Visit With Radiology Oncologist (RO)

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SubicSquid
Regular Member


Date Joined Oct 2009
Total Posts : 252
   Posted 4/28/2010 9:47 PM (GMT -6)   
Met with RO today since PSA went from .07 to .21 over past six months. Will start IGRT week of May 24. Delayed because doctor will be on mainland donating bone marrow (nice guy). It is funny how people in the same office see things differently. When I walked in the nurse looked at my chart and said my PSA looks great. I replied only if doubling in six months is great. Since my hospital has the latest equipment, I will not have any catheters, balloons or other such intrusive objects involved. Will start a soft stool, low gas, regular bowel movement diet one week before treatment. Only thing required when coming to daily treatments is empty bowel and full bladder. The distance from my office to the hospital should allow for time to drink a nice bottle of water. Doctor said prognosis is good. Unfortunately the side effects in my case may not be. My previous stricture problem could be affected by the radiation resulting in scarring and blockage. Mentioned getting a SP catheter in advance and RO and Uro both seem to think it is not necessary. We shall see. Because I am fat (mostly all in the gut) dosage will be a challenge for the RO. Being fat is definitely not good. Since I have had surgery for internal hemorrhoids in the past, RO says there is a chance of developing fissures (or something like that) between prostate bed and rectum. Not good. The incontinence I have been experiencing since stricture surgery will continue. Yuck. But, the goal has to be removing the last of the cancer cells so I will just hope for the best. I definitely did not like the blockage problem, but the incontinence I have now with the new "super flow" the surgery gave me is not fun either. I will get treated for 8 weeks and I think he said the dosage was something like 70g (not sure about that). All in all, I will just have to hang in there and hope for the best.
*Age 63, PSA July 2009 5.66
*Diagnosed July 2009, Biopsy: 2 of 12 cores positive, Gleason 3 + 5 = 8
*MRI and Bone Scan Negative.
*open Surgery October 22, 2009
*Prostate, both nerve bundles, seminal vessels, and lymph nodes removed during surgery.
*Post surgery Biopsy, Gleason 4 + 3; 2 positive margins
*Still slightly incontinant after 3 months - 1 pad per day (light). Dry at night. 1-2 trips to toilet.
*ED - Yes (will start Levitra possibly in January)
*30 day PSA (ultra-sensitive) .07
*90 day PSA (standard) <0.15
*01/10 - bladder neck stricture. opened during cysto exam. Cath #2 in for 5 days.
*IMRT/IGRT delayed until April pending 180 day PSA result
*03/01 - bladder neck stricture. Dilated during cysto exam. Cath #3 in place.
*03/11 - Bladder neck surgery. Cath #4 in place.
*03/15 - Cath #4 out. Great urine stream. Unfortunately, incontinence back to post surgery level.
*04/14 - Six month PSA - .21.
*04/28 - Will start IGRT week of 5/24.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/28/2010 10:01 PM (GMT -6)   
Subic,

Good report was waiting to hear back from you. With your past stricture issues, similar to mine, surprised the dr's didnt see the logic of doing the SP like I had/have. If you develop a problem during that 2 months of treatments, it will be difficult for them to deal with any new strictures or closures. Just my opinion. In my case, my bladder neck shut down 100% within the first 2 weeks of radiation, much as I and my uro expected, so in my case it was a good call. My rad. oncologist pushed for it too as a pre-emptive thing.

You need the SRT, just like I did, so all I can say is go forward, and hope for the best. Keep me well posted. Too bad you got back into the incontinence picture, because the radiation isn't going to do much to improve on that end. But one step at the time.

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, 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 4/28/2010 10:01 PM (GMT -6)   
Squid, my stats are very much like yours. I went from .07 to .31 over about 12 weeks. I am seeing a radiation oncologist tomorrow and would like to start SRT by end of May. I had no adverse effects from surgery, and I am now worried that I will get them from SRT. Will you have HT with SRT? Good luck with your treatments. BB
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


Galileo
Veteran Member


Date Joined Nov 2008
Total Posts : 697
   Posted 4/28/2010 10:33 PM (GMT -6)   
Subic, best wishes.

I was a squid, myself, btw. Recently found an old buddy online and sent him a picture of himself from Grande Island, PI. I was on a carrier, and we spent a lot of time in the PI. Looking at our ages, you were probably there and gone way before me.

Maybe our common health problem is tied to too much San Miguel beer? Or maybe not enough recently?


Anyway, good luck on your treatments.
Galileo

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NX MX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 and thereafter <0.1
http://pcabefore50.blogspot.com


SubicSquid
Regular Member


Date Joined Oct 2009
Total Posts : 252
   Posted 4/29/2010 12:13 PM (GMT -6)   
David,
I will have to trust my docs on this (SP cath) and see what happens. Hoping for the best.

BB_Fan,
There was no mention of HT in my case. If it comes up after the IGRT treatment I will have a hard decision to make because I really don't want to deal with HT.

Galileo,
I was stationed in Cubi Pt./Subic Bay from 67-69, 72-74, and 81-92. Also did a couple WestPacs on the USS ORISKANY 69-71. I too believed that drinking San Miguel beer in large quantities was good for your health. Maybe I should not have stopped drinking it when I retired!!!!!

Squid
*Age 63, PSA July 2009 5.66
*Diagnosed July 2009, Biopsy: 2 of 12 cores positive, Gleason 3 + 5 = 8
*MRI and Bone Scan Negative.
*open Surgery October 22, 2009
*Prostate, both nerve bundles, seminal vessels, and lymph nodes removed during surgery.
*Post surgery Biopsy, Gleason 4 + 3; 2 positive margins
*Still slightly incontinant after 3 months - 1 pad per day (light). Dry at night. 1-2 trips to toilet.
*ED - Yes (will start Levitra possibly in January)
*30 day PSA (ultra-sensitive) .07
*90 day PSA (standard) <0.15
*01/10 - bladder neck stricture. opened during cysto exam. Cath #2 in for 5 days.
*IMRT/IGRT delayed until April pending 180 day PSA result
*03/01 - bladder neck stricture. Dilated during cysto exam. Cath #3 in place.
*03/11 - Bladder neck surgery. Cath #4 in place.
*03/15 - Cath #4 out. Great urine stream. Unfortunately, incontinence back to post surgery level.
*04/14 - Six month PSA - .21.
*04/28 - Will start IGRT week of 5/24.


Old Sailor
Regular Member


Date Joined Aug 2009
Total Posts : 208
   Posted 4/29/2010 3:56 PM (GMT -6)   

Squid, maybe it was a combination of the San Miguel and the jeepney rides down Megsaysay (sp?) that has caused our prostate problems.  All kidding aside, the IMRT that I'm now undergoing (14 sessions completed out of 38) has really been a non-event.  I did have to have a catheter and rectal probe/tube (at the same time) as the Oncologist was mapping out my treatment plan.  This was the worst part of the process so far.  Everything I read seems to indicate that more than 30% of prostatectomies eventually fail (probably the 7+ gleason guys) so IMRT salvage is not that uncommon.  There are several men here at Mayo undergoing SRT.  The RO doc gave me an instruction sheet and emphasized the need to drink at least 18 oz. of water (only) about 45min to an hour prior to therapy so the bladder pushes up the other organs etc which helps to avoid any chance of radiation hitting the colon etc.  So far, works great but I have to go to GQ as soon as therapy (about 15 minutes) finishes. I'm sure you will do well with RT - especially since you survived the PI.  I hope I gave you some useful information.   The Old Sailor  

 


Dx 07/09  -  28 core saturation biopsy w/5 positive  (2 gleason 8, 2 gleason 7, 1 gleason 6)
RRP 8/13/09 Mayo Clinic Jacksonville
Path report upgraded gleason to 4+5=9
Negative margins, extraprostatic extension, seminal vessicles, lymph nodes.  Perineural invasion present.
Two month post surgery PSA 0.022
Five month post surgery PSA  0.081
Seven month post surgery PSA 0.190
Eight month post surgery PSA 0.217
Started IMRT at Mayo Jacksonville on 12 April, 38 sessions, so far very little if any side effects except urinary urgency and  frequency during the day. 


142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6983
   Posted 4/30/2010 8:56 PM (GMT -6)   
Squid,
I am 7 days into a 39 day IGRT, and DaVinci +27 weeks. I'm having a few bowel issues that may just be stress (or too much water - I'm drinking more now than I ever have before) , but the process is clean, quick, and (so far) painless. Was talking to a man in his mid 70's today at the clinic. He is down to 8 remaining, and has no complaints except for a rash and the daily mad dash to the can. I'm hoping if he can do it, I can too.

They originally asked for 500 ml of water 45 minutes befors appt. time, but that results in wet jeans and empty bladder, so we adjusted down to 35 minutes - I make a mad dash to the can afterwards, then have to stop at my friendly Kroger half way home. I don't think my bladder holds that much, maybe 200 ml if I am beyond full. I would suggest trying the timing, and perhaps getting into that routine early.

I'm posting day by day on my "IGRT / Calypso" thread.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/30/2010 9:39 PM (GMT -6)   
Galileo, were you on the Constellation or the Independence, when I was in the PI, Sangley Point Naval Air Station with VP-17, use to watch the Phantoms being launched all the time.

Subic, of course I would expect you to take your dr's advice, just concerned for you if you developed another stricture issue in the middle of SRT.
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


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2216
   Posted 5/2/2010 2:38 AM (GMT -6)   
Squid

5th of 33 on Monday for me. (and an appointment with the RT doc on Monday too)

I'm having a total of 66gy

I too have to drink beforehand 10oz/320ml or so to get full, which I find a bit of a problem. I've not leaked or anything, but I just find it difficult to get the timing right, and I'm not sure my kidneys know what they're meant to be doing, as twice I've not peed out very much after the RT which must mean it's been done when the bladder was not full! (It was very hot here last week so maybe I'd sweated it out, even though this water was in addition to all that I drink normally.)

I wonder why they can't offer us a penis clamp of some sort to keep the pee in during RT, and then perhaps even have a bucket in the RT room to be able empty the system straight away rather than have the dash. The dash was also an issue one day as there are lots of patients and the mens room was occupied; I had to use the ladies.

No diarhoea yet, as such as BMs are still basically once a day and at the normal time, but things are very soft and happen very quickly. Also, for a lot of the time yesterday it felt like I needed a BM so it was not easy going out.

And yesterday farts were a problem too for the first time, but having been forewarned not to trust them I "dashed and sat", and twice was saved getting myself in a mess due to a tiny bit of solid stuff about the size of a large raisin coming out with the gas.

I am surprised to have had bowel side effects so soon into the treatment, makes me worry about how bad they will be by the end.

I've also been told no HT just yet. They are hoping that the RT alone will do the job.

This talk of Phantoms is reminding me of being a kid and watching the Phantoms and Bucanneers at the Royal Naval Airstation at Yeovilton in England. And we lived on the coast between Portsmouth and Plymouth so aircraft and ships of the Royal Navy were always exercising in the bay. There's a big aircraft museum at Yeovilton too which always fascinated me - my sisters as well, one sister was at school with the granddaughter of Lt-Col Bell-Davis who was the first guy to land an aircraft on a ship - brave man or crazy!

Alfred
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

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