RT Consult Appt.

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vam4710
Regular Member


Date Joined May 2010
Total Posts : 89
   Posted 7/29/2010 1:07 PM (GMT -6)   
Hi Guys....
 
Ok.. this is actually for my Dad and not me for a change.  We just came back from the URO.  got his PSA results.... looks like he had the Ultrasensitive test done... but I'm not sure.  Now mind you.. these numbers are after his Lupron shot a few months back. This is what the report reads:
 
Free PSA %     8.7%
PSA-Hyb          0.563 ng/mL
free PSA          0.049 ng/mL
 
Pre Lupron was PSA 20!
Called and set up an appointment with the Rad. Onc...... my question is... which is the most beneficial therapy to go with for max results and least side affects?  I need to do some research before we go and sit down with the doc.
Can't believe he had recurrance after 16 years!!  He was all zero's until last Sept.
 
As usual... thanks guys!!!
Diagnosis June 1, 2010 @ age 50
PSA  1.7    Sept. 2008
PSA  2.14  Sept. 2009
PSA  2.75  April  2010
 
May  25, 2010  - Biopsy  1 of 12 cores positive;  Gleason 3+4 = 7  25%;   Stage T1c
June 04, 2010  - CT and Bone scan - All Negative
July  07, 2010  - Da Vinci Robotic Lap. Surgery
 
PATHOLOGY
Tumor involvement - 15% both right and left halves
Gleason Down graded to 3+3=6
Seminal Vesicles - Negative
Lymphnode - Negative
Subcapsular perineural Invasion - Present
Bladder Neck Margin Positive (right posterior) - Microscopic invasion-1mm Focus
pT3a-N0-MX
 
Incontinence - Dry at night, 2 or 3 pads during the day)
 
ED  - Total flat tire.... no spare, not even a donut
 
First PSA scheduled for 10/14
 
 
Northern NJ


Minn1951
Regular Member


Date Joined May 2010
Total Posts : 21
   Posted 7/29/2010 1:25 PM (GMT -6)   
You mention that this is a recurrence after 16 years, what type of treatment did you have 16 years ago.
Diagnosed with Prostate Cancer 4/10/2010
 
Age 58
Stage: T2B
Greason Score: 3+ 3 = 6
PSA: 3.0
Prostate volumne 19cc
Tumor present in 3 of 5 cores on both the right and left with 6 of 55  mm or 11% on the right  and 4 of 59 mm or 7% on the left
 
No angiolymphatic or perineural invasion.  No high grade prostatic intraepithelial neoplasia.


vam4710
Regular Member


Date Joined May 2010
Total Posts : 89
   Posted 7/29/2010 1:34 PM (GMT -6)   
Minn1951 said...
You mention that this is a recurrence after 16 years, what type of treatment did you have 16 years ago.

 

 

Wasn't me MINN... it was my Dad... he had an open RP


Diagnosis June 1, 2010 @ age 50
PSA  1.7    Sept. 2008
PSA  2.14  Sept. 2009
PSA  2.75  April  2010
 
May  25, 2010  - Biopsy  1 of 12 cores positive;  Gleason 3+4 = 7  25%;   Stage T1c
June 04, 2010  - CT and Bone scan - All Negative
July  07, 2010  - Da Vinci Robotic Lap. Surgery
 
PATHOLOGY
Tumor involvement - 15% both right and left halves
Gleason Down graded to 3+3=6
Seminal Vesicles - Negative
Lymphnode - Negative
Subcapsular perineural Invasion - Present
Bladder Neck Margin Positive (right posterior) - Microscopic invasion-1mm Focus
pT3a-N0-MX
 
Incontinence - Dry at night, 2 or 3 pads during the day)
 
ED  - Total flat tire.... no spare, not even a donut
 
First PSA scheduled for 10/14
 
 
Northern NJ


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 7/29/2010 2:51 PM (GMT -6)   
Hi Vam,

Sorry to hear your dad had a recurrance. But I have got to question the RT at this point. You are 50, so I take it that you dad is 70+ and there isn't any study I know of that will indicate that radiation therapy will work when PSA is above 2.0. You said his was 20 which would make it systemic and not local. You can use radation for mets to control pain if he has mets and is in pain, but otherwise I would think the protocol would be to stay on the HT route and keep it in remission which seems to be working now.

I will love to hear what the radiation oncologist will say about this.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009     .06
                   6 month Apr 2009     .06
                   9 month Jul  2009     .08
                 12 month Oct 2009     .09 
                 18 month April 2010   .19


vam4710
Regular Member


Date Joined May 2010
Total Posts : 89
   Posted 7/29/2010 3:18 PM (GMT -6)   
LV-TX said...
Hi Vam,

Sorry to hear your dad had a recurrance. But I have got to question the RT at this point. You are 50, so I take it that you dad is 70+ and there isn't any study I know of that will indicate that radiation therapy will work when PSA is above 2.0. You said his was 20 which would make it systemic and not local. You can use radation for mets to control pain if he has mets and is in pain, but otherwise I would think the protocol would be to stay on the HT route and keep it in remission which seems to be working now.

I will love to hear what the radiation oncologist will say about this.
 
Thanks for the response LV.... Dad is 77.  He doesn't have any mets... the tumor was actually growing just below the bladder neck.  You mentioned that RT would not work about 2.0... would that be pre Lupron??  I too amy curious to see what the RAD ONC is going to say.... I'll be posting his comments when I meet with him.


Diagnosis June 1, 2010 @ age 50
PSA  1.7    Sept. 2008
PSA  2.14  Sept. 2009
PSA  2.75  April  2010
 
May  25, 2010  - Biopsy  1 of 12 cores positive;  Gleason 3+4 = 7  25%;   Stage T1c
June 04, 2010  - CT and Bone scan - All Negative
July  07, 2010  - Da Vinci Robotic Lap. Surgery
 
PATHOLOGY
Tumor involvement - 15% both right and left halves
Gleason Down graded to 3+3=6
Seminal Vesicles - Negative
Lymphnode - Negative
Subcapsular perineural Invasion - Present
Bladder Neck Margin Positive (right posterior) - Microscopic invasion-1mm Focus
pT3a-N0-MX
 
Incontinence - Dry at night, 2 or 3 pads during the day)
 
ED  - Total flat tire.... no spare, not even a donut
 
First PSA scheduled for 10/14
 
 
Northern NJ


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 7/29/2010 6:11 PM (GMT -6)   
Vam,
I would assume that it would be treated much the same as if it were the prostate. As he has been been undetectable for all these years it could not have been systemic therefore there have been no mets to date. A relapse so long after treatment is statistically a local development. You mentioned it can be seen by scan in the bladder neck which would tend to reinforce this. The rapid rise from 0 to 20 in under a year is definitely a cause for concern though......it seems it is doubling every 2 months 8. I should think that if your fathers general health is good it would be reasonable to nuke that area.
Bill
Biopsy

4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007

Post-op

Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct '07 <0.1 undetectable
PSA Jan '08 <0.1 undetectable
PSA April '08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August '08 <0.001 undetectable (disregarded due to lab "misreporting"-----it is not possible for any lab to get a reading of less than .003)

Post-op pathology rechecked by new lab:

Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September '08 <0.01 (new lab)
PSA February 09 <0.01
PSA May '10 <0.01

www.yananow.net/Mentors/BillM2.htm

Never underestimate old people ............ you don't get to be old by being stupid.


vam4710
Regular Member


Date Joined May 2010
Total Posts : 89
   Posted 7/29/2010 7:31 PM (GMT -6)   
BillyBeans said...
Vam,
I would assume that it would be treated much the same as if it were the prostate. As he has been been undetectable for all these years it could not have been systemic therefore there have been no mets to date. A relapse so long after treatment is statistically a local development. You mentioned it can be seen by scan in the bladder neck which would tend to reinforce this. The rapid rise from 0 to 20 in under a year is definitely a cause for concern though......it seems it is doubling every 2 months 8. I should think that if your fathers general health is good it would be reasonable to nuke that area.
Bill

 

Hey Billy....  First off.... great conversation last night.  It was my first chat session and picked up alot of info.  The Uro actually saw the growth when dad got scoped a few months back. His health is pretty good. In his caase though, isn't there RT that focuses on a specific area instead of bombarding the whole pelvic region?


Diagnosis June 1, 2010 @ age 50
PSA  1.7    Sept. 2008
PSA  2.14  Sept. 2009
PSA  2.75  April  2010
 
MAY 11, 2010  - DRE Negative - PCA3 Test
May  18, 2010  - PCA3 Results  39 (cutoff = 35)
May  25, 2010  - Biopsy  1 of 12 cores positive;  Gleason 3+4 = 7  25%;   Stage T1c
June 04, 2010  - CT and Bone scan - All Negative
July  07, 2010  - Da Vinci Robotic Lap. Surgery
 
PATHOLOGY
Tumor involvement - 15% both right and left halves
Gleason Down graded to 3+3=6
Seminal Vesicles - Negative
Lymphnode - Negative
Subcapsular perineural Invasion - Present
Bladder Neck Margin Positive (right posterior) - Microscopic invasion-1mm Focus
pT3a-N0-MX
 
Incontinence - Dry at night, 2 or 3 pads during the day)
 
ED  - Total flat tire.... no spare, not even a donut
 
First PSA scheduled for 10/14
 
 
Northern NJ


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 7/29/2010 8:22 PM (GMT -6)   
Sure there is Vam. If it needs to be, RT today can be very specific in the area it hits and the depth as well. Much like the Cyber Knife spoken about on chat yesterday. You are right about chat........ you get a good feel for your fellow members. I wish your father well.
Bill

vam4710
Regular Member


Date Joined May 2010
Total Posts : 89
   Posted 7/29/2010 8:53 PM (GMT -6)   
BillyBeans said...
Sure there is Vam. If it needs to be, RT today can be very specific in the area it hits and the depth as well. Much like the Cyber Knife spoken about on chat yesterday. You are right about chat........ you get a good feel for your fellow members. I wish your father well.
Bill
 
Thanks Billy..... I appreciate it.  I'm glad I was steered to this forum.... even though I've never met anyone or been here that long, I feel like you are all part of my family.

Diagnosis June 1, 2010 @ age 50
PSA  1.7    Sept. 2008
PSA  2.14  Sept. 2009
PSA  2.75  April  2010
 
MAY 11, 2010  - DRE Negative - PCA3 Test
May  18, 2010  - PCA3 Results  39 (cutoff = 35)
May  25, 2010  - Biopsy  1 of 12 cores positive;  Gleason 3+4 = 7  25%;   Stage T1c
June 04, 2010  - CT and Bone scan - All Negative
July  07, 2010  - Da Vinci Robotic Lap. Surgery
 
PATHOLOGY
Tumor involvement - 15% both right and left halves
Gleason Down graded to 3+3=6
Seminal Vesicles - Negative
Lymphnode - Negative
Subcapsular perineural Invasion - Present
Bladder Neck Margin Positive (right posterior) - Microscopic invasion-1mm Focus
pT3a-N0-MX
 
Incontinence - Dry at night, 2 or 3 pads during the day)
 
ED  - Total flat tire.... no spare, not even a donut
 
First PSA scheduled for 10/14
 
 
Northern NJ

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