SRT Questions???

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BB_Fan
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Date Joined Jan 2010
Total Posts : 1011
   Posted 4/23/2010 9:59 PM (GMT -6)   
Met with my Uro and two oncologists this week to discuss further treatment for rising PSA after RP. I received 3 different recommendations: SRT, SRT with 6 months of HT, and SRT with 2-3 years of HT. The rationale for 6 months HT was my gleason 8 and the need to beat up the PCa to make SRT more effective. The rationale for SRT with 2-3 years of HT was studies that indicted that it had a better outcome (as opposed to no HT or HT for shorter periods of time) in people that had ART. It seems to me that most people here have HT just to hold off progession of PCa until SRT can be started. Am I wrong? Have others had SRT with HT. Have outcomes been favorable? Has anyone gone as long as 2-3 years in connection with SRT alone?

Also, with regard to the radiation oncologist and facility (equipment and techs). Is getting the best one as important as a surgeon for RP. When I had surgery it was a difficult and one-time procedure with significant ramifications. I wanted the best person that I could get and was willing to travel if necessary. With SRT it isn't as easy. You have to be available near the treatment facility and Dr for 7 week. The Drs and facility near me is good. But if I travel two hours I get a Dr with a very good reputation and a top self facility. Is it worth the effort of a 4 hour round trip every week day for 7 weeks.

I would appreciate any comments and recommendations.
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


Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 4/23/2010 11:06 PM (GMT -6)   
Interesting question, BB. I'll be interested to see what the pros here have to say on this.

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
From "knock out" to wake up in recovery less than two hours.  Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
 
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
 
First post op PSA Sept 09  less than 0.02
PSA on Oct 23 test again less than 0.02
PSA on Jan 8 less than 0.02
PSA on April 9 less than 0.02 
 
  


Magaboo
Veteran Member


Date Joined Oct 2006
Total Posts : 1211
   Posted 4/23/2010 11:40 PM (GMT -6)   
Hi BB,
 
What ever decision you make will be the right one for you. If I was in your shoes, I would definitely go for the best Dr and the best facility. 7 weeks will pass surprisingly fast, but you will have to live with the result for the rest of your life. The decision of cause rests with you. What's right for me may not be right for you.
All the best to you whatever you decide.
 
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


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 4/24/2010 12:19 AM (GMT -6)   
BB,

I had decided to travel to New York City from central NJ - almost two hour trip each way. I don't know if it makes a significant difference, but I wanted the best. My radiation oncologist recomended and I agreed to a three years of HT.

I am a year into HT. My thinking is that I should hit it as hard as I can while I can. No results yet, but I hope I am not suffering through side effects of HT for nothing.
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


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2217
   Posted 4/24/2010 2:44 AM (GMT -6)   
BB

I'm due to start RT on Monday in Amsterdam.
It'll take me about two hours each way.

I think that the most important thing with RT is the planning stage, not specifically where the procedure is carried out.

IE what matters is the knowlegde and skill of the person examining the images from my CT scan to work out exactly where the prostate bed etc is and thus where the machine has to aim.

I have the idea that once the "coordinates" of the target have been programmed into the computer the machinery basically takes over. There are simply some human technicians who ensure that the tattoos on my body are alligned correctly with the machine before they press a button.

It does occur to me that it ought to be possible to email those coordinates to the hosptial that is ten minutes away from home so that that the local machine and local technicians could treat me.

My team are not planning to give me HT at this stage.

Meanwhile I am not enjoying the weekend as I have got a bad cold. Coughing, sneezing, a nose that is running like a tap, sore throat, lost my voice etc, so not keen to even go outside, let alone go to Amsterdam.

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


BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 4/24/2010 6:21 AM (GMT -6)   
Greeba/Alf/Magaboo: Thanks for your comments. Greeba/Alf, I see that you both are pretty young. What did you/will you do about work? Shortened work day/leave of absence? I can't imagine working a full day after being on the road for 4 hours. Alf, hope you feel better. Good luck on Monday.
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


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 4/24/2010 6:52 AM (GMT -6)   
Google the abstract and information on 'Bolla Study' it did show that patients did fare better or longer in this study and seems to have value, how much, how perfectly, look for yourself. As primary treatment I did the concept of Bolla study with neo-adjuvant ADT3 5-6 months before radiations, and ADT after radiations (total of 2 yrs.), then switched to different drug used intermittently thereafter (which I posted on a number of times). If you look at Bolla results, they are impressive differences....one has to weigh the trade offs and decide for yourself. You could consider various other drugs in doing similar works(discuss with oncologists if you are curious), uros all push Lupron and their equivalents, they don't prescribe other choices, some onco docs do.

Based upon my original stats and total urinary blockage from PCa (bad stats), I believe this protocol and the specialized radiations helped me to get this many years, thus far (8 yrs.+). Also, quality of life is especially decent after getting off of ADT drugs, thereafter.
 
Weigh everything is probably a good idea.

 


Youth is wasted on the Young-(W.C. Fields)

Post Edited (zufus) : 4/24/2010 5:56:39 AM (GMT-6)


BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 4/24/2010 7:02 AM (GMT -6)   
Thanks Zufus. Your advice has been helpful. I will check out Bolla.
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


60Michael
Veteran Member


Date Joined Jan 2009
Total Posts : 2243
   Posted 4/24/2010 8:52 AM (GMT -6)   
BB,
I could have gone to Atlanta which is a 2 hour drive one way, but chose a place 25 minutes from my home. He did not have the same great reutation that I would have found at Emory but the trip would have taken it out of me. I discussed all this with my URO and he even said I should go to the closer facility and recommended the Oncologist to me. I am pleased with my tx there and didnt have to dread a long drive thru horrible traffice. But that just my take on it.
Michael
Dx with PCA 12/08 2 out of 12 cores positive 4.5 psa
59 yo when diagnosed, 61 yo 2010
Robotic surgery 5/09 Atlanta, Ga
Catheter out after 10 days
Gleason upgraded to 3+5, volume less than 10%
2 pads per day, 1 depends but getting better,
 started ED tx 7/17, slow go
Post op dx of neuropathy
T2C left lateral and left posterior margins involved
3 months psa.01, 6 month psa.4, 6 1/2 month psa.5
Starting IMRT on 1/18/10, Completed 39 tx at 72 gys on 3/12/10
Great family and friends
Michael


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/24/2010 9:01 AM (GMT -6)   
Michael, I also faced the same travel option as you. Go to a bigger clinic in Atlanta, a good 2 hour drive, or stick to the local one, which still had a pretty decent rep, that 15-20 minutes away. The wear and tear of that much travel time would have only added to my woes when I went through radiation this time. Having been through major radiation prior, I already pretty well knew what to expects.
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, 4/8 .04, next one:  July
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, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 4/23 put in


BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 4/24/2010 9:11 AM (GMT -6)   
Thanks Michael. This is my dilemma. Will the treatment be suffiently better. Probably no way to know. I't helps to get different views. In the end it will probably come down to piece of mind verses the wear and tear of the daily drives. Which I am sure will become more difficult as the treatment progresses. I also will have to deal with the job issue. Looks like you didn't have HT with SRT?
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


60Michael
Veteran Member


Date Joined Jan 2009
Total Posts : 2243
   Posted 4/24/2010 10:29 AM (GMT -6)   
BB,
I didnt have the HT although they offered a clinical trial to me, which meant I might or might not get HT with the radiation. I was just ready to get started with radiation and get it over with. I chose to have my SRT at 2:30 each day so that I could work in the morning and then I took sick leave from 2-5 pm, 5 days per week. Was also able to exercise early in the morning as I knew it would be more difficult after the SRT each day.
Michael
Dx with PCA 12/08 2 out of 12 cores positive 4.5 psa
59 yo when diagnosed, 61 yo 2010
Robotic surgery 5/09 Atlanta, Ga
Catheter out after 10 days
Gleason upgraded to 3+5, volume less than 10%
2 pads per day, 1 depends but getting better,
 started ED tx 7/17, slow go
Post op dx of neuropathy
T2C left lateral and left posterior margins involved
3 months psa.01, 6 month psa.4, 6 1/2 month psa.5
Starting IMRT on 1/18/10, Completed 39 tx at 72 gys on 3/12/10
Great family and friends
Michael

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