What's next after robotic?

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mr bill
Veteran Member

Date Joined Sep 2010
Total Posts : 673
   Posted 9/27/2010 8:36 AM (GMT -6)   
Had robotic on 9-8-10.  Gleason 9, PSa 21.00. Invasion to 2 of 9 nodes, invasion seminal vesicles, and vas deferens all of which were excised. Stage was pT3b, pN1,pMX.
My question is: When I meet with Oncologist on 9-29-10 what is he likely to reccommend as follow up?
 I feel certain with all those scores they will want some sort of follow up treatment.  At this point I have not had a post PSa done. 
Calling on the vast knowledge that is available on this website is there anything in particular I should know about each treatment?
 I do have Walsh's book.  However, I feel there is a great deal to be learned from the experience of others who have been there and done that.
I have a tendency to second guess myself, usually after the fact.  Now I am wondering if I should have gone with Proton.
Here is an excellent read detailing the journey of another.  The author is an excellent writer.

Age 66
BPH since 2000. at least three negative biopsies Erie. Uro did not prescribe finasteride
2007 acute urine retention photoselective vaporize Clev. Clinic
8-9-10 Aug PSA rose to 10.14 with finasteride positive biopsy Cleveland gleason 9, cat & bone scan negative
9-8-10 Robotic prostatectomy at Cleveland. B iopsy 9 nodes, 2 positive,seminal & vas deferens positive invasive adenocarc

Regular Member

Date Joined Jun 2010
Total Posts : 38
   Posted 9/27/2010 8:52 AM (GMT -6)   
Hi there. I have the same staging as you. I also had robotic RRP. My surgeon, my medical oncologist and my radiation oncologist all want me to have radiation and hormone therapy now. The rad oncologist even says i should do chemo after that. The only disagreement is when it should start. Since post op PSA is only 0.54, surgeon wants to start HT now and wait for RT until ED and urinary recovery has maximized. The oncologists want to start after 3 or 4 months post-RRP. My surgeon has agreed to call the oncologists next week. Of course I'll go with the oncologists recommendation if there is still disagreement.

It will be important to get your PSA before deciding on the next step. But my oncologists, who recommended surgery in the first place, also recommended followup RT and HT even before the surgery's poor results.
Age 52

At Diagnosis of PCa, had Gleason 9 and normal PSA

Radical Prostatectomy on July 7th, 2010 by Dr. Fagin using daVinci

25% to 50% nerves spared on left, 100% spared on right.

Continent from day one.

Pathology showed postive margins and extension beyond gland, including seminal vesicals and lymph nodes. Stage upgraded to T3b.

Veteran Member

Date Joined Jul 2010
Total Posts : 3596
   Posted 9/27/2010 9:07 AM (GMT -6)   
Walsh's book, pages 377-384 pretty much spells it out...I'm G-9, positive margin, positive vesicle and my docs recommend the same path as Julio..Hit it as hard as you can NOW and hope for the best...
Age 68.
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 age 66 9.0 DRE "normal", 2ed biopsy, negative, BPH, Proscar
PSA at age 67 4.5 DRE "normal"
PSA at age 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RRP performed Sept 3 2010

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4170
   Posted 9/27/2010 9:51 AM (GMT -6)   
Mr Bill,
A gleason 9 with a psa of 21 is an extremely high risk cancer. Since a gleason 9 tumor generates a small amount of psa for it's size there was a very high probability that the pc is growing outside the gland. Many doctors would have refused to do surgery on you. Was surgery done as a debulking procedure? Proton or any other mono therapy would not have been appropriate with your stats.
The next step should have been the first step, go on hormone therapy. Salvage radiation will have a very small chance of curing you and will only cause more side affects. Radiation to the entire lymph system is an option along with HT, and I would talk your oncologist about it. Seminal Vessicle invasion usually means it has spread to the nodes and this was confirmed. The issue is that the nodes that were sampled are a different path than the nodes fed by the seminal vessicles. This and your psa would indicate more extensive lymphnode involvement.
I would read "Beating Prostate Cancer Hormone Therapy and Diet" or Prostate Cancer Basics" by Dr Stephen Strum. Books or recommendation by surgeons will not help you now as you are now in a stage that is above their training and skill level. Get a good medical oncologist that specializes in PC.
Good luck to you and it would have been better for you and other patients to have this type of information before you chose a treatment and not after.

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.


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