital for the pre-radiation measuring party.
 
This link is an article my doctor wrote and the next one is a rebuttal by a Dr. Izawa.
 
 
 
 
I also got a second 3 month Lupron shot on Feb. 26.
 
What to do?
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. ( march 20)
 
First PSA test since surgery on March 25th.
 
Next appointment with the surgery Doc is April 13.
 
.


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7213
   Posted 3/14/2010 11:59 AM (GMT -6)   

Good question. This is a grey area.

I had the surgery and due to the pathology, the guy who gave a second opinion (Jon Epstein of Hopkins) recommended adjuvent radiation. My doctors at Ford Hospital disagree. Given my first post-op PSA of 0.01, I've decided not to do adjuvent. I'll do salvage if it becomes necessary based on my PSA readings.

My reasoning was this: suppose between salvage and adjuvent, the latter has a 10%-15% advantage. But one has to factor in the real probability that neither is necessary. That swings it in favor of waiting, hoping to avoid the tx. altogether.

In YOUR case, I'm not sure. Your pathology seems to suggest that the cancer has spread beyond the prostate, but hopefully still in the prostate bed area. Adjuvent may be your best shot for a cure.

 

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 was about 75 (way above the 35 threshold). That led to:

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. Suddenly got MUCH better on 3/10/10, almost overnight. Still some urgency but no pads about 90% of the time.  As of 3/12/10--completely continent!

First post-op PSA on 3/10/10--DRUM ROLL: 0.01 Next PSA in late May.


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7213
   Posted 3/14/2010 12:18 PM (GMT -6)   

These articles are VERY INFORMATIVE AND INTERESTING.

It is interesting to note that even in the pro-adjuvent article, they made it clear that someone in my situation (1 focally positive margin) should wait.Yet there are plenty of experts (eg: Jon Epstein) who still advocate adjuvent radiation in my case. So the article may even be conservative!

 

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 was about 75 (way above the 35 threshold). That led to:

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. Suddenly got MUCH better on 3/10/10, almost overnight. Still some urgency but no pads about 90% of the time.  As of 3/12/10--completely continent!

First post-op PSA on 3/10/10--DRUM ROLL: 0.01 Next PSA in late May.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 3/14/2010 12:53 PM (GMT -6)   
JB, your's is a good and common situation.

Based on your stats, the "old school" thinking would have reccomended the adjuvant radiation, as a pre-emptive strike. An in the normal use of the term, it would have been done within six months of your surgery or less.

My own uro/surgeon and the 3 radiation oncologists I met last year and my former medical oncologist from previous cancers, all agreed, that they do not like to do adjuvant radiation unless its a strong situation, and let me invoke our dear Brother Sonny in Florida's situation, where he had strong recurrance right out of the box so to speak.

The doctor's I talked to, all felt that it was best to wait to see if you even have recurrance. Even with bad stats, that does not guarantee you will have reuccrance. They all felt it was best to wait until you have 3 PSA readings at or above .10 in a row. If so, then plan out the timing and use of radiation, IMRT in particular.

You also need to remember, that after you have used your surgery card, you only have one curative card left to use, and that is radiation. The dr's. I spoke to feel its best to save that for when you really need it and when you have evidence of recurrance.

Of course not everyone agrees with that line of thinking. Made sense to me. PC is so bizzare, a good pathology can lead right to recurrance and a bad pathology can keep you in the zeros. Makes no sense, but thus is the nature of PC.

Another reason for waiting till needed, that many drs. feel that its best to use the "zero PSA" time, if you are fortunate enough to have some, to regain your continence and ED issues. Not written in stone, as always exceptions, but one's level of continence usually doesn't improve after adjuvant or salvage radiation. Also gives you more time to fully recover from your surgery.

In my own case and decision process, I had such a terrible pre-PC radiation experience in my past, there was no way I was going to consent to any form of radiation until it was proven beyond a shadow of a doubt that I had recurrance. Once I did, I consented with strong reservations, but knowing if I had to do it, then there was no point letting the PSA climb higher and higher.

Hope this helps, its a tough call either way.

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


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 3/14/2010 4:34 PM (GMT -6)   
I would say that your pathology definitely speaks for radiation now. The question will remain unanswered as to how far the cancer has moved from the bed, but hopefully it is still concentrated around the PC bed where the radiation will get it.

The bladder neck is of concern, and the multiple other areas where apparently the PC has penetrated the capsule.

Of course the other option is to continue on HT, but I would say that radiation is your next best shot for a cure.

Good luck, and keep us informed on your journey.
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


Herophilus
Veteran Member


Date Joined Sep 2009
Total Posts : 663
   Posted 3/14/2010 5:01 PM (GMT -6)   

I’m doing a bunch of research for my brother on this same topic. He had a 3 mm positive margin and at his age (just turned 47) this is just about as tough as it gets. I cant say what I would do because it isn’t me. He has to make the decision for himself. I’m just providing info and explanation. But I’ll tell you this….The decision to have surgery was a walk in the park compared to what he is going through now. Best of luck to you and Godspeed.

Hero


Opa N
Regular Member


Date Joined Sep 2009
Total Posts : 150
   Posted 3/14/2010 5:08 PM (GMT -6)   
I went adjuvant, it's done, and I don't regret my decision a bit.
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.

 

 

 


Opa N
Regular Member


Date Joined Sep 2009
Total Posts : 150
   Posted 3/14/2010 5:08 PM (GMT -6)   
I went adjuvant, it's done, and I don't regret my decision a bit.
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.

 

 

 


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 3/14/2010 9:03 PM (GMT -6)   
Thank you Mr Ohio State, for bringing me back to earth. And here I thought I was an expert.

If people wanted experts, they wouldn't ask for opinions on HW. I ( and I clearly stated I), was stating my opinion.

Go ahead, study it to death and give all your modalities. The fact of the matter is, JB71 most likely has cancer outside his prostate.

How many opinions and tape recordings should he make to determine what most guys can determine and what his surgeon has already determined, that he has cancer outside the capsule.
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


142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6983
   Posted 3/14/2010 9:42 PM (GMT -6)   
I am also meeting with a Rad. Oncologist in the morning for my initial visit. My Dr. is convinced that first PSA 0 aside, with my post-op (DaVinci 10/2009) Gleason 9 and multiple EPEs / positive margins (no lymph node or bone scan indications, but the lymph channels were completely involved), waiting for a rising PSA is not wise. The post op path being much worse than the biopsy indicated, I'm convinced, and would rather get it over with now than to find out later that I waited until it was too late.

kuls
Regular Member


Date Joined Mar 2010
Total Posts : 57
   Posted 3/15/2010 7:50 AM (GMT -6)   
While I''m a new member here, and CERTAINLY not an expert, I can tell you that in the 20+ years I've worked as a Radiation Therapist, I've definitely seen an increase in men opting for adjuvant rather than salvage RT to the prostate bed.

Here in Canada, the ROs are not paid on a per-patient basis, so have no monetary incentive to push a patient into treatment. Obviously, cost to the patient is also is also not an issue here.

Ultimately, of course, the choice is up to the individual ......seems there are MANY crappy choices one has to make when dealing with this disease!

As someone mentioned, Make CERTAIN the studies you are reading are current, and also, not just a single-center trial!

Another thing one needs to be aware of is is that radiation treatments to areas of the body OTHER than the prostate bed are going to cause MUCH different side effects!! For example, if you are treated in the head and neck area, you are very likely to have a quite severe skin reaction, whereas with prostate bed irradiation, you are HIGHLY unlikely to experience skin irritation. The horror stories you may hear from others who have undergone radiation therapy (especially years ago), are very likely to be totally irrelevant to your particular situation.

Your RO will discuss the potential for acute (short-term) side effects, and possible long term effects. I would certainly recommend you meet with an RO....at least then you are making an informed decision.

All the best to you, and I hope you are able to put your mind at rest and come to a decision that you are the most comfortable with.

Karen
-Husband's 1st PSA done (age 45) at routine physical  PSA 3.8
-DRE at physical indicated no abnormality other than slightly enlarged
-Consult with urologist Jan. 2010---DRE negative, PSA 3.89
-Biopsy Feb. 10, 2010:  T1c, Gleason 3 + 3, 2/10 cores pos. (5% in one core, <5% on other core) 1% of core volume positive, gland size     38.84


JB71
Regular Member


Date Joined Nov 2009
Total Posts : 206
   Posted 3/15/2010 8:06 AM (GMT -6)   
Thank you all and that certainly includes Goodlife. I asked for opinions otherwise I would not be here and you offered yours.

Everyone on this board has either a question or a suggestion, most times based on their knowledge PLUS personal experiences, even OhioState's.
 
I think right now my main concern is my level of incontenence. It's FAR from perfect so I hope to postpone the adjuvant radiation (if I go that route) as long as possible, hoping it will somehow, magically improve in the meantime.
 
I'll be back here later today, once I get home from the
tests and meeting with the radiation ocologist, Dr. Glen Baumer.
.


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. ( march 20)
 
First PSA test since surgery on March 25th.
 
Next appointment with the surgery Doc is April 13.
 
.

Post Edited (JB71) : 3/15/2010 7:13:42 AM (GMT-6)


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 3/15/2010 12:28 PM (GMT -6)   
JB,
 
My pathology was a little better than yours as far as margins, but with the gleason 9 I also was advised to look at adjuvant.
 
It was precisely the same reason as yours that I did not go with adjuvant, my wet pants.  But, I did have a good post-op PSA to hang my hat on, and negative margins in sopite of an EPE.
 
The folks at U of M said that their study showed four months as kind of the cut-off for improved results with adjuvant.  That study was showing a 25 % improvement in cure rates if the patient started adjuvant within 4 months, so it sounds as tho you will be able to slide in under that target if your April PSA is unsatisfactory.
 
Of course, these are all just stats.  No guarantees, no money back.
 
Best of luck.
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


JB71
Regular Member


Date Joined Nov 2009
Total Posts : 206
   Posted 3/15/2010 5:18 PM (GMT -6)   
Well I'm back from being measured/CT scanned to get ready for the adjuvant radiation.

It's a very simple proceedure and the two ladies ( I wanted to ask if they were yet out of high school) were fun and very sociable.

BUT . . . . . . . they had allready booked me for my first treatment for April 5th. I'm NOT READY !

So I called my oncologist from there but, of course, I forgot, it's Spring Break and he is out of town with his family untill next Monday. So I cancelled the April 5th. appointment ! I NEED MORE TIME. (incontenence is a *****)

Someone told me the other day that the time period between diapers and Depends can be very short)

I am starting to think towards adjuvant (part because of your responses) and will consider (with the Docs approval) to start the first week in May.

Even though someone had me scheduled, no one could/would tell me the number of procedures and the amount of each exposure.

I understand from some sources, that adjuvant uses less radiation over a shorter period of time, i.e. 32/33 times with a slightly lower dosage. This should help with the potential fatigue problem because I really do want to drive the 130 mile trip. No, that doesn't sound right, I mean, I want to sleep in my own bed every night in my home, with my wife.
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. ( march 20)
 
First PSA test since surgery on March 25th.
 
Next appointment with the surgery Doc is April 13.
 
.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 3/15/2010 5:41 PM (GMT -6)   
jb,

130 mile round trip? are you going to some special rad ctr by choice, or are you just in a real rural area. for your sake, i hope than can do less treatments for you, to cut down some of the wear and tear. my clinic was usually a 15 minute drive each way or less, depending on traffic.

will be interested to know what your final plan will be like, how many gys and how often its being distributed.

good for you about changing the start up, it's your choice, and within reason, should be at a time of your choosing for sure, its so important to be both pro-active for yourself and being compliant at the same time.

good luck
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


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 3/15/2010 9:06 PM (GMT -6)   
JB,

Sounds like it went well, and I think ( my opinion haha) that you made a wise choice in waiting until u are ready. Also by then u will have a PSA to help make your final decison.

Good luck my friend !
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


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 3/15/2010 11:58 PM (GMT -6)   
JB,

Newer machines (like TomoTherapy or Arc) are able to deliver higher dozes in shorter time and smaller number of visits. You may want to explore this, as driving 130 mi may become difficult towards the end of the treatment. Not so much because of fatigue, but urinary urgency and diariah.
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


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 3/16/2010 8:47 AM (GMT -6)   
JB,

Thought I might weigh in with a little personal experience and knowledge of what you are going through.

I started IG/IMRT at just 74 days following surgery and after 3 successive rises in PSA. First post op was .4, then .53 followed by .6

I had also read the articles about the prognosis of adjuvant vs salvage therapy even before this rise. So while technically I fell within the ideal 4 months time frame, I guess you could say mine was actually salvage. So is it tomato or tamato.

When I was diagnosed with PCa I was 60, by surgery time I was 61. Put me in a whole other level of statistics for outcomes. Another, so what.

The one thing that I remember very well from my consult with my RO was him asking very pointed questions about my continence. He said he would not start rad unless I was continent. The rad can bring on a lot of issues for someone who is still dealing with incontinence.

By the end of my treatments I was definitely dealing with major urgency issues that did not subside until about 4 weeks after rad completion.

I know you have stated that you want to sleep in your own bed every night, however you might want to consider temporary housing arrangements (with your lovely wife) a little closer to the treatment center. Mine was only about a 25 minute drive each way and by the end of the treatments even that was becoming a major pain. The wear and tear of going someplace every day for 35 days (7 weeks) will wear on even the healthy individual. I was reminded of why I do not have, nor do I want a full time job. Having to be somewhere at a given time every day is a royal pain.

I received 70Gys, at 2 per day for 35 days.

My journey throughout the entire PCa process is well documented here. I had the surgery and it was a non event, recovery went extremely well and I was continent from the day the cath was removed. My post PSA tests sucked to say the least. IG/IMRT was tolerated well. The post PSA tests sucked. Still waiting to do the tests again. I was the model of how everything is supposed to go with each of the procedures with only minor inconveniences.

All in all I wouldn't change anything I have done. PCa is just fickle that's all.

What you do, when you do it and how you do it are the only things we can control. So cuddos to you for changing the schedule until you are ready. We are in control in that aspect of treating this carpy disease. All involved should be ready to work within our time frames not the other way around.

Good luck in your decisions and approaches. Blessings to your and your family and hopes that you beat the beast.

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

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