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Kark60
Regular Member


Date Joined Jun 2008
Total Posts : 91
   Posted 9/20/2010 12:07 AM (GMT -6)   
At this point, it looks like I am the next one heading for SRT. Most recent PSA last week came back 0.15 (although at a different lab) after several 0.1, after almost two years of 0.0. Anyway... it is what it is!!

I'm curious how quickly SRT typically begins after the initial consultation with the radiation oncologist.

Thanks...
Age 47 when diagnosed (currently 50). Pre-surgery PSA: 13.7 Pre-surgery Gleason: 4+3=7. CT Scan, Bone Scan, PET Scan: Clear. LRP May 28, 2008. Left nerve bundle removed. POST-SURGERY PATH REPORT: Gleason: 4+3=7;10% of prostate with all quadrants involved; EPE at left base and apex; extensive perineurual invasion present. Bladder neck, lymphvasular space, seminal vesicles, 17 examined lymph nodes, and all surgical margins FREE of tumor. T3a. Four-week post-surgical PSA = 0.1; Seven-week post-surgical PSA = .01; October 2008 – April 2010 PSA = 0.0; April 2010 PSA =0.1; May 2010 and August 2010 PSA = 0.1.

Magaboo
Veteran Member


Date Joined Oct 2006
Total Posts : 1211
   Posted 9/20/2010 12:59 AM (GMT -6)   
Hi Kark.
 
Although you are a lot younger than I, our numbers, as you can see by my
signature, are similar (although my gleason was 3+4 rather than 4+3). Many here will tell you  that  that they will wait or have waited with SRT until they had
3 consecutive increases in PSA above .1, but certainly before it reaches .5. I
jumped the gun a bit and had mine when my PSA reached .09. I was told that
hitting the remaining bad cells early gives the best chance of successful
result. Side effects were minimal and thus far the result is encouraging.
With your numbers, you should probably start talking to the best Oncologist
you can find so that you will be ready when you and you doctor are sure that you have in fact a recurrence. Here in Canada it took about 4 weeks between talking to the Onc and actually starting SRT.
All the best to you and good luck in the remainder of your journey.
 
Mag

Born 1936
PSA 7.9, Gleason Score 3+4=7, 2 of 8 positive
open RP Nov 06, T3a, Gleasons 3+4=7, Seminal vesicles and lymph nodes clear
Catheter out 15 Dec 06, Dry since 11 Feb 07
All PSA tests in 2007 (4) <.04
PSA tests in 2008: Mar.=.04; Jun.=.05; Sept.=.08; at SRT Start=0.1, Salvage RT completed (33 days-66Gy) 19 Dec 08
PSA: in Jan 09 =.05, all tests to date (Jul 10) <.04

Post Edited (Magaboo) : 9/20/2010 3:27:33 PM (GMT-6)


pasayten
Regular Member


Date Joined Mar 2007
Total Posts : 448
   Posted 9/20/2010 2:10 AM (GMT -6)   
Kark,
 
Once I had my consultation,  I had the option of immediately saying yes and they would have a "coordinator" (for lack of better word - she was great btw)  call me the next day to get things rolling.   Or I could wait til I made a decision and then call the coordinator.
Actual SRT started about 3 1/2 weeks after I decided to "go"... 
 
Once I decided to go with the procedure, the coordinator did the following...
 
1. Checked everything out with my insurance company
2. Scheduled nearly a full day of tests for the xray/mri bone scan stuff, prostate bed pictures, and blood work.  The time frame was about 2 weeks for an open slot.  She gave me an itemized sheet of activities for the day...   stuff I would be drinking/taking...   whatoffice/what floor to go to for each appt...   very well thought out and easy to follow
 
Oncologist got results of test,  determined treatment plan, talked with me,  refered back to coordinator to set up preliminary schedule of treatments for the srt.
 
The first SRT treatment visit occurred about a week after the above... 
 
The first visit was a dry run...  went thru the whole procedure on the table with the machine and technicians,  but only the initial calibration xrays were taken and then the machine did the normal treatment routine, but with the radiation OFF...   Just to let me get familiar with the technicians, noises and timing of the procedure.   I also got my "permanent" tattoo dots for future alignment.  Also met with treatment scheduler to fine tune the whole next 7 weeks/32 treatments schedule.   Was given a calendar and written followuo to what we also talked about verbally for preparing for each daily treatment...   Potential side effects, what to watch for, and come in with a near full bladder!
 
Then went thru the next 32 days/6 1/2 weeks of treatments...   one day the machine 'broke' and treatment was cancelled and one added to the end of my schedule...   postponing a treatment one day is no big deal.   I also decided to change time of day for a few appts to fit in some other scheduled activities... 
 
They would retake alignment xrays during the treatments once a week and I would also meet with an oncologist (not neccessarily my own) or a lead radiation technologist once a week to go over any questions/issues/side effects...
 
After treatments were done,  I met with oncologist for followup on how I felt and then scheduled a post-SRT  followup appt for side effects/issues/questions in 6 weeks and another post-SRT PSA test and oncologist visit for 3 months later.
 
That is about it in a nutshell...
 
The time actually went by very fast once started and I had minimal side effects during my procedure.  I am also VERY happy with the results...
 
pasayten 
 
3/2007 - Dx 59 y/o - 12 point biopsy - Left 0/6 Right 1/6 Gleason 3+3 T1c
4/2007 - DaVinci RRP performed - Gleason 6 T2c Nx Mx
PSA 7/07 0.01, 6/08 0.02, 12/08 0.03, 10/09 0.13
11/09 Consult BCR and recommendation for SRT
1/2010 IMRT SRT started 32 sessions at 2 gys for 64 gys total.
6/2010 3 mth PSA post SRT = 0.02 :-)
My Extended Signature

Post Edited (pasayten) : 9/20/2010 1:15:27 AM (GMT-6)


BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 9/20/2010 5:36 AM (GMT -6)   
I think that the time period depends on how busy the doctor and radiation facility is and what you need to do in advance. If you are going on HT they will want you to start it several weeks in advance. They also wanted me to take MRI's and CT scans. I also consulted with two radition oncologists and two medical oncologists. I started SRT a little less than 2 months after consult with the doctor doing the treatments. I think that this is about normal, although it could have been done more quickly. Perhaps in one month of consult.
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

English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2218
   Posted 9/20/2010 7:21 AM (GMT -6)   
My signature gives my time line for SRT, but as the signatures are smaller than they used to be I'll give a little bit of extra info.

My surgery was 29th July 2009
And the crucial thing was getting an upgrade to 3+4, plus the seminal vesicle invasion which meant that they were going to want to act quickly and do RT as and when I had a PSA rise.

Thus it was an additional pointer for me to start thinking about RT being a possibility when my very first post-surgery PSA on 17th Novemebr 2009 was 0.1 (not less than 0.1)
My next PSA on 17 March 2010 was way up to 0.4 and the uro had fixed up an appointment for to see RT doc within five minutes of telling me my test results.
So I was talking to the RT doc six days later on the 23 March 2010.
Having agreed that RT was what we would do they said it would start as soon as they had fitted in the CT scan and had a conference to work out where to aim the RT.

Only a couple of CT scanner for the whole hospital (It's a cancer-only specialist hospital and the Netherlands National cancer institute), but they could fit me in to do the CT scan two weeks later on 13th April 2010, when I also got a tour of the department and explanation about what they do and how etc.
They have nine RT machines (and a tenth under construction) but it was 26th April 2010 before there was a free slot for me to start RT.
I had 66Gy (33 sessions) and so was finished on 11 June 2010

The important numbers are thus that it was 28 working days between getting the PSA results and starting RT. Or about 6 Weeks. And I was finished RT 14 week as after getting the PSA result.

The important postscript to this explanation is that I heard last week that my PSA was down to below 0.1

As far as side effects go I was very tired, and am now just occasionally tired. My continence is about 75% of what it was before RT, but that basically means I'm still dry, don;t wear pads, but like to be near a WC. I simply have to get up several times a night instead of twice and during the day time have to pee about every 60 minutes instead of every 90. I also have up to four noisy BMs per day instead of two rather quieter ones.

Still no ED, but it does take longer than it used to to get things "ready"



Alf
Born Jun ‘60
Apr 09 PSA 8.6
DRE neg
Biop 2 of 12 pos
Gleason 3+3
29 Jul 09 DaVinci AVL-NKI Amsterdam
6 Aug 09 Cath out
PostOp Gleason 3+4 Bladder neck & Left SVI -T3b
No perin’l No vasc invasion Clear margins
Dry at night
21 Sep 09 No pads daytime
17 Nov 09 PSA 0.1
17 Mar 10 PSA 0.4 sent to RT
13 Apr 10 CT
28 Apr 10 start RT 66Gy
11 Jun 10 end RT
Tired
BMs weird
14 Sep 10 PSA <0.1
Erections OK

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7085
   Posted 9/20/2010 9:06 AM (GMT -6)   
Kark,
 
Pasayten had a pretty good run-down. Alf & I were doing ours about the same time.
 
My IGRT had some "minimum" times between the first steps.
 
Mine used the Calypso system beacons (some use gold markers, others a mini-ct scan at each session) as guides, and since that is a rectal insertion (same process as a biopsy), there is the need to get things healed up before starting radiation.
 
It went this way:
 
(DaVinci surgery + 20 weeks)
 
Day 1) Uro / Surgeon consult, referral to RT (had met with them as part of my second opinions, so files had already been sent over).
Day 4) Radiation Consult, Appointment made with uro for Calypso beacon insertion.
Day 5) Blood drawn at Uro for tests.
Wait for appointment date (blood work had to come back first).
Day 14) Insertion appointment.
Minimum 15 day "healing" wait expected.
Day 33) Appointment for Planning CT scan.
Planning process - allow at least 1 week.
Day 41) Test walk-through with xrays and simulated radiation session.
Day 42) Next day started the 39 sessions.
 
After sessions were finished, there was a 6-week wait before the followup visit, with PSA test.
Handed back to the uro at that point.
 
The day-by-day is in the thread in my sig.
 
Hope all goes well for you - any questions, let us know.
 

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 9/20/2010 9:54 AM (GMT -6)   
It was about 2 weeks from when I agreed with the radiation onologist to begin SRT, to the first zap.
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.

Galileo
Veteran Member


Date Joined Nov 2008
Total Posts : 697
   Posted 9/20/2010 7:10 PM (GMT -6)   
Like David, it was 2 weeks from radiation oncologist consultation to first SRT for me.
Galileo

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

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 9/20/2010 7:58 PM (GMT -6)   
I had 7 micro-dot tatoos in my prep for radiation. Some men have markers inserted, some have 2-3 tatoos. With both IMRT and IGRT, there is a lot of serious planning and calculating that has to take place. The way it was explained to me by my rad. oncologist, is that they took their bone scans and ct scans, and took my surgeon's notes, and kind of made a simulation of how my prostate bed looked, and where my prostate was formerly located, along with the measurements of the one known positive margin I had in my post surgery pathology. Then the IMRT in my case, was supposedly designed to target that area precisely. I was shown a 3-D modeling of this computer created prostate bed of mine, with an image of my former prostate in place.

There are a variety of ways that they plan for the radiation, they also factor in your body's shape and size, weight and BMI, etc. The trend now days, is to have higher doses in gys of radiation being delivered in a more precise manner, to make SRT more effective than the older tables showing the percentages.

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.
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