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pogmothoin
Regular Member


Date Joined May 2010
Total Posts : 84
   Posted 8/27/2010 11:00 PM (GMT -6)   
I'm 5 weeks out from my RRP and had my first follow-up this week. The PSA test came back at 1.59, and a second one that was done to rule out lab error came in at 1.7. It's probably no big surprise that I'm a little freaked out. The doctor's office sent me an email saying they are recommending a Lupron injection and Casodex tablets. From what little I've read so far about hormone therapy, I am not at all thrilled. They also said that after I'm fully continent that they recommend radiation therapy.
 
After surgery the final pathology showed clear margins and lymph nodes, but with seminal vesicle invasion detected.
 
I had such high hopes that the surgery would be the end of it.

daveshan
Regular Member


Date Joined Jan 2010
Total Posts : 363
   Posted 8/27/2010 11:24 PM (GMT -6)   
Darn Pog' don't know what to say except that I'm really sorry to hear this.
Best of luck with the salvage.
Dave in Durango CO

dkob131
Regular Member


Date Joined Apr 2008
Total Posts : 364
   Posted 8/27/2010 11:59 PM (GMT -6)   
Pog:  First take a deep breath and relax as much as possible.  The next thing I would do if I were you is go get Dr. Smuffy Meyers book on Hormonal therapy, you'll understand a lot more about the therapy.  There are some people on this forum who pooh pooh HT but the alternatives aren't very palatable in my opinion. 
 
I've been on HT for one year and although it hasn't been a cake walk it also hasn't been the beast that some make it out to be.  Everybody does react differently to the therapy.
 
You'll probably do a couple of months of HT and then begin SRT, the HT will do a couple of things, it will probably drop your PSA to undetectabl and it will help weaken the cancer so the SRT will have an easier time of killing the cancer.  When you start SRT you'll probably stay on the HT for a total of 2 years and then stop and see where your PSA goes from there. 
 
That's basically what my treatment has been and it seems to be the norm.
 
There are some very promising drugs in the pipeline right now that may help many of us down the road.  A couple are Arbiterone and MDV 3100, they're both in clinical trial right now and the reports are very promising.
 
Good luck
David
 
 

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 8/28/2010 12:30 AM (GMT -6)   
Ditto dkob"s comments. Dr Myers book is a must if you are going into HT. I am in your boat, recurrence of PSA after RP. Although I got a bit of a tease. My PSA was`undetectable for 6 months. For me, once you get past the ED, side effects were more of an annoyance than anything else. take a deep breath and move foreward. SRT with HT has gotten some good reviews.
Dx with PC Dec 2008 at 56, PSA 3.4


Biopsy: T1c, Geason 7 (3+4) - 8 cores taken with 4 positive for PCa, 30% of all 4 cores.

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Jun 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
psa May 10 .50

April 10 MRI and Bone Scan show lesion on lower spine, false positive.

Started HT 5/25/10 with 3 month shot of Trelstar. SRT scheduled for late July

psa July 10 <.01 HT at work

pogmothoin
Regular Member


Date Joined May 2010
Total Posts : 84
   Posted 8/28/2010 12:58 AM (GMT -6)   
Thanks, guys. This has been a heck of a week. I saw the local urologist (the surgery was done out of town) on Monday, saw the nurse practitioner for continence training and the rep for the vaccum pump on Tuesday, then had a trial with trimix on Thursday. I got the PSA results on my way out of the office. I had the repeat PSA done Thursday night and got those results this afternoon. On top of that, this is my first week back at work.

dkob131
Regular Member


Date Joined Apr 2008
Total Posts : 364
   Posted 8/28/2010 7:55 AM (GMT -6)   
Pog:  The other thing you need to do is find a Prostate specialist medical oncologist the urologist is no longer useful to you.  Make sure the Onc. is a Prostate guy.
 
David

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 8/28/2010 8:40 AM (GMT -6)   
Pog:
 
Can you add a signature with your information (G score, etc.)?
 
Mel
PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (PSAf: 24%), PCA3 =75 .
Biopsy 11/30/09. Gleason 4+3. Stage: T1C. Current Age: 64
Surgery: Dr. Menon @Ford Hospital, 1/26/10.
Pathology Report: G 4+3. Nodes: Clear. PNI: yes. SVI: No. EPE: yes. Pos. Margin: Yes-- focal-- 1 spot .5mm. 100% continent by 3/10. ED- in progress. First post-op PSA on 3/10/10-: 0.01. PSA on 6/21/10--0.02. Next PSA late Sept.

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2460
   Posted 8/28/2010 11:38 AM (GMT -6)   
Pog,
Get a color Doppler before you start radiation. You don't want to go through radiation if the horse is out of the barn.
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

pogmothoin
Regular Member


Date Joined May 2010
Total Posts : 84
   Posted 8/28/2010 10:19 PM (GMT -6)   
Forgive my ignorance, but what would they be looking at with the color doppler? I recall hearing about it before, but I thought it was used for imaging the prostate. Since I don't have one anymore......?

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3887
   Posted 8/28/2010 10:46 PM (GMT -6)   
I'm at a loss also to explain the benefit of ultrasound, color doppler or otherwise at this point. However, there ARE some very sensitive imaging techniques that MIGHT be able to spot any leftover tumor and verify whether radiation would be effective...

If you start HT, chances are it will make any remaining cancer invisible to ANY scanning technique, localized or not..

What was your PSA and Gleason before surgery??
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..

ChrisR
Veteran Member


Date Joined Apr 2008
Total Posts : 831
   Posted 8/29/2010 6:44 AM (GMT -6)   
Wait a second. You are only 5 weeks post surgery. You should be waiting 3 months before you determine if your PSA is undetectable. What was your pre surgery PSA? What was your post surgery stats? Did you have a positive margin? Etc. Everyone is jumping to conclusions at this point without enough information.

I also don't understand what "barn" you are talking about ed c. He doesn't have a prostate.

Post Edited (ChrisR) : 8/29/2010 6:09:04 AM (GMT-6)


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 8/29/2010 7:19 AM (GMT -6)   
Chris, I disagree with your post. If Pog's first PSA test came in at say 0.1, no problem...wait for the next test. But his first PSA was almost 1.6 and the second one came in at 1.7 ... that's too high no matter how long after surgery the PSA test is done. His original post indicates that seminal vesicle invasion was noted so this definitely puts him at a higher risk of surgery not doing the job. As to Ed C's comment about the horse being out of the barn, no sense having radiation to the pelvic area (the "barn") if there is evidence that the disease has advanced beyond this area.

Pog, knowing your final Gleason score would be helpful as would your pre-op PSA. Come back and let us know how things are going.

ChrisR
Veteran Member


Date Joined Apr 2008
Total Posts : 831
   Posted 8/29/2010 7:55 AM (GMT -6)   
Well, johns Hopkins says three months to first PSA. I think they have more experience then "anyone" here. Again what "barn" are you talking about. This makes no sense. If his PSA was 7 before surgery 1.7 might be reasonable at 5 weeks. Your PSA doesn't instantly disappear right after surgery.

Sephie where are you getting your data from that says his PSA is too high. Everyone washes PSA out at a different pace. What do you know that I don't that says his PSAis too high?

Post Edited (ChrisR) : 8/29/2010 7:04:15 AM (GMT-6)


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 8/29/2010 8:03 AM (GMT -6)   
ChrisR, I think they are saying that using local radiation on a systemic spread is a case of the horse out of the barn, RE: the old saying "it's too late to close the door once the horse is out of the barn" If the disease spreads or methestisised (SP) beyond the pelvic area, most protocols don't radiate, except for pain control. That's my understanding, at least.
James C. Age 63
Gonna Make Myself A Better Man www.youtube.com/watch?v=a6cX61oNsRQ&feature=channel
4/07: PSA 7.6, Recheck after 4 weeks Cipro-6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS3+3=6
9/07: Nerve Sparing open RRP, 110gms, Path Report- Stg. pT2c, 110 gms., margins clear
3 Years: PSA's .04 each test since surgery, ED continues: Bimix- .3ml PRN, Trimix- .15ml PRN

ChrisR
Veteran Member


Date Joined Apr 2008
Total Posts : 831
   Posted 8/29/2010 8:09 AM (GMT -6)   
I'm not saying he does not have systematic desease. Anyone of us could. What I am saying is 5 weeks is too soon to tell.
Dx 42
Gleason 6 (tertiary score 0)
OPEN RP 10/08  Johns Hopkins
pT2 Organ confined Gleason 6
PSA Undetectable as of 10/15/09
Next PSA 10/15/2010

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 8/29/2010 8:37 AM (GMT -6)   
Chris: Noted. I was speaking to your comment about still not understanding the barn comment... For what it's worth, I think 5 weeks is too early to begin planning further treatment. Study and learn- sure, but I'd wait a full 3 months then a recheck before pulling any trigggers. Just my opinion.

NEIrish
Regular Member


Date Joined Aug 2010
Total Posts : 245
   Posted 8/29/2010 9:22 AM (GMT -6)   
Here's hardcore med. info from Dr. Catalona (Chicago) quoted verbatim: "Management of Postoperative Biochemical Recurrence: Patients with detectable PSA (>0.1ng/mL) after radical prostatectomy usually have persistent cancer, although some have only retained benign prostatic tissue causing the PSA elevation. In the latter case, the serum PSA level increases slowly. Of patients destined to have biochemical recurrence after radical prostatectomy, approximately 50% of recurrences appear within 3 years, 80% within 5 years, and 99% within 10 years. Rarely, recurrences appear more the 15 years after radical prostatectomy.
The PSA velocity or doubling time, the interval from surgery to biochemical recurrence, and the Gleason score usually reflect how rapidly the tumor is likely to progress (Freedland et al, 2005) In many patients, progression occurs reatively slowly, and only about one third actually develop mestatstases (Pound et al, 1999b)"
The article continues, but it shows it isn't necessarily bad news with PSA still readable post-surg so soon. It also mentions how important immediate salvage radiation is for survival ("If salvage radiotherapy is planned, it should be initiated before the PSA level rises much over 0.5 ng/mL")

pogmothoin
Regular Member


Date Joined May 2010
Total Posts : 84
   Posted 8/29/2010 9:24 AM (GMT -6)   
I have had only a small amount of communication with the doctor's office (either the local I'm using for follow-up, or with Dr Catalona's office) since the most recent PSA results. A short email I received Friday from Dr Catalona's nurse said he recommends starting with a Lupron injection right away, along with Casodex tablets. I have to wait until at least Monday to get any additional info. I wish I knew what this all means; whether I have mets or what.

NEIrish
Regular Member


Date Joined Aug 2010
Total Posts : 245
   Posted 8/29/2010 9:32 AM (GMT -6)   
Forgot to list this keypoint summary from the same chapter:"Adjuvant radiotherapy shortly after surgery is most likely to benefit patients with positive surgical margins or extracapsular tumor extension without seminal vesical invasion or lymp node involvement. Patients most likely to have favorable respones to salvage radiotherapy are those with PSA recurrence long after surgery, slwoly rising PSA, low-grade tumor, and no seminal vesible invasion or lymph node metastases."
There's also a section of intermittent hormone therapy as being a reasonable alternative. There's a scarcity of data for hormone therapy's efficacy mentioned in the article.
Frustrating disease with all it's grayness. Wishing you good luck, Pog...

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7080
   Posted 8/29/2010 10:08 AM (GMT -6)   
Pog,
My doctor did my first PSA a +7 weeks only because of a long holiday that would have pushed it to 9 weeks otherwise. He was concerned that at even +7 it might show some residual, but was betting that a good result would settle my anxiety. It did come back <0.1, but that didn't help much after all the stress here to get ultrasensitive tests. Their practice does not do ultrasensitive.

As to Adjuvant RT (i.e. done immediately after surgery) - I did that. Waited longer than they preferred, hoping to get down to 0 pads, but that didn't happen, so we went ahead.

My doctor argued preemptively that my PCa was likely "out of the barn", since I had multiple positive margins (no detected lymph node or seminal vesticle invasion), but not so far that radiation was ruled out. I did not do HT, but was warned that it would be needed if there had been a detectable PSA. The immediate RT is a trade-off. Will it have side effects that will dog me for years, or will it have killed any residual cancer with no side effects?
When I get to the point that I can tell the answer ....
 
added -
(and of course, my best wishes to you - )

Post Edited (142) : 8/29/2010 9:11:07 AM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 8/29/2010 10:22 AM (GMT -6)   
Chris - your anger/frustration/intolerance is showing in your posts above. No need for that. First rule here: you have to learn to agree to disagree. No one is an expert or a trained doctor hear. Your remark to Sephie is uncalled for, you owe her an apology. She is perhaps one of the finest women posters we have here, and you remarks do her a great disservice.

5 weeks is way too soon after surgery, I can't imagine any surgeon/uro wanting at reading at that point. My surgeon insisted on a full 90 day window to make sure all things are calmed back down.

Also, my doctor only uses ultra sensitive post surgery and/or if a patient is post-radiation. It only needs to read to .xx, not .xxx. The trouble with the <.1 readings, it may not show a recurrance trend until it jumps and rounds up over that range.

David in SC
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
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 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

pogmothoin
Regular Member


Date Joined May 2010
Total Posts : 84
   Posted 8/29/2010 10:30 AM (GMT -6)   
I filled out my sig with some basic info, but haven't figured out how to turn it on by default. Hopefully this will show it at least in this post.
Age at diagnosis 5/10: 49
PSA: 5/08 1.6, 5/10 4.7
Initial GS 7 (4+3)
Biopsy: 14 out of 15 positive, up to 95%
Bone scan and CT clear
RRP on 7/20/10 by Dr William Catalona at Northwestern
about 40% nerve-sparing on each side, with bilateral nerve graft performed
Final GS 7 (4+3) with a tertiary amount (less than 5%) showing at 5
PSA 8/23/10 1.59, confirmed 8/26/10 1.7

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 8/29/2010 10:44 AM (GMT -6)   
It's hard to second guess Pog's Doc's. We don't know his PSA pre-surgery or his gleason score. His PSA may have been low and his gleason high. Also, it is troublesome that the second test came back higher than the first. SRT is more efffective with a lower PSA. Who knows what it will be at 90 days.
Dx with PC Dec 2008 at 56, PSA 3.4


Biopsy: T1c, Geason 7 (3+4) - 8 cores taken with 4 positive for PCa, 30% of all 4 cores.

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Jun 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
psa May 10 .50

April 10 MRI and Bone Scan show lesion on lower spine, false positive.

Started HT 5/25/10 with 3 month shot of Trelstar. SRT scheduled for late July

psa July 10 <.01 HT at work

Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 8/29/2010 10:49 AM (GMT -6)   
Chris, didn't intend to come off as an expert - I was simply stating my opinion based on what I know (and I admit that my knowledge is sketchy). I doubt that I know anything more than you do - at least in terms of prostate cancer.

David, thank you.

Pog, apologies for your thread going off track here. As you can see, there is alot of knowledge on this forum and lots of opinions but none of it is intended as medical advice. Since three months appears to be the magic number when determining success of surgery, then you have time for this to happen. NEIrish hit the nail on the head - this can be a very frustrating disease with lots of gray areas. I do wish you well and hope that you will continue to keep us informed.

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 8/29/2010 11:02 AM (GMT -6)   
Pog, didn't see your stats before my previous post.I am not expert either, but with your gleason and postive seminal vesals many doctors would suggeste adjuvant RT. I know that Dr Walsh says it's advisable in his book.
Dx with PC Dec 2008 at 56, PSA 3.4


Biopsy: T1c, Geason 7 (3+4) - 8 cores taken with 4 positive for PCa, 30% of all 4 cores.

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Jun 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
psa May 10 .50

April 10 MRI and Bone Scan show lesion on lower spine, false positive.

Started HT 5/25/10 with 3 month shot of Trelstar. SRT scheduled for late July

psa July 10 <.01 HT at work
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