Barn door open?--questions for the oncologist

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Date Joined Nov 2009
Total Posts : 7270
   Posted 10/24/2010 2:42 PM (GMT -6)   
As you might recall from my posts, I have PC with a relatively poor pathology (G 4+3, PNI, very small focal positive margin of <0.5mm, and ecp. SMI and LNI are negative). I had the surgery and after some discussion I am following the Ford doctors' recommendations/protocol which is to monitor post-op PSA and go to SRT if needed (the alternative was to do adjunct radiation). My last pre-surgery PSA was 4.19.
OK, my PSA is creeping up, unfortunately. It has gone in 3-month intervals from .01 to 0.02 to 0.06. My next PSA is scheduled for 12/21 but I will probably delay it until just before my next Ford appointment, set for 1/7/11. (No use ruining the holiday season).
But, I have also scheduled a 11/1 appointment with Dr. Hussein, supposedly a very good medical oncologist specializing in PC, at Umich.
Basically, I want to hook up with a good medical oncologist if things go south. So, my question to this group is: what questions should I be asking Dr. Hussein? So far, I want to ask:
1) How do I know if the barn door is open? In other words, is there any way to determine if the PC has gone systemic, which would eliminate the need for SRT?
2) Does it make any sense to do any kind of scans? If the probability of anything showing up is say 4%, does it make sense to subject myself to those tests?
3) Does it make sense to get on HT before SRT? If so, right now? Or under what conditions?
4) I am assuming that SRT is the next step if my PSA rises. If so, what PSA level would trigger that next step?
5) Supplemett/diet recommendations. I read a lot of contradictory reports (except for D-3). Opinions?

OK, your input. Other questions?
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

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Date Joined Jul 2010
Total Posts : 3893
   Posted 10/24/2010 3:09 PM (GMT -6)   
Well Mel, I think that's the big question nobody can answer..Many of us are in that exact same boat, including myself...The docs seem to depend on using the same tables and numbers we all use to predict (guess) whether or not the horse is out of the barn..

SRT IS successful in enough cases so everyone agrees its worth doing...A 30 or 40% chance of a cure is better than NO CHANCE, even if it means 60% of the subjects ultimately gain no benefit but must endure the side effects...

Also, standard practice seems to be not to acknowledge advanced disease until bone mets are positively detected. Only then will they admit defeat..While they acknowledge the possibility of undetectable "micro-mets" floating around, they seem to feel the combination of radiation and hormone therapy can actually eliminate these pesky PSA producers, suppress them for years and thereby extend the life of patients by a worthwhile amount...

My cynical / pessimistic side must also admit this plan of treatment will extract the maximum number of dollars possible from PC victims...But two docs that I REALLY trust have told me "Bob, you really need to stop thinking that way, money and profit is NOT how we plan your treatment..."
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

John T
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Date Joined Nov 2008
Total Posts : 4269
   Posted 10/24/2010 5:08 PM (GMT -6)   
The only test I'm aware of that may indicate systemic disease are PAP and blood test that may pick up circulating cancer cells. There is no scan other than the Combidex that can pick up small amounts of PC.
All of your other questions will be subject to many different viewpoints depending on who is answereing them. There are some supplements that may help and they sure won''t hurt you, Vit D and Pomegranite extract. Possibily finisturide can delay a reoccurrance.
The Slone Kettering nomograms on salvage radiation can give you some probabilities based on your pre and post op numbers.
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

Veteran Member

Date Joined Nov 2009
Total Posts : 7270
   Posted 10/24/2010 6:19 PM (GMT -6)   
I was reading about that blood test. But there seems to be some debate. Suppose they find circulating tumor cells. There is still a question regarding whether this means the PC is beyond the curable stage (one would think that it is now systemic, but that is still under debate I believe)
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