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compiler
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Date Joined Nov 2009
Total Posts : 7204
   Posted 11/1/2010 4:13 PM (GMT -6)   
OK, I am back from seeing Dr. Hussein today at Umich. It was a well-spent hour.
 
She is very nice, articulate, knowledgeable, and spent sufficient time with us.
 
First, she does recommend immediate radiation. We discussed it at length. Her reasoning does not pertain to my PSA scores; they pertain to my pathology. With my pathology, studies have shown adjuvent appears to work best. But, actually, that was my big discussion with the Ford doctors when I first got my pathology results. They recommended I wait since a large percentage of patients with my stats end up not needing it. Why subject myself to this treatment. Dr. Hussein could also see that viewpoint. She says with their adjuvent philosophy, they know they are overtreating people. She said that, for example, out of every 100 people treated, it might well be that only 30 really needed it. So, again, we have that grey area. While she recommends treatment solely on the basis of my pathology, she feels the PSA rise probably indicates activity, but, as she put it, "what am I to make of numbers below 0.1?" Basically, Umich (like Ford) really prefers the non-sensitive test. With their criteria, I would still be <0.1 (undetectable). In short, my reasons for deciding to wait haven't changed. She really did not push me to have SRT (it would be almost ART in my case).
 
Regarding how do we know if I have a very aggressive PC, we don't know. I probably do not (given a G4+3). It was stated that whoever discovers a definitive test for that might get a Nobel Prize in medicine. That's still one of the unsolved problems with PC.
 
As far as doing any scans: not at this time.
 
AS far as doing HT prior to or along with SRT: they don't recommend that.
 
As far as supplements: most of it is BS put forth by charlatans (this is my interpretation of her comments, which were much more refined!). There is NO specific supplement they recommend. I can get what I need by eating a good heart healthy diet. (Vegan not necessary)
 
Since I am still sticking with my original choice of SRT, I asked what PSA score will trigger it. She was really not definitive about that. In fact, I was amazed: she said their radiation oncologists use 0.30 as the trigger point. She did seem to indicate this was a very grey area without much agreement.
 
Wednesday is my off-campus day. I intend to spend part of it searching for some cruises and maybe even finalizing an itinerary!
 
Mel
 
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

Herophilus
Veteran Member


Date Joined Sep 2009
Total Posts : 662
   Posted 11/1/2010 4:26 PM (GMT -6)   
Mel,
Thanks for sharing of the info....best of luck.
Hero
Age 51 PSA 6.8
Bxy 10 of 12 Cores positive for Gleason 6. up to 75%
Robotic surg 11-02-09
Post op path. 20% neoplasm;4+3=7 Gleason
All nodes (14) and other related tissue negative for cancer
No EPE
Post op PSA x 3, all <0.01

Cajun Jeff
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Date Joined Mar 2009
Total Posts : 4106
   Posted 11/1/2010 4:45 PM (GMT -6)   
Have a great trip and put the PCa stuff in a box and leave it there till you get back. When you get back we will still be here for you.
Enjoy your self.

Cajun Jeff
9/08 PSA 5.4 referred to Urologist
9/08 Biopsy: GS 3+4=7 1 positive core in 12 1% cancer core
10/08 Nerve-Sparing open radicalSurgery Path Report Downgrade 3+3=6 GS Stage pT2c margins clea
r3 month: PSA <0.1
19th month: PSA <0.1
Only issue at this time is ED

Jazzman1
Veteran Member


Date Joined Sep 2010
Total Posts : 1160
   Posted 11/1/2010 4:46 PM (GMT -6)   
Good deal, Mel.

I say a cruise is the best medicine right now. Have a fabulous time.
Age 55

PSA:
8/09 2.69
7/10 4.00
8/10 4.11

Biopsy 8/10
Three of 14 cores positive: 10%, 60% & 80%
Stage T1C
Gleason 6

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7204
   Posted 11/1/2010 4:53 PM (GMT -6)   
Sorry -- you can't get rid of me so fact. Our window is only 10 days in December!!
 
I'll be here awhile.
 
Mel

spottydog10
Regular Member


Date Joined Dec 2009
Total Posts : 345
   Posted 11/1/2010 5:24 PM (GMT -6)   
Mel, your doc seems very knowledgable which I'm sure
will reinforce positivity.
Good luck with the cruise, my sister just came back from
one, Miami, Bahamas, etc and complained the service was too good!
Mike

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2458
   Posted 11/1/2010 5:29 PM (GMT -6)   
Mel,
I like your decision to wait until you see a rise in PSA. That is exactly what I would do if my situation changes. I hope you never have to have RT. Have a great cruise in December.
Age: 67 at Dx on 12/30/08 PSA 3.8
2 cores out of 12 were positive Gleason (4+4)
Davinci surgery 2/9/09 Gleason 4+4 EPE,
Margins clear, nerve bundles removed
Prostate weighed 57 grams 10-20% involved
all PSA tests since (2, 5, 8, 11, 15, 18 months) undetectable
Latest PSA test (21 months) .005

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 11/1/2010 5:43 PM (GMT -6)   
your answers from here were mostly in line with the advice i was given in my local area.

the concensus of opinion here, is to not do HT with SRT. To save the HT, if the SRT doesnt work.

sounds like good and balanced view on the dietary stuff, mirrors what i have been saying here for some time, no diet extremes, just a good healthy heart diet for general well being

the cut off for SRT varies so much, some say .20, some .30, some higher, some lower. The overall opinion I got, was that it is most
effective below .5, and less effective above 1.0.

you must remember, there are many guys with similar pathology to yours, that never have BCR. not telling you what to do by any means, but I would still wait to see some basic evidence of BCR before committing, at least 3 rises if you ever go over .10. trust me, you sure dont want to go through SRT if you really didn't need it.

sounds like you got enough good info to rest your mind for now, and you shouldnt have any problems putting off any other PSA tests till after the holidays, like I have chosen to do.

enjoy a "time off" from PC, enjoy the holidays, your trip, and all the other things you enjoy in life.

just my take, still sounds like you got a lot of good advice today

daviid
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 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

clocknut
Veteran Member


Date Joined Sep 2010
Total Posts : 2667
   Posted 11/1/2010 5:50 PM (GMT -6)   
That all sounds like very good news.  Now relax and enjoy the cruise.

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 11/1/2010 5:54 PM (GMT -6)   
Good post, Mel,
And thank you for sharing your visit with us. What your doctor said is perfectly in line with what I have heard. You need to take it easy for a while and know that you have a lot of ammunition still to fire off. Enjoy that cruise and take care of yourself.

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

Old Sailor
Regular Member


Date Joined Aug 2009
Total Posts : 208
   Posted 11/1/2010 6:31 PM (GMT -6)   
Mel, the Old Sailor thinks you might be putting the carriage ahead of the horse.  My Rad Onc at Mayo (Dr. Buskirk) believes wait until psa reaches .2 before RT (which I did).  He also indicated that High Gleason (8-10) chances only fair for cure with SRT but your 7 doesn't sound too bad. If I remember, you had a positive margin which from what I have read, gives you a better chance for cure with SRT then those of us with negative margins.  Whatever decision you make, I wish you success and a long life.

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 11/1/2010 7:54 PM (GMT -6)   
Mel,

As you stated, no surprises. I think I predicted adjuvant therapy. I think she cosponsored a trial or something. She really is s neat lady. If you google her name, she looks like a who's who in oncology and medicine.

Hopefully she put you at ease a little, or at least until next time.

Bettar also start dieting. Cruises are good for 7 or 8 pounds.

Glad to hear it went well.
Goodlife
 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01
1 year psa (364 days) .01
15 month PSA <.01

daveshan
Regular Member


Date Joined Jan 2010
Total Posts : 363
   Posted 11/1/2010 10:23 PM (GMT -6)   
Mel,
Sounds like you've got a Dr with a good plan.

I'm with the rest of the guys, take a break and enjoy the holidays.
Best to you
Dave in Durango CO

bsjoplin
Regular Member


Date Joined Feb 2010
Total Posts : 308
   Posted 11/2/2010 6:53 AM (GMT -6)   
good plan: check your prostate stuff at the door and step out for a little...then you can come back and hit it again refreshed....take care
bob
Age@dx: 55
5/05 PSA: 1.8 ;12/07 PSA: 3.7 ;7/08 PSA:4.7
8/08 Biopsy1: 3 of 6 irreg
11/08 PSA: 6.5; 12/08 Biopsy 2: of 12, 3 cancer, other 9 irreg; Gl:3+3=6.
1/22/09 RRP; 1/25/09 Released; 1/28/09 Pathology: Cancer on 10% of gland, lymph & SV were benign, Gl re-typed 3+4=7, stage T2c
2/13/09 PSA:0.1
3/9/09 back to work
6/09 PSA:0.1; 10/09 PSA:0.1; 2/10 PSA:0.3 ; 4/10 PSA:0.4 Referred to RO
5/4/10 First RT.;6/25/10 Final RT. ended up 36 treatments, 64.8 Gy.
8/10 PSA:0.2

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 11/2/2010 7:05 AM (GMT -6)   
Sounds almost like PCa is like politics and playing both sides at times, it seems.  Take a break Mel and enjoy some time away from this Twilight Zone of PCa, in your case maybe you better not seek more opinions (ha), why add more questions to this mix?  It is almost like now you know what you have come to have found out, so who makes the ultimate decisions, you or somebody else?  Whom lives with the decisions, or walks the walk...that is self evident question.  It gets crazier when you get into various drug therapies, but maybe I am guessing (ha).

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 11/2/2010 7:06 AM (GMT -6)   
actually mel, it couldnt be ART in your case, as its been more than 6 months since your surgery, it would have to be SRT
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 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

Jerry1
Regular Member


Date Joined Mar 2007
Total Posts : 460
   Posted 11/2/2010 7:32 AM (GMT -6)   
 
Sounds like some really good advice.  Your PSA is still very low so you have the right idea go and have fun and try to forget about PC for a while.
 
Jerry1

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7204
   Posted 11/2/2010 12:29 PM (GMT -6)   
David:
 
Yes, she did mention that. But her point was that the decision/reasoning for ART remains the same in terms of her advice. It is technically SRT. She said it would effectively be ART if I did it now. Their definition of ART is actually <= 4 months post surgery.
 
It's a tough call, but I'm sticking with my decision. I dealt with all of that in my discussions with the Ford team. The only difference now is that the PSA is creeping up. To use someone else's phraseology, I'm going to watch it (the PSA) like a hawk and jump in quickly when we determine I have a BCR. I suspect there might be some tough decisions ahead (eg: suppose the next PSA is 0.11).
 
That is a concern for early January. It's a 2011 concern. Yeah, Happy friggin' New Year, right?
 
Mel

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 11/2/2010 2:19 PM (GMT -6)   
Mel,
 
There you go, thinking about next time all ready.  Stop it.
 
Actually, .11 would be an easy one, or at least an easy call to action.  The hard one will be if you have a .07 or .08.
 
So which cruise brochures do you have ?
 
Goodlife

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7204
   Posted 11/2/2010 5:21 PM (GMT -6)   
Goodlife:
 
PC definitely stays with you -- a cloud that's always there. But, actually, I'm not thinking that much about it. I am back to enjoying life.
 
We have looked online (Vacationstogo, an excellent cruise site) and tomorrow we will drop by AAA. We may decide to do something other than a cruise. Due to other commitments, we only have like a 9-day time slot in December. We will definitely go somewhere warm.
 
Right now, Norwegian Lines/Carribean looks best.
 
We have never been on a cruise. Now would be a good time.
 
Mel

mr bill
Veteran Member


Date Joined Sep 2010
Total Posts : 688
   Posted 11/2/2010 5:28 PM (GMT -6)   
Mel,
Thanks very much for the update. I guess I am facing some of the same decisions. Is there any particular reason no HT with RT? I may have to make that decision in the near future.

Enjoy your cruise. It sounds as if you are really looking forward to it. I understand the food/entertainment is beyond fantastic!

Bill
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. Biopsy 9 nodes, 2 positive,seminal & vas deferens
PSA 3 week .06

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7204
   Posted 11/2/2010 5:41 PM (GMT -6)   
Bill:
 
I don't remember if she gave me a reason.
 
She seems to rely a lot on research.
 
Maybe it's just not definitive enough, given the SE of HT?
 
I don't know.
 
Mel

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 11/2/2010 7:50 PM (GMT -6)   
Mel,

We think Royal Carribean puts on a heck of a cruise as well. We really enjoyed it. Was able to take all of my 5 kids. Had our own table. It was fabulous.

Goodlife
Goodlife
 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01
1 year psa (364 days) .01
15 month PSA <.01

mr bill
Veteran Member


Date Joined Sep 2010
Total Posts : 688
   Posted 11/4/2010 6:03 PM (GMT -6)   
Mel,
By any chance have you heard anything more about the Varian Trilogy system?
 
Mr. Bill

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7204
   Posted 11/4/2010 9:37 PM (GMT -6)   
Mr. Bill:
 
I have not looked any further into the Varian Trilogy RapidArc system. I was impressed with the presentation at our local support group.
 
If I need SRT, I will go that route.
 
Mel
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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