Dad's PCa is back

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vam4710
Regular Member


Date Joined May 2010
Total Posts : 89
   Posted 8/11/2010 4:40 PM (GMT -6)   
Well... I don't even know where to start.  Some of you may remember from past posts that I mentioned my Dad's PCa coming back after 15 years.  Yesterday was the first consultation with the Rad. Onc. Back in 1994, when he had is RRP, thought it was over and done with. There weren't resources back then like there are today, and certainly no forums that I was aware of to pull info off of.  During our visit with the doctor, he asked me to request my dad's PSA score for as far back as I could go.  I called his old Uro's office and they supplied me with the following info which I shared with the Rad Onc.:
1994 -1999  <0.01
2000  0.16
2002  0.7
2003 1.0
2004 1.9
2005 3.3
2006 4.6
2007 6.1
2008 9.0
2009 15.3
2010 20.70
July 2010 .05 (due to Lupron) 
 
The 15.3 was found by his cardio doc and prompted me to take him to my URO which has definetely put him on the right track.  I was ignorant when it came to PCa back then and didn't understand it like I do today.  What REALLY ANGERS me, is that his Uro never told him that his PSA was going up! His lame brain doctors should have taken action back in 2000 - 2002!! All my dad knew was that he was told everything was ok and he was cancer free.  The Rad Onc. was also very angry that someone at the old office dropped the ball and said he sees cases like this all the time. Fortunately, my dad has no mets and all his scans were clean.  There is a 3.5cm tumor growing in the prostate bed next to the bladder neck, which is where he had a postitive margin. Doc said that he will be starting IMRT next week @ 70gy going for 39 visits.  He also stated that he is very confident that my father will pull through this like a champ.
I'm keeping my fingers crossed. He would have tolerated the treatment better 8 years ago... and for his old Uro's sake, he had better not have any issues!
 
As for me... recovery is going well... I'm 5 weeks post op today and totally dry for the last 4 days... WOO HOO. Just came back from my primary doc today who gave me the great news that I now have a hernia in the site where the camera was inserted...just my luck. It's small enough that I can deal with it in a few months after I get dad squared away.
 
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
4 weeks post op... down to 1 pad a day - still dry at night

ED - Total flat tire.... no spare, not even a donut

First PSA scheduled for 10/14/2010


Northern NJ

Post Edited (vam4710) : 8/11/2010 5:31:36 PM (GMT-6)


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2461
   Posted 8/11/2010 4:59 PM (GMT -6)   
Sorry about your Dad's rising PSA. I can't believe that in this day and age we have doctors and Urologists who ignore the rising PSA that started back in 2000. Those doctors put their patients in danger and should be held accountable.
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm in circumference.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 5 months
2 months PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1
8 months PSA test 10/9/09 result <0.1
11 months PSA test 1/21/10 result 0.004
14 months PSA test 4/19/10 result 0.005

Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2448
   Posted 8/11/2010 5:20 PM (GMT -6)   
Vam, am really sorry to hear about your dad's issues. Given my newly acquired impatience with fumbling, bumbling, make me wait docs, lately, I would have probably not been as kind as you have appeared to be.

Really hope your dad tolerates this next phase well and he can get on with enjoying life.

Glad to hear about your progress. Keep it up,

Sonny
60 years old when diagnosed
PSA 11/07 3.0
PSA 5/09 6.4
da Vinci 9/17/09
Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5%
positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT completed 1/15/10 35 treatments- 70Gy

2/24/10 FIRST POST RAD PSA 1.0---CARRRP --waiting for the next test.
3/22/10 Second Post RAD PSA 1.5 Dammmmnnn stubborn son of a gun
4/19/10 YAHOO PSA dropped to 1.2 Moving in the right direction.
5/7/10 PSA test 1.3 Sodium Fluoride PET Scan & CT SCAN -performed
5/20/10 PSA test 1.2 Holding off on future tests for 3 months- single lytic lesion found and scheduling radiation.
7/22/10 PSA test 1.3 - Begin radiation for MET on leg
8/9/10 - Met radiation completed

vam4710
Regular Member


Date Joined May 2010
Total Posts : 89
   Posted 8/11/2010 5:46 PM (GMT -6)   
Thanks Ed... Sonny..... Just wanted to vent a little.... I'm not a vindictive person by no means... but I did put a call out today to my attoreny. All I hope for is that dad can tolerate the treatment and that he will be ok.... if things go well, I'll be happy with that, if not then I'll do what I have to. He's 77 now and has some heart issues which he didn't have 8 years ago when his PSA started to rise and he's on blood thinners to boot.
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
4 weeks post op... down to 1 pad a day - still dry at night

ED - Total flat tire.... no spare, not even a donut

First PSA scheduled for 10/14/2010


Northern NJ

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 8/11/2010 5:55 PM (GMT -6)   
This is just another example of why a patient needs to be his own advocate. Keep all of your medical records and don't depend on the doctor's office to tell you something. Get copies of all test results and ask questions if you are unsure. Things like this never should happen.
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


vam4710
Regular Member


Date Joined May 2010
Total Posts : 89
   Posted 8/11/2010 6:34 PM (GMT -6)   
Your absolutley right JT.... Unfortunately Dad is old school european and trusted that the doctors office was giving him correct results back then.
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
4 weeks post op... down to 1 pad a day - still dry at night

ED - Total flat tire.... no spare, not even a donut

First PSA scheduled for 10/14/2010


Northern NJ

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 8/11/2010 6:51 PM (GMT -6)   
vam,

it's a shame that your dad had a slacker of sorts over all those years. When his numbe went over the .10 mark in year 2000, according to what you posted, there should have been concern and followup from his doctor(s). Hard to believe that it kept going up and up for ten years since. Yes, he would have been several years younger, and obviously in better shape to deal with a secondary treatment, i.e. radiation.

with those steady rises, its a miracle that he doesn't have any mets at this time.

not blaming you, or any of your careteam or your dad, but John is right, each patient has to be their own advocate. no point in having all those PSA tests done all those years, if no one was paying attention to them (not trying to be insulting here). we all have learn as we go along with this. His doctor, would be hard pressed to come up with a legitimate reason that followup wasn't needed in your father's case.

i am no attorney, but you might just have a legit issue there with what is going on. probably wouldn't hurt to speak
to a good attorney that specializes in malpractice, if you feel up to going through all of that.

glad to hear that your own recovery is going well too. please keep us posted on both you and your dad. i hope he does well with the SRT, I can't remember his age for the life of me. good luck

david in sc
Age: 58, 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, 8/6 .06, next test 11/10
Latest: 7/9 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 - 38 days, mapped 9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4, Caths #11 and #12 ,Cath #11 - 21 days, Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, Cath #17 - 39 days, 7/2 - Corr Surgery #6, Cath #18 - 13 days, Cath #19 - 17 days, Total Blockage, Cath # 20 - 7/19

erbob
Regular Member


Date Joined Jan 2010
Total Posts : 281
   Posted 8/11/2010 7:19 PM (GMT -6)   
I also had rising PSA and my Primary Doc didn't really alert me to that fact or the importance of the higher numbers. Those numbers really meant nothing to me at the time. Here's mine:
2.6 4/96
1.9 5/97
2.3 4/98
2.2 10/99
2.4 8/00
2.3 6/01
2.9 2/03
3.6 4/04
3.0 5/05
4.7 4/06 (ouch)
3.7 4/07
3.2 1/08
6.1 4/09 (ouch again)
5.3 5/09
5.3 8/09
6.9 10/09
7.3 12/09 (well, here we go)
6.1 1/10
5.0 3/10
0.7 5/10 (Lupron/Bicalutamide)

Was not very concerned about my numbers until April of 06. Then in April of 09 they really jumped up and the Doc said we'd better watch them.
December 09 they really jumped up to 7.3 and that prompted a biopsy. smhair
Now I really wonder how long I have had this blasted PC. Perhaps started between years 05 and 06 but will never know now. Two weeks from tomorrow, on 8/26 I'll get a blood draw for the latest PSA. That will be only three months after Brachytherapy so I do NOT expect to be anywhere near my lowest PSA point yet. We shall see though.
Bob, located in Southern Colorado

Age 73 Retired Railroader.
Dx Jan 2010, Volume 51.345
Gleason 3+4=7, second opinion 4+3=7 (Don't know which to believe)
PSA
2.6 4/96.......... 3.7 4/07
1.9 5/97.......... 3.2 1/08
2.3 4/98.......... 6.1 4/09
2.2 10/99......... 5.3 5/09
2.4 8/00......... 5.3 8/09
2.3 6/01......... 6.9 10/09
2.9 2/03......... 7.3 12/09
3.6 4/04......... 6.1 1/10
3.0 5/05......... 5.0 3/10
4.7 4/06......... 0.7 5/10 (Lupron/Bicalutamide)
Volume study at CPCC (Westmont, IL) Feb 15, 2010 = 55.7cc
On Feb 15, 2010 put on 90 days of Bicalutamide
Got LHRH Lupron shot on Feb 29,2010
Another Volume study May 24, 2010 = in mid-40cc
BRACHYTHERAPY received May 26, 2010
Received 80 I-125 (Iodine seeds)
Activity per seed (mCi) 0.373
Total activity implanted (mCi)29.80
Measured exposure @ 3 feet (mR/hr) 0.06
Received the Brachytherapy at the Chicago Prostate Cancer Center from Dr. Brian Moran
Walked in the facilty and just a few hours later walked right out.
No after effects other than just a little sore from the needle sticks but NOT serious
enough to take ANY meds for pain.
PSA to be taken in three months (Aug 2010).

livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 8/11/2010 7:27 PM (GMT -6)   
I agree that we have to be our own advocate when possible. Relying on the medical community which we have to do most of the time is not the best way to go. We have to use the medical community in conjunction with our own knowledge then we have some power. I am sorry to hear about this for your dad. At his age Lupron may be pretty tough, My prayers are with you and your family.

peace to you
Dale
My PSA at diagnosis was 16.3
age 47 (current)

http://www.caringbridge.org/visit/dalechildress

My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's
I was on Lupron, Casodex, and Avodart for two years with my last shot March 2009. I am currently (7-22-2010) not on any medication.
My Oncology hospital is The Cancer Treatment Center of America in Zion IL
PSA July of 2007 was 16.4
PSA May of 2008 was.11
PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
PSA July 28th 2009 is .01
PSA OCt 15th 2009 is .11
PSA Jan 15th 2010 is .13
PSA April 16th of 2010 is .16
PSA July 22nd of 2010 is .71
Testosterone keeps rising, the current number is 156, up from 57 in May

T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%

daveshan
Regular Member


Date Joined Jan 2010
Total Posts : 363
   Posted 8/11/2010 9:02 PM (GMT -6)   
Sadly not too uncommon for a doctor to drop the ball, your father's case is the most extreme I've ever heard of.

Best wishes to both you and your father.
Dave in Durango CO
Diagnosed 12-09 age 55
07-06 PSA 2.5
01-08 PSA 5.5 (PCP did not tell me of increase or schedule follow-up!!!!)
09-09 PSA 6.5 Sent for consult with Urologist
11-09 Consult, scheduled for biopsy, found out about PSA from '08 (yes I was pissed)
12-09 Biopsy, initial Gleason 9 (4+5) later reduced to 8 with tertiary 5, ain't much but I'll take it.
01-10 Bone Scan, "appears negative"
03-01-10 RRP in Durango CO by Dr Sejal Quale and Dr Shandra Wilson, no naked eye evidence of spread, Vesicles and lymph nodes taken for microscopic exam.

03-16-10 Removal of cath' and pathology results of samples.
Multifocal carcinoma with areas of Gleason pattern 3, 4 and 5, Overall Gleason grade 4+4 with tertiary 5, Bilateral involving 21% of left lobe, 3% of right lobe, Invasion of left Seminal vesicle, Tumor focally present at left resection margin, 9 lymph nodes removed all negative, Tumor staging pT3b NO MX

04-23-10 PSA <0.04....... 06-07-10 PSA <0.04..... 08-03-10 <0.04
05-03-10 1 week without pads
06-28-10 ;-)

vam4710
Regular Member


Date Joined May 2010
Total Posts : 89
   Posted 8/11/2010 10:08 PM (GMT -6)   
Guys... thank you all for the replies.... David, I know your not blaming anyone.... if anything, I was young and ignorant back then when it came to this Beast... Dad always went for his blood work up and neither of us new better to actually ask for the PSA scores back then. Dad is 77 now, he would have been 67 when the PCa reared its ugly head again. I always thought back then (10 years ago) that once the prostate was gone, that was the end of it.

The only side effect from the Lupron he is having is hot flashes. I too am surprised that he doesn't have any mets given this long a time. Like I said.... depending on the outcome, I'll decide what the best route is to go...although at this point, it won't give us back the 10 years we needed to act on this.
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
Lymph node - Negative
Sub capsular 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
5 weeks post op... down to 1 pad a day and a couple of drips - still dry at night

ED - Total flat tire.... but there is signs of life!

First PSA scheduled for 10/14/2010


Northern NJ

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7087
   Posted 8/11/2010 10:34 PM (GMT -6)   
Vam,
Sure a mixed bag of news for you, but dry helps a lot (I'm not at almost a year out, so I envy you).
Your Dad's story sounds like bad doctors. I did the 39 IGRT treatments after DaVinci, and have a few side effects. Worse than most, better than many.

Saw you came through on chat - was typing a reply as you were leaving - come back next week a little earlier. Think we were all dragging tonight.

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 8/11/2010 11:06 PM (GMT -6)   
On the other hand, I am a little envious of your dad in a way. I hope I can just forget about darn PC someday and just go for 10 years assuming all is well.

He had 10 years of no worries, no PSA anxiety, no family meetings, etc., etc.

And it sounds as tho the PC is just sitting there waiting to be handled by the radiation. Hopefully his bladder neck isn't involved.

Best of luck to both of you.
Goodlife
 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01
1 year psa (364 days) .01
15 month PSA <.01

vam4710
Regular Member


Date Joined May 2010
Total Posts : 89
   Posted 8/12/2010 5:56 AM (GMT -6)   
Thanks guys.... 142, if you don't mind me asking, how long did your side effects last?  With his current condition, at this point, that's my concern barring there are no other problems.
 
Goodlife.... I hear what your saying, like I said, dad is very old school european, I'm not making him sound like he's clueless, but I really don't think he fully understands the ugly path that we could have gone on with this situation. I too am hoping that his bladder neck is not involved, but it is so close that after he was scoped,  his current Uro is suprised he had not had problems or symptoms already.
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
Lymph node - Negative
Sub capsular 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
5 weeks post op... down to 1 pad a day and a couple of drips - still dry at night

ED - Total flat tire.... but there is signs of life!

First PSA scheduled for 10/14/2010


Northern NJ

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7087
   Posted 8/12/2010 10:25 PM (GMT -6)   
Vam,
I am 8 weeks from the end of radiation, and feel like I've stopped getting any worse. Not getting better yet, but the GP told me 2 months out was normal. The Rad. oncologist said no side effects were expected, but was wrong. I am waiting for my upturn.

My radiation is chronicled at:
 

The fatigue has been the most evident issue, but I was also not yet continent after DaVinci, and had some setbacks there.

Postop
Regular Member


Date Joined Feb 2010
Total Posts : 385
   Posted 8/13/2010 12:05 AM (GMT -6)   
We don't hear about many cases like your fathers on this board. Prostate cancer can be cancer in slow motion. A few cells left at a positive margin, then 16 years later the PSA gets up to 20, and those cells turn into a 3.5 cm lump of cancer cells. Without PSA testing, he might not know it was even there. I'm with Goodlife, that 10 years without treatment is a gift of sorts, and that there is an excellent chance that treatment will beat it back so that your father will live the rest of his life without sickness from PCa.

I think this story can give some perspective on active surveillance. It's not that small or lower grade PCa will somehow sit there and never grow, or go away. It must always grow some. The question that people with early PCa have to face is whether they will live long enough for the PCa to make them sick. If they get a biopsy every year, that might tell them something about how fast the PCa is growing. If they are in their 40s or 50s in good health, though, it's kind of scary and risky to decide that the PCa is not going to make them sick in 20 or 30 years--a lot can happen in 20 years. On the other hand, if someone in their 50s with a smaller PCa decides to have surgery (like I did at 57), it's an attempt to give themself freedom from sickness from PCa in their 70s and 80s.

vam4710
Regular Member


Date Joined May 2010
Total Posts : 89
   Posted 8/13/2010 5:47 AM (GMT -6)   
142.... I read your excerpt.... if I'm understanding this correctly, they did it without anesthesia??  My dad is going to be put under for his. Thanks for your input, at least I know what to expect when I take him home.
 
Thanks PostOp...  Yes, I consider my Dad very lucky that this didn't get out of control. I'm hoping that his discomfort will be minimal. He's been going through alot in the last 3 years... Mom's in the nursing home, so he has a tremendous amount of stress, and between the blood thinner's, and heart problems he has I'm worried about how he's going to tolerate the Rad.
A
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
Lymph node - Negative
Sub capsular 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
5 weeks post op... down to 1 pad a day and a couple of drips - still dry at night

ED - Total flat tire.... but there is signs of life!

First PSA scheduled for 10/14/2010


Northern NJ

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 8/13/2010 10:34 AM (GMT -6)   
vam,

What 142 just posted caught my eye:

"Rad. oncologist said no side effects were expected, but was wrong"

If your dad still has these other serious health issues, and considering his age, going through radiation might be a real strain on his body. I am the poster child of what can go wrong with radiation, as I see here still damaged and with daily pain almost 9 months after salvage radiation ended.
Now I might be the exception, and not the rule. But radiation is still a major event to go through. Of course, he needs to do whatever he, his family, and his doctors think best in his case.

I was 47 the first time I went through major radiation (different cancer), and I never got over all the fatigue from it, and I still have quality of life issues over 10 years later. I was 57 when I went through radiation because my prostate surgery failed, and I am still dealing with the effects every single day.

Not every man will have issues like these, but radiation poisons the body and does a number on the immune system. Yes, I feel that my radiation oncologists really gloss over the side effects and risks ahead of time, as they make some much money off of radiating people.

In your father's case, definitely a case of quallity of life vs. quantity of life, in my opinion.

David in SC
Age: 58, 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, 8/6 .06, next test 11/10
Latest: 7/9 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 - 38 days, mapped 9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4, Caths #11 and #12 ,Cath #11 - 21 days, Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, Cath #17 - 39 days, 7/2 - Corr Surgery #6, Cath #18 - 13 days, Cath #19 - 17 days, Total Blockage, Cath # 20 - 7/19

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7087
   Posted 8/13/2010 11:45 AM (GMT -6)   
Vam,

Yes, the Calypso markers were done without "putting me under" - I think being knocked out would not have changed much.
Question is, will they use Calypso markers, gold markers, etc. - some systems do not, such as those that do a mini-ct before each treatment. That will all depend on the equipment the radiation therapists use.

David has a point I've learned as well - the Rad. docs say that my issues are either left over from DaVinci, or just stress. My GP sees a lot of post-radiation folks day-to-day. He says I have classic issues (none really severe for now, it seems), and that they take a while (many months) to go away even in the best of cases. On the other hand a lot of men in their 70's (I met at the clinic in the daily time in the waiting room) had no evident problems at all, and said they felt great.

So we have to consider the possibilities. David has had a really rough go, I'm seeing a few months with too many trips to the WC, wanting to believe they did it right, and others walk away whistling and happy.

And I have the prospect that if something does go wrong, it may be years off in the future. (I'm 57)

As always, we hope for the best, plan for the worst, and more often than not land in the middle somewhere. As everyone will remind you, the ones of us here everyday are not representative of the "best results" category.

vam4710
Regular Member


Date Joined May 2010
Total Posts : 89
   Posted 8/13/2010 10:43 PM (GMT -6)   
Dave and 142..... Thanks guys..... All very good points and very true.... Like I mentioned, I just hope that he doesn't have major
side effects.  the only thing he really looks forward to with his life all flipped upside down, is taking care of his great grandaughter
(my grandaughter).  If the fatigue really gets to him, he won't be able to..... aside from the fact that he won't really be able to spend time with my Mom and the home.  I'll keep you posted on the outcome when we go to have the guides put in Thursday.
I hope this isn't something that I'll have to look forward to later in life with having my prostate out at an early age cry
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
Lymph node - Negative
Sub capsular 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
5 weeks post op... down to 1 pad a day and a couple of drips - still dry at night

ED - Total flat tire.... but there is signs of life!

First PSA scheduled for 10/14/2010


Northern NJ

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3895
   Posted 8/15/2010 9:31 AM (GMT -6)   
Just as a point of information, the latest and greatest radiation treatment machines are called "Varian Triology RapidArc". These machines require no markers to direct their precisely focused beams and they can safely deliver a slightly higher dose than the older equipment that is in general use today..

The downside is only the biggest hospitals and treatment centers have them and the machines are very expensive to buy and therefore being treated on one can be very expensive. Make sure the provider gets pre-authorization from your insurance company..Also be aware, most Medicare plans only cover 80% of the cost of radiation treatment so you might want to find out in advance what your co-pay will be...
Age today: 68. Married, 6', 215 pounds, active, no health issues.
PSA at age 55: 3.5, DRE negative. Advice, "Keep an eye on it".
PSA at age 58: 4.5
PSA at age 61: 5.2
PSA at age 64: 7.5, DRE "Abnormal"
PSA at age 65: 8.5, DRE " normal", biopsy, 12 core, negative...
PSA at age 66 9.0 DRE "normal", BPH, Finesteride. (Proscar)
PSA at age 67 4.5 DRE "normal" second biopsy, negative.
PSA at age 67.5 5.6, DRE "normal" U-doc worried..
PSA at age 68, 7.0, third 12 core biopsy positive for cancer in 4 cores, 3 cores Gleason 6, one core Gleason 9. Finesteride discontinued, still no urinary symptoms, never had any..From age 55 to 65 I had no health insurance.

I have a date with the robo surgeon on Sept 3 but I'm keeping my options open. I'm also looking at seeds combined with IGRT which seems to be having good results with high-risk patients..

freinds
Regular Member


Date Joined Jun 2010
Total Posts : 76
   Posted 8/19/2010 1:54 PM (GMT -6)   
vam, my prayers go out to your father and for your continued recovery.
I know I felt that my rising psa was not taken seriously enough and I was fortunate that my regular uro was out for 6 months training and I had a different guy to recommend a new biopsy.

age 50, diagnosed April 2010

pre-op PSA 3.7
One month post surgery PSA ZERO
Gleason 6 upped to 4+3=7 post surgery

post op. surgical margins clear

Bone scan clear

vam4710
Regular Member


Date Joined May 2010
Total Posts : 89
   Posted 8/19/2010 2:18 PM (GMT -6)   
Thanks friends.... I'm actually with him right now waiting for the doc to put the markers in for his IGRT. Poor guy has been without food or water since midnight last night. Going to the diner after this.
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
Lymph node - Negative
Sub capsular 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
5 weeks post op... down to 1 pad a day and a couple of drips - still dry at night

ED - Total flat tire.... but there is signs of life!

First PSA scheduled for 10/14/2010


Northern NJ

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7087
   Posted 8/19/2010 10:33 PM (GMT -6)   
Vam,
Hope all went well, or at least was neutral.
The markers are no fun, but then it is over pretty quickly. He will be less than happy for the rest of the day ....
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