I have a question.....

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JoeyG
Regular Member


Date Joined Jul 2009
Total Posts : 162
   Posted 4/23/2010 6:18 AM (GMT -6)   
I am still looking to hook up with an oncologist; in the meantime something continues to go through my mind that I just don't quite understand:
 
Many of you have have radiation following surgery. (1) Have any of you had radiation following surgery where nothing more was noted other than a high GS (ie, no perineral invasion, clean lymphnodes)? To me that is a giant-sized crap-shoot but one which I would take, if the onco suggested it AND if insurance covered it. I would assume that the radiation would cover the entire prostate bed and as many adjacent lymphnodes, as possible. So that brings me to question 2. (2) if your answer to question 1 is yes, did insurance cover the radiation treatment?
 
Thanking yinz in advance.
 
Joey G
 
 
Age -57; Diagnosed 10/05 PSA 13.4 GS 7 (4+3) Organ confined (T2B)
Cryoablation 4/06 Allegheny Hosp-Dr Ralph Miller (Cohen/Miller)
Post Cryo Nadir 8/06 0.2
Rising steadily to 0.7 4/09 :-(
Steady at 0.7 (7/09)
Doubled to 1.5 (2/10) YUCH!
Hoping to qualify for salvage cryo or radiation


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 4/23/2010 6:28 AM (GMT -6)   
Hi Joey...sure you'll be hearing soon from many who have gone (or are going through) salvage radiation after surgery.

PCa is a crap shoot. While a high Gleason score indicates a more aggressive form of PCa, not having any adverse pathological findings (EPE, positive margins) is NOT a guarantee against recurrence. Likewise, having one of these does not mean you face recurrence down the road.

Checking out the signatures of some of our guys who faced SRT after surgery, you will see some good surgical pathology reports and some not so good.

The extent of radiation (prostate bed only vs. a wider area) would be determined by the radiation oncologist based on numerous factors, including the surgical pathology report. I do not know how it would work with a patient who had cryo as the primary treatment. I wonder if bracytherapy (seeds) would be possible for you at this point? Others will chime in so stay with us.
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!


JoeyG
Regular Member


Date Joined Jul 2009
Total Posts : 162
   Posted 4/23/2010 6:42 AM (GMT -6)   
Sephie,
 
Thank you for your thoughts!
 
As to brachy, that would not work. The prostate gland is both very tiny and very dead. The only possibility would be to radiate the area. Ah,somehow I think, its more of a crap-shoot than winning the lottery. Its really too bad scanning cannot give better results; that would take a lot of guess-work away.
Age -57; Diagnosed 10/05 PSA 13.4 GS 7 (4+3) Organ confined (T2B)
Cryoablation 4/06 Allegheny Hosp-Dr Ralph Miller (Cohen/Miller)
Post Cryo Nadir 8/06 0.2
Rising steadily to 0.7 4/09 :-(
Steady at 0.7 (7/09)
Doubled to 1.5 (2/10) YUCH!
Hoping to qualify for salvage cryo or radiation


BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 4/23/2010 6:56 AM (GMT -6)   
Joey, I was a gleason 8. Which I found out from the pathology report. I went into surgery with a biopsy result of (3+4). Needless to say that I was pretty bummed out. I went to my surgeon and a medical oncologist to see what additional treatment I could have. Both said that since my tumor was fully contained in th prostate that I should wait to see if the PSA rises. I found out later that unless you are clearly at high risk for a recurrence (positive margins, lymph nodes, epe...) then it is best to let youself heal from surgery and get some function back than go straight to radiation. Frank
Dx with PC Dec 2008 at 56, PSA 3.4, Biopsy: T1c, Geason 7 (3+4)

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Junl 09 <.01
psa Oct 09 <.01
psa Jan 10 .07 re-test one week later .05
psa Mar 10 .28 re-test two weeks later .31


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2218
   Posted 4/23/2010 7:05 AM (GMT -6)   
Joey

I live in Holland so the insurance aspect of your question is not relevant as all my treatment is covered.

Even though my post op pathology showed seminal vesicle invasion, and I was upgraded from Gleason 6 to 7, they did not want to give me radiation therapy straight away after surgery.
They said they would wait till my PSA showed signs of rising and that only when it went over 0.2 would they want to use RT.

That is what happened and so I start RT on Monday morning, which will be nearly 9 months after surgery.

Alf
Age at Dx 48 No Family history of Prostate Cancer
Married 25 years, and I cannot thank my wife enough for her support.
April 2009: PSA 8.6 DRE: negative. Tumour in 2 out of 12 cores. Gleason 3+3.
RALP (nerve-sparing) at AVL-NKI Hospital Amsterdam on 29th July 2009. Stay 1 night.
Partial erections on while catheter still in. Catheter out on 6th Aug 2009.
Dry at night after catheter came out
Post-op Gleason 3+4. Tumour mainly in left near neck of bladder.
Left Seminal Vesicle invaded, (=T3b!)
no perineraul invasion, no vascular invasion. clear margins,
Erection 100% on 15th Aug 2009, but lots of leaking
Stopped wearing pads on 21st Sept 2009
Pre-op style intercourse on 24th Oct 2009 !! No use of tablets, jabs, VED etc.
Nov 17th 2009 PSA = 0.1
Mar 17th 2010 PSA = 0.4!!! referred to radiation therapist


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 4/23/2010 7:22 AM (GMT -6)   
Joey, hopefully some of our more experienced members will chime in soon. As to further tests, I've read about the ProstaScinct (not sure of the spelling) but is not always accurate.

Have you spoken with a medical oncologist yet? They may give you some insights that will help you make as informed a decision as possible.

As to insurance coverage, in the U.S. our insurance carrier would have covered my husband's salvage radiation if he needed it so there were no issues there. You may want to give your insurance company a call and chat about what they'll cover including further tests and second/third opinions.
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!


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 4/23/2010 11:00 AM (GMT -6)   
Joey,
The only thing they can do is take a biopsy of the prostate bed to see if it is still local. I would also look into a color doppler ultrasound and this may be able to distinguish some remaining tumor. With a low psa there is no scan that will pick up PC anywhere else in your body, so don't waste your time or money. They may want to radiate the pelvic area along with the prostate bed; I would ask you oncologist about this. If they can identify a local reoccurrance then salvage would be a good option. It they can't then it is a crap shoot with your only other option being HT.
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT

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