Radiation Therapy - How many sessions?

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English Alf
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Date Joined Oct 2009
Total Posts : 2216
   Posted 5/17/2010 10:10 AM (GMT -6)   
Just had RT #16 of 33 and also saw the RT doctor. A different doc yet again; I have yet to see the same one twice!, but this one was at least one who said "Oh yes I know a lot about you" as she had been part of the team that had worked out my plan.

I checked with her why I was having 33 sessions (ie 66Gy with 2 at each session) as nearly all the other guys I've been bumping into the the waiting room had mentioned that they were having 39 sessions (ie 78 gy with 2 at each session)

She explained that if RT is the primary treament, ie the prostate is still present, then they give 39 sessions and that if the RT follows surgery and there is no prostate around then they give 33 sessions to the prostate bed. And she added that if they only had to kill the tuimor, then they could basically give all 66gy in one dose, but they spread it out like they do to reduce the damage to surrounding tissues over the course of the seven weeks. However...

She then said that they have now introduced a new third method, or rather an alternative one to the 33 sessions. There are now some patients who are having their 66 gy spread over just 19 sessions, and with 3.4 gy at each session. (I think I've got the math right) These guys only get RT on Mondays Wednesdays and Fridays, so the overall time for RT is more or else the same as with 33 sessions.

Has anyone else heard of this, as I can clearly see the benfit of almost having the number of triups a guty has top make to the hospital?


Othwerwise a bit of a difficulty developed today, which I guess is a side effect of the RT, namely I seem to have been having to pee about twice an hour all day and have felt like my bladder is full the whole time. The doc said she could give me tablets to calm my bladder down, but I am going to wait a couple more days minimum to see if it goes back to the way it was yeterday of its own accord.

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
April 13th 2010 CT scan.
April 28th 2010 Started Radiation Therapy (66Gy - 33 sessions)


John T
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Date Joined Nov 2008
Total Posts : 4237
   Posted 5/17/2010 10:20 AM (GMT -6)   
Alf,
Take the medication offered as most likely it will get worse not better while you are undergoing therapy.
These are normal side affects of radiation and will go away in a few weeks after treatment stops.
JT

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


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 5/17/2010 10:21 AM (GMT -6)   
Alf,
Yeah, when RT is giving as the primary treatment for PC, not uncommon to go 39-42 treatments, usually from above 70 gys to sometimes over 80 gys. That is because there is a prostate in place, of course.

With our SRT, Salvage Radiation, it can range from 33-39 typically for treatments (not in all cases), and the gys can be as low as 60 to the mid 70's, depending on the individual data and history of the patient.

I went for 39 great ments for a total of 72 gy, which is higher than average in my area for SRT.

I saw the same radiation oncologist each and every week of my treatments, same one that made my plan. Usually saw her every Monday.

The urgency you describe is very typical side effect while going through the SRT, never experienced that, since all mine were done with a catheter in place. Since you have to travel so far, might be wise to take the tablets from the dr, should ease some of those feelings.

As far as those stronger doses given over lesser time, my own dr. said that not member people could endure that much radiaition poisoning without really getting sick or having more serious side effects. From my own experience, I would tend to agree.

Good luck as you continue. You are getting there, a day 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


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2216
   Posted 5/17/2010 10:31 AM (GMT -6)   
David
The idea with the 19 sessions is not to give the 66gy over nineteen days ie thre weeks, but just to give bigger (almost double) doses on alternate days and thus still spread the total dose over about seven weeks.
It may be a follow on from what I had heard previously that they sometimes gave some patients 4 gy on one day and none on the next if their machine was going to be out of use for servicing on the second day.

Alf

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 5/17/2010 10:54 AM (GMT -6)   
Alf, I believe you, of course, but couldn't imagine the average person enduring 4 gys a day dose. That's way over what is considered normal for radiation poisoning to the body. Probably would have done me in at that rate, lol. Geez thats a lot of radiation at one time

where i live, if a machine was down (never heard that happen here before) or if the patient is too sick. can't be there, etc, they skip the treatment and add it back on the tail end of the treatment number. saw that lots of time, when i was going through mine. despite my foul reaction to it, i toughed it out and never missed or postponed a treatment, just wanted it to be all over with.
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


JB71
Regular Member


Date Joined Nov 2009
Total Posts : 206
   Posted 5/17/2010 12:59 PM (GMT -6)   
Alf, just got home from day 6. My trips take 3 hours and 15 minutes. The 15 minutes are the ones I actually spend in the hospital. Was having problems drinking 500 ml. of water one hour prior to the treatment and changed it to 350 ml. and 45 minutes prior. Seems okay for now or at least until the rad. side effects kick-in.
 
Today was also the first meeting since the start of rad. to meet with the oncologist and was told my treatment would be 33 times for 66 whatever they call them.
 
Will ask him next time though about the doubling up of the radiation but a friend of mine had his prostate removed 6 years back and started the radiation of 4 gy's per day, every other day. Today he has severe bowel problems, his PSA is back up to 5 and has been told that chemo might be needed next.
 
He had been planning for years to sail his boat down from the Great Lakes to the Carribean this fall but is now concidering cancelling his lifetime dream.
 
Jerry in Canada.
.

English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2216
   Posted 5/17/2010 1:30 PM (GMT -6)   
There is clearly a dose that is too high, but what is it 3.8 or 4.1 or 5?

There is also the question of the total dose, plus the daily dose, or the dose per 48 or 72 hours etc.
the fact that she said 3.4 gy per session and not 4 makes me think that this is about fine tuning the maximum permitted daily dose. If it was say simply 22 sessions of 3gy then I'd feel that they were simply redoing the math for no good reason.
Frankly I'm glad that it's not 66 sessions of 1gy each.

The current arrangement at this hospital regarding the servicing the machines is that there are eight machines plus one spare which patients get sent to on the day when their normal machine gets its service. (And they are in the process of adding another machine.)

Also where are your RT departments located in the building? mine is in a single story block above ground, but I have heard that other RT buildings are underground or in bunkers. The dangerous bits of the deperment are in the middle of the wing and shielded with concrete walls/roof etc but the waiting and changing areas etc are around the outside so there are windows and glass walls etc to give it a very open character. The room itself is also very large, light and spacious so it doesn't feel the least claustrophobic.

Alf

don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 5/17/2010 1:30 PM (GMT -6)   
Cheerio, ALf,

Primary treatment was radiation. See the signature for details. There are some more recent treatments like Cypberknife that give higher fractions over shorter periods. I checked in to it when diagnosed and it was not right for me due to potential metastasis.

Best of luck to you.
Don
Diagnosed 04/10/08 Age 58 at the time
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear and chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
Started Casodex on May 2 and stopped on June 1, 2008
Lupron injection on May 15 and every four months for next two years
Started IMRT/IGRT on July 10, 2008. 45 treatments scheduled
First 25 to be full pelvic for a total dose of 45 Gray to lymph nodes.
Last 20 to prostate only. Total dose to prostate 81 Gray.
Completed IMRT/IGRT 09/11/08.
PSA 02/08 21.5 at diagnosis
PSA 07/08 .82 after 8 wks of hormones
PSA 10/08 .642 one month after completion of IMRT, 6 months hormone
PSA 03/09 .38 six months post radiation and nine months into hormones
PSA 06/09 .36 or .30 depending on who did the test
PSA 09/09 .33 one year after IMRT and 16 months into hormone
PSA 03/10 .32 18 months after IMRT Still on hormones


142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6980
   Posted 5/17/2010 1:45 PM (GMT -6)   
Alf,
I am doing 39 at 1.8 gy per day. I was told mine is shorter (they normally do 45 days) and lesser dose since this is followup rather than primary.

I remember all the training for radiation "accidents" and Civil Defense - there is a breaking point for radiation, and going over that does long term damage. One would hope that these doctors know what they are doing, but I would take 39 days at half the dose as a good thing. Higher dosages sound like lab rat fodder to me.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 5/17/2010 2:15 PM (GMT -6)   
Jerry, good to hear back from you. Your 66 gys over 33 sessions is considered, at least by my drs, the minimal they like to admin for SRT. They tend to want to give more, if you have had a lot of PSA velocity issues in the past, both pre- and post- surgery. Again, like all things PC, too many variables and differences between patients.

I still wouldn't reccomend those higher daily doses being discussed here. I know my case is unique to me, but when I think of all the colataral damage I have been dealing with, and its been 6 months almost since my SRT ended. I don't think any radiation treatment should be taken lightly. People need to read the fine print and in-between the lines. Just like many surgeons downplay the side effects and complications of prostate surgery, I firmly believe that the Radiation Clinics do the same thing.

Be glad when you, 142, and now Subic, get through yours. It will be a relief.

And yes, thankful, that I live in an area where I didn't have to travel far or long. 2 minute drive to Uro's office, 4 min drive to GP, 1 minute drive to nearest ER if needed, and less than 15 easy minutes when I was going to the radiation clinic. And my hospital of choice, where I have had all my surgeries, is less than 20 mins even at rush hour. For you guys that have long drives, in time and/or distance, I feel for you.

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


Old Sailor
Regular Member


Date Joined Aug 2009
Total Posts : 208
   Posted 5/17/2010 2:45 PM (GMT -6)   
Alf, I finished 26 of 38 today ( will have total 68.4gys).  Same problem, urgency and frequency.  Told doctor today and he recommended an over the counter drug called pyridium ( but said can turn your underwear orange if leak etc.) He also recommended very little liquid after 9:00 pm so I don't have to be getting up at night.  He said should return to normal about 3 weeks after radiation stops.  Just in case,  I carry a plastic urinal in the car, used it after surgery in hospital.  Hang in there, you'll be OK.

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. 


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2216
   Posted 5/18/2010 2:32 AM (GMT -6)   
I'm definitely more tired than I though as I now see that I started this thread by saying that I'd had #16 of 33 whereas it was actually only #15.

Also overheard others in waiting room saying that they are getting forgetful.

I guess the stress, distruption etc is making me a bit absent-minded.
It might be easier if all my appointments were at the same time too, I now find that after breakfast I actually have to write down on a piece of paper what time I have to set off and leave it on the kitchen table with the kitchen timer set. (My times have been anything between 11.15 and 15.45)

Alf

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 5/18/2010 8:20 AM (GMT -6)   
Alf, it's a shame your appt. are not at a set time. Mine were the very same time for all 39 treatments, seems to me it was at 1430 everyday. That way, I could plan my day around it.
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


142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6980
   Posted 5/18/2010 8:42 AM (GMT -6)   
Alf,
My therapists were a bit astounded that the time changes. They think that a regular schedule helps you fit the treatment into your life, rather than having to live around the treatment. All to help the mind settle in. But I guess in a large hospital environment you could not possibly use the machines "full time" without schedule changes.
Different systems - different rules.

I'm off to #19. Hope your day went well.

English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2216
   Posted 5/18/2010 10:56 AM (GMT -6)   
I'm not yet sure whether always having it at a different time is a good or bad idea. And even though today's appointment was at the same time as yesterday I and to go to a diferrent wing in the department today anyway as my normal nachine was having its service.
Yes I'm being seen at a big department 8 or 9 machines, which are in use from 8am till 5pm approx with a new patient every 15 minutes. The whole hospital and Institute are for cancer patients only, so you don't see any other sort of patients. It is sobering to see the other folk coming along for RT who clealry do not have PCa who are often in wheelchairs or hospital beds or walking with drips on racks. Many of them are very ill, thin, grey, bald etc and occasionally you encounter someone who is clearly having a bad time emotionally. Almost everyone who you walk past, or who walks past you says "hello" or smiles be they staff or patient.
The staff are very helpful, friendly etc. There are also volunteers who are often walking around handing out free coffee, tea, lemonade etc to both patients and relatives.

Anyway my bladder was a great deal better behaved today, in fact frequency was back to the same as last week and urgency was only there half the time.

Strange thing today was that there was a shift change during my session so I was set up by two male nurses and then two ladies took over.

And weirdly the machine I was on today was not the same as normal in as much as the bit I lie on was a newer design and felt warmer and somehow softer; the RT "eye" was the same as it whirred and clicked and clunked around me.

I was also home 3hours & 15 minutes after setting off which is a record.

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
April 13th 2010 CT scan.
April 28th 2010 Started Radiation Therapy (66Gy - 33 sessions)


bsjoplin
Regular Member


Date Joined Feb 2010
Total Posts : 308
   Posted 5/18/2010 1:07 PM (GMT -6)   
just to add my "2cents worth", i will later today go to number 10 treatment.  i am scheduled for 37 of them at 1.8Gy, for a biblically scary total of 66.6
it's convenient to have them all scheduled at 4:00--i can leave work a little early, head on down to the hospital, get my quick treatment, and the rest of the afternoon is mine.
after 9 shots, i don't feel the oft-quoted comment about fatigue (tho my wife would say i'm a little on the lazy side anyway), but the bowels feel different, more sensitive somehow, so i expect that will present itself into something here after a few more.
other than that, NO issues to speak of, so praying it will continue minimal like that....
all the best to youall in similar situations!
bob
 

Age@dx: 55

5/05             PSA test 1.8  --12/19/07  PSA test 3.7  --7/25/08    PSA test: 4.7

8/26/08        1st Prostate Biopsy: 3 samples out of 6 have irregular cells

11/25/08      PSA test: 6.5

12/11/08      2nd Prostate Biopsy :  of 12 samples, 3 are cancer, and all other 9 are irregular.  original NJ lab sent samples to Johns Hopkins for special reading.  Gleason 3+3=6.  now:read book, and think about options: radiation, surgery, etc

1/22/09        Radical Retropubic Prostatectomy.  main issue was use of BOTH pre-donated units of blood during surgery, and then required 2 additional units in recovery, before going to room

1/25/09        Released from hospital. No drive, no lift >5 lb

1/28/09        Pathology results from removed tissue:  Cancer was seen on 10% of gland, lymph nodes & SV were benign, nothing seen outside of the prostate.  One area of cancer extended right up to edge, but not beyond.  Gleason was re-typed as 3+4=7, staged T2c

2/13/09        PSA=0.1

3/6/09          6week appt, start back to work Monday, 3/9.  script for Cialis

6/8/09          PSA=0.1

10/9/09        PSA=0.1

2/10/10        PSA=0.3 discussed possibility of radiotherapy and/or hormone.

4/7/10          PSA= 0.4  Recurrence of the cancer is probable. Referred me to RO

5/4/10                   First RT.  RO is recommending 37 treatments x 1.8Gy=66.6 Gy

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