Radiation after surgery

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alicomp
Regular Member


Date Joined Feb 2010
Total Posts : 40
   Posted 3/15/2010 6:02 PM (GMT -6)   
We got my husband's pathology results today and it appears that the cancer was not contained in the prostate as the doctor had expected. We haven't seen the pathology report yet; just a phone call, but he said Harvey went from Gleason 3+3 to 3+4 and is now a T3, and will need radiation. Have any of you gone through radiation after surgery? What should we expect? He just had surgery 3/9 and the doctor said the radiation should probably start in 3 months. Any advice? What questions should we ask?
I thought we were done with the research phase, but is seems like it is just beginning. Thank you. Alice

___________________________
Husband age 60, PSA 4.5 ;biopsy 12/09 8/12 positive cores 5% - 50%, Gleason 3+3
DaVinci at UNC on 3/9/10. Gleason 3+4, T3, cancer not contained to prostate

Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 3/15/2010 6:53 PM (GMT -6)   
I would wait for a copy of pathology report and a post-op PSA test before making any decision. If PSA is undetectible, there is a school of thought that says wait if the cancer recurrs, then go SRT route, since they claim the results are the same as adjuvant.
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


60Michael
Veteran Member


Date Joined Jan 2009
Total Posts : 2222
   Posted 3/15/2010 7:54 PM (GMT -6)   
Alice,
Sorry to hear about the possible need for IMRT. A number of us on here have recently completed radiation tx. If your husband does require radiation look for a good radiation oncologist with state of the art equipment, i.e IGRT & IMRT and perhaps Proton. Ask the length and strength of the treatment. Visit the facility to get a feel for it, as bigger is not always better or more comfortable. You can also look for past threads on here regarding radiation tx after surgery and that is helpful. Others on here will give you additional feedback soon as well. Keep us posted and take care.
Michael
Dx with PCA 12/08 2 out of 12 cores positive 4.5 psa
59 yo when diagnosed
Robotic surgery 5/09 Atlanta, Ga
Catheter out after 10 days
Gleason upgraded to 3+5, volume less than 10%
Margin slightly involved
2 pads per day, 1 depends but getting better,
8/5 1 depend at night only, now none
 started ED tx 7/17, slow go
Post op dx of neuropathy
3 months psa.01, 6 month psa.4, 6 1/2 month psa.5
Starting IMRT on 1/18/10
Great family and friends
Michael


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 3/15/2010 8:19 PM (GMT -6)   
I am sorry to hear the news. Poor path reports can be absolutely devastating. We had a similar experience and just when you think and hope you are done with PC, you find out you are just getting started. So, I am sorry.
Second, take time to heal emotionally and physically. Your husband has time to heal and then start making an educated decision on his next treatment step. My father waited a few months and then began his adjuvant radiation. He tolerated it very well physically. Emotionally, it is tough. Cancer sucks. Hang in there and please keep us posted!
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


Magaboo
Veteran Member


Date Joined Oct 2006
Total Posts : 1210
   Posted 3/15/2010 9:02 PM (GMT -6)   
Hi Alice,
 
Sorry you didn't get the pathology report that you were expecting or hoping for. Without giving us more info about the pathology report, it is not possible to make a really meaningful comment. about 3 years ago I had similar stats as your husband (see my signature). I had good post op PSA stats for about 15 month, but then the PSA started to slowly increase. When it reached 0.08 we (Uro, Onc and myself) decided to go to the next level. When radiation stated, my PSA level was 0.1. I had few side effects from the salvage radiation. It is my understanding that radiation has a better chance to succeeding when the PSA level is very low. If the PSA level is relatively high after surgery, adjuvant radiation may be advised by your doctor. If it is quite low, waiting and closely monitoring the level is probably not a bad idea.  
Wishing you and your husband all the best.
 
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


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 3/16/2010 5:58 AM (GMT -6)   
Alice, as a wife, I can empathize with what you are going through. My husband was also upgraded after surgery to a 3+4, Stage IIIA (due to extraprostectic extension). Once you have the surgical path report in hand, you and your husband will have all the information you need right now. Personally, I would not jump the gun with RT until you know exactly what the path report says and see what the PSA does. Just because the cancer has been upgraded in Gleason and stage, doesn't mean that any further treatment is needed. Also, Stage III is further broken down into a IIIa (extraprostectic extension) and IIIb (involvement of seminal vesicles and/or bladder neck). Many here were upgraded to stage III after surgery and are doing just fine without any further treatment.

Stay with us, Alice - we will get you through this.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (solitary focus of extraprostatic extension). Perineural tumor infiltration present. Apex margin, bladder neck and SVs negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009- 0.1, September 0.3, October back to 0.0, December 0.0. Thank you God!


Bootheel
Regular Member


Date Joined Oct 2007
Total Posts : 300
   Posted 3/16/2010 9:31 AM (GMT -6)   
I would wait until the first PSA test before I would jump into radiation. Radiation can stop future progress in the continence and the ED department. I would wait for a rising PSA before doing anything. Most Uro docs will try and wait until a patient is continent. Just a thought.
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


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 3/16/2010 11:20 AM (GMT -6)   
I would question everything and always as this is PCa of which the expertise is lacking, they don't have certainty. Salvage radiation or any salvage proceedure might be worth doing, but it is a gamble and likely less than 50/50% so if your doc says 80-100%, better find out how he knew and is he correct! We as patients need to get heavily envolved in what we wish to gamble on, you can see what patients herein are dealing with and gone through some is all good (great), some is not, consider that a clue as to how it can go. Learn all you can pro and con, only you live with the decisions and 'monday mornings'.
Youth is wasted on the Young-(W.C. Fields)


Patricio
New Member


Date Joined Mar 2010
Total Posts : 2
   Posted 3/29/2010 9:02 AM (GMT -6)   
Every situation is different in some way. You did not mention if there had been invasion in the lymph nodes or seminal vissiles.  I too had Prostate Cancer and in 1999 opted for surgery.  My PSA reading at that time was 6.4 and a Gleason of 6 (3+3)  After surgery the Gleason was moved to 7 (3+4) and was diagnosed with T3 with no invasion in lymph nodes or seminal vissiles.  For the first 4 years after surgery my PSA was <0.1.  In 2004 it began to rise slowly and finally in 2007 it had risen to 0.7 and I opted for radiation at City of Hope using tomo therapy.  There were 36 sessions and during this time very little side effects.  In August of 2007 I had my first reading after the radiation and it was <0.1.  Last week I had another reading and it is still at <0.1.  You have time to make the right decision.  Best of luck to you.

English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2215
   Posted 3/29/2010 9:14 AM (GMT -6)   
Hello Alice,

Your husband's situation is not perfect, but he is not the first one top be there. me too

My post op pathology upgraded my cancer, also to T3, but my surgeon said let's just monitor the PSA to start with before deciding on extra treatment, thus it is only now that my PSA has also gone up after my second post op test I am now booked for Salvage Radiation Therapy next month. Not good news of course, but I feel that RT now will be easier as I am much fitter and thus better able to cope with it than I might have been straight after surgery.

As with so much related to PCa it is the combination of various test results that tells you more rather than just one thing.

Alfred

Jerry1
Regular Member


Date Joined Mar 2007
Total Posts : 460
   Posted 3/29/2010 11:32 AM (GMT -6)   
 
 
I also agree wait until you get the path report and first PSA.  My gleason score after surgery was a 4+4 but had undetectable PSA for 9 months.  I recently finished SRT and feel that the time I had to heal before radiation helped me go through it with minial side effects.  Hang in there he needs time to heal.
 
Jerry1
Age 70
DX 8/13/08 , PSA 4.0, Biopsy 14 samples 1 positive 12% of sample,
Gleason Score 4+4 =8  Bone scan and MRI negative
Da Vince surgery on Oct 17, 08 Florida Hospital Dr Vipul Patel
Post Gleason report  4+4 = 8 Lymph nodes on both sides negative
margins Negative  Stage II (pt2a) 
Cath out on October 29th left in longer due to small leak.
11/19/08 dry no more pads
12/2/08 first PSA <0.1
 3/6/09 6 Month PSA 0.0
6/3/09 9 month  PSA 0.1
7/14/09  PSA still 0.1
10/15/09 PSA 0.3
10/26/09 surgery to remove 3 clips in bladder neck  
11/16/09 PSA 0.3
12/14/09 PSA 0.4 
12/28/09 PSA 0.5
Start salvage radiation treatments on January 18th. 


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 3/29/2010 1:20 PM (GMT -6)   
Ali, hold off until you know more. My husband's surgical path report showed him at a T3a with Gleason 3+4, and he's done fine for two years. T3 does mean that the cancer was found outside the gland but you still don't know if it was in the seminal vesicles, bladder neck area and whether or not the margins were clean.

Personally, I would wait to see what his PSA does before "pushing the button". Radiation has its place in treatment but I wouldn't use it til it's proven necessary.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (solitary focus of extraprostatic extension). Perineural tumor infiltration present. Apex margin, bladder neck and SVs negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009 - 0.1, September 0.3, October back to 0.0, December 0.0, March 2010 0.0. Next PSA in 6 months. Thank you God!


142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6946
   Posted 3/29/2010 1:50 PM (GMT -6)   
Alice,
I had DaVinci 10/09 (age 56), path pT3a, 4+5, extra-capsular extensions, positive margins even after taking extra just to be sure. I'll be starting IGRT on 21 April (CT & xrays the week before, markers implanted last week). I was told I needed to wait at least 18 weeks before having the markers implanted to allow everything to heal up. I actually waited 22 weeks, but more because of the Doctor's schedule than mine.
I won't be able to give you much more than the view from a few weeks further down the road, but will be happy to.

JB71
Regular Member


Date Joined Nov 2009
Total Posts : 206
   Posted 3/29/2010 3:28 PM (GMT -6)   
Alicomp: Your path report sounds very similar to mine and I'm scheduled to start IMRT on April 26 and I'm not sure why!!!

I'm also on Lupron since November and my first PSA, done 8 weeks after surgery is <0.03

Beginning to think that someone is
messing with my body.
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 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 15)
 
First PSA test since surgery on March 18th.
with the results of 0.03 !!!
 
Next appointment with the surgery Doc is April 13.
 
Started a Facebook page for bikers with prostate issues at:
 
IMRT to start approx. April 26.
 
.


deer hunter
Regular Member


Date Joined Jan 2010
Total Posts : 246
   Posted 3/29/2010 6:46 PM (GMT -6)   
Alice,Ialso agree with some of the others I would wait for the pathology report and for the first PSA test as a wife myself of a PC guy I know the anxiousness that you both feel but there is still time to make a decision and it is best to wait until he has time to heal from surgery, this is not a easy journey to travel ,but you and your husband will find a lot of support from these guys here at HW,
DEERHUNTERS WIFE
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. psa the last of 7/09was .55 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 3/10 psa.05

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