Radiation Appointment

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Date Joined Nov 2009
Total Posts : 7187
   Posted 10/6/2010 7:59 PM (GMT -6)   
 I had my medical appointment this afternoon. It lasted over 2 hours (wait, fill out plenty of forms, wait, see the nurse to confirm everything I filled out, wait, see the doctor, who gave me a complete physical and spent plenty of time with me explaining what to expect).

I was impressed with the doctor. He is very sharp. The salient points: He does not think my tailbone pain is PC related (that's a relief). He also thinks my PSA would be 1000 times higher for me to have such clinical manifestations. He did a DRE (I sure thought I was done with that). He felt nothing unusual. Smooth, no nodules. He explained a lot of the procedural details regarding SRT. I should be able to go through the whole process and be able to work the whole time, although side effects vary greatly. The big issue will be fatigue. He can't predict where I will end up on that spectrum. Ditto for bowel problems (some immediate but also commencing even a year after treatment) and urinary problems. Their equipment is extremely up-to-date, comparable if not newer than Umich. Also, now that I am officially his patient, when the time comes I can call him and get an appointment within a week. The first radiation appointment consists of setting up the parameters. The actual treatments start a few days later. It will be 7 1/2 weeks; 68 gys. So, all that is now in place when needed. He also agrees with the Ford protocol regarding when I will need to do radiation. Hopefully, it will not come to that, but I think the odds are not with me. If it does come to that, my odds are decent as I do not have seminal vessicle nor lymph node involvement and I do have a focally positive margin. All of those factors increase my odds of success with SRT. Of course, he was very clever in NOT mentioning any specific odds.
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. 9/21/10--0.06

Ed C. (Old67)
Veteran Member

Date Joined Jan 2009
Total Posts : 2457
   Posted 10/6/2010 8:09 PM (GMT -6)   
At what PSA level will you start SRT?
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

Veteran Member

Date Joined Nov 2009
Total Posts : 7187
   Posted 10/6/2010 8:15 PM (GMT -6)   
Above 0.20 for SURE.
Most likely if my latest result (0.06) doubles, I would do one more PSA a month later and unless that trend is reversed, it would be time to start. That's my current thinking and I would welcome other opinions

Veteran Member

Date Joined Feb 2010
Total Posts : 3771
   Posted 10/6/2010 9:20 PM (GMT -6)   
Mel -- your thinking is exactly like mine. good luck!
age: 55
PSA on 12/09: 6.8
no symptoms, no prostate enlargement
12/12 cores positive....gleason 3+4 = 7
received 3rd and last lupron shot 9/14/10

Forum Moderator

Date Joined Jan 2010
Total Posts : 6858
   Posted 10/6/2010 9:34 PM (GMT -6)   
I started IGRT on principle, not PSA. If you go that route, remember that I've been there. Will be here if you have questions.
My IGRT journey -
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