Met with Rad Oncologist Re SRT

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Regular Member

Date Joined Jan 2010
Total Posts : 91
   Posted 10/23/2010 8:33 AM (GMT -6)   
I met with a Rad Onc at Yale (New Haven, CT) on Oct. 15 just to get a dialogue started in case treatment becomes necessary. In short, our discussion led to the conclusion that for a patient with my stats (see signature below) the efficacy of SRT would be a "crapshoot". Seems to be due to the fact that I had negative surgical margins. As for side effects, he mentioned that the only one that is just about 100% unavoidable is ED. He told me that if the surgery didn't get you, the SRT surely will. In his experience, it is extremely rare for patients to escape unscathed in this department. He also mentioned that he always uses ADT in conjunction with SRT.

Bottom line is I'm no further along in my decision whether to start SRT or not. Still monitoring for now. Will go back to my Uro with another PSA test in early to mid-December.

Best wishes for good health to all,

Dx: in 6/2005 age 49, PSA 4.1, 2/10 cores pos, G6, T1c
bone scan: negative
daVinci RRP 8/2005, Hartford Hospital, Dr. Wagner
Post-surgery upgraded G7 (3+4), pT2c, NX,MX, neg. margins, perineural invasion present, tumor invades capsule wall, but not entirely through it.
PSA <0.1 until 4th yr post surgery, then 7/09 0.1, 10/09 0.2, 1/10 0.2, 2/10 0.14, 4/10 0.16,
8/10 0.25, 9/10 0.23

Veteran Member

Date Joined Dec 2008
Total Posts : 3149
   Posted 10/23/2010 11:18 AM (GMT -6)   
You have the choices of going straight to hormone therapies if you want and the SRT for any failed patient is a gamble no matter if you had clean margins and all those pluses one would love hearing, we have failed patients herein with so called fully contained scenarios (posted in their histories or posts). So it is a choice and decision, the docs cannot know with certainty if anyones PCa is 100% boils down to best guess assessment or gamble or agenda. Never easy choices for patients to consider on the plus side SRT done by a master should not be all that nasty for side effects and top with marginal people at the helm who knows? I would never tell a patient what you personally should decide, even though I did pretty darn well using radiation. Good luck in whatever you decide to do. As for the ADT in SRT that has controversies still even though like the Bolla studies show survival improvement (that is not the same as SRT and flat out cure which would be masked for years by adding the ADT, makes me wonder as usual and this was not done that way in the past).
Dx-2002 total urinary blockage, bPsa 46.6 12/12 biopsies all loaded 75-95% vol.; Gleasons scores 7,8,9's (2-sets), gland size 35, ct and bone scans look clear- ADT3 5 months prior to radiations neutron/photon 2-machines, cont'd. ADT3, quit after 2 yrs. switched to DES 1-mg, off 1+ yr., controlled well, resumed, used intermittently, resumed useage

Regular Member

Date Joined Jan 2010
Total Posts : 91
   Posted 10/23/2010 6:24 PM (GMT -6)   
Thank you for your insight. Your viewpoints and knowledge of the research are invaluable to so many of us. From what I've read, it seems that when BCR happens 2 or more years after surgery and PSADT is greater than 10 months, chances are good that the recurrence is local as opposed to distant. So, one could logically conclude that I have local recurrence. However, as you've stated, nothing is guaranteed with this disease.

Veteran Member

Date Joined Jul 2010
Total Posts : 3887
   Posted 10/23/2010 11:46 PM (GMT -6)   
My third biopsy found Gleason 9 in 20% of one core..Post surgery pathology found plenty of G-9, positive margin, seminal vesicle involved, lymph nodes clean...Six weeks later, PSA 0.9 not exactly in the zero club...They are foaming at the mouth to start HT and SRT as soon as I recover from the staph infection I picked up during the surgery..I have an appointment to see a new radiation oncologist (the head of radiation oncology at one of Denver's better hospitals) who has access to the latest Varian Trilogy Rapid Arc machine. Is my cancer still contained in the prostate bed?? Who knows..But since I'm running out of chances, I figured this one better be the best shot I can come up with..
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
age 61: 5.2
age 64: 7.5, DRE "Abnormal"
age 65: 8.5, " normal", biopsy, 12 core, negative...
age 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
age 67 4.5 DRE "normal"
age 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RRP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9

Regular Member

Date Joined Apr 2008
Total Posts : 364
   Posted 10/24/2010 8:21 AM (GMT -6)   
I'm a Gleason 8 with no positive margins but I also received a lupron injection before my surgery because I was considering RT as my primary therapy and then decided on surgery.  I remember my surgeon specifically saying to me that the prostate was very sticky because of the lupron and was hard to remove.  I mention this because I'm banking on that being my reoccurence reason.  A small piece left in the prostate bed area hopefully. 
I also had what is known as"full pelvic" SRT, they target the seminal vessels along with the prostate bed.  As you can probably tell I'm in the "lets throw the kitchen sink at it" group.  I just don't believe you want to sit around and let any cancer grow if there are any options.  I'm also 18 months into 24 months of lupron before, during, and after SRT.  I'm going to kill the cancer plain and simple.
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