Salvage Radiation

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*Optimist*
Regular Member


Date Joined Jun 2009
Total Posts : 35
   Posted 11/8/2010 8:56 AM (GMT -6)   
As I have posted earlier I had my RP on Nov. 3rd and am now at home recovering. Biggest issue so far was constipation but thanks to the good advise at this forum this has been resolved.
 
So now I am taking it easy till I get the catheter out and the staples removed on Nov. 16th. At that same visit I will get the pathology results on the prostate. I am hopeful for good news but I have been wondering if it is not so good what the protocal is for salvage radiation. If it is recommended, how soon after surgery do you begin? I assume you must recover from the surgery before starting.
Jan/09: PSA 3.48 / Free PSA 10%
Feb/09 - Biopsy - cancer diagnosed - age 55
PSA at time of Biopsy - 3.48
DRE: Nornal
Trus volume: 34cc
3 out of 10 cores positive

Gleeson 3+3
On active surveillance for 18 months then had first follow up biopsy
Sept 1/10 - biopsy - 3 cores positive 2 @ G6 (20% & 50%) & 1 @ G7 (70%)
Surgery booked for Nov 3/10

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 11/8/2010 9:51 AM (GMT -6)   
Glad you are slowly improving. You will feel better once the staples and cath are removed. And hopefully you will have some peace of mind with a good pathology report.

There's a lot of answers to your question, like all things PC, no one straight way of doing anything. There was a time, when if you had bad pathology after surgery, they would want to rush adjunct radiation as soon as practical to "stop" any remaining cancer cells. There has been some change in thinking with many doctors.

First, a less than perfect pathology report doesnt mean that you will have recurrance immediatley, or even at all. Then, the thinking is for the patient to become as continent as they can before radiation, as radiation treatments tend (not always) to stunt any further improvement to any lingering incontinence issues.

We have men with terrible pathology, that still don't have evidene of reccurance or BCR, and men with good pathology, that had almost instant BCR. So, it varies much, both with the stats and condition of the patient, as well as the philosophy of the patient's medical team.

I am of the school, where I think (IMO) that there needs to be confirmed proof of BCR before any type of secondary treatment after surgery. By some standards (and this varies too) at least 3 rises in PSA above .10, with each test 90 days apart.

There's even a lot of variance in when to start radiation even if you have BCR. The doctors I spoke with, say its most effective if started below .50 and not effective at all above 1.0. Other doctors draw a line at .20. I started Salvage Radiation at .16, but I had BCR within 9 months of surgery, and had extreme PSA velocity issues even before surgery. BTW, my pathology report actually looked good in theory.

Hope some of this helps. If you ended up with a less than stellar pathology report, make sure you discuss this all with your doctor, and make sure you understand everything on the report, and of course, make sure you have a copy for your records

david in sc
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

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7087
   Posted 11/8/2010 9:54 AM (GMT -6)   
On the basis of what I was told by the Uro, surgeon, and rad. oncologist, RT (as adjuvant, not waiting for a psa rise) would start no earlier than 18 weeks out from DaVinci. There are two reasons - healing from the surgery, and impact on incontinence progress.
 
All of that has to do with the effect radiation has on tissue that is already in some state of trauma.
 
I waited at the doctor's suggestion, hoping that my incontinence would improve before starting. We intended to start at 21 weeks out, but with scheduling issues, it actually started at 26 weeks out (prep & markers were done several weeks before).
 
The reason for mine was a really brutal post-op pathology, with a G 4+5.
My IGRT journey -
www.healingwell.com/community/default.aspx?f=35&m=1756808

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 11/8/2010 2:24 PM (GMT -6)   
*Optimist* said...
...I am hopeful for good news but I have been wondering if it is not so good what the protocal is for salvage radiation....
 
 
Relax, you have every reason to remain highly optimistic and anticipate good results...sit tight.
 
I don't believe you'll need to explore this further, but for the sake of answering your question and for other possible readers in the future, about a month ago there was a 3-page thread started by James C ("Possibly my turn in the barrel") which has some good discussion/considerations.  In that thread, I wrote this:
 
Separate (the verb, not the adjective) ultrasensitive PSA testing for patient monitoring from management decision making…they are not the same.  The very early possible trending that James might be seeing [possible PSA rising], for example, is not enough—from the work of the esteemed doctors referenced in the Choo report—to trigger SRT management actions.  There is no established “standard of care” for when to start SRT; but, when these reports speak of the benefits of acting early on SRT, they are talking about at the 0.5 to 1.0 ng/mL levels.  Not starting early generally means after PSA is above 2.0 ng/mL.  [Bold added here for emphasis.]  Furthermore, the report does also speak about SRT overtreatment which would occur with patients monitored by ultrasensitive PSA tests when the trigger for SRT is pulled too early; some increases at the very low levels of utrasensitive measurement capability are just natural variation (measurement variation plus biological variation) and will not result in BCR.
 
 No established "standard of care" for starting SRT, or ART...specific protocols will vary doctor-to-doctor, but this gives some idea on the ballpark which is in the minds of most docs...
 

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 11/8/2010 2:43 PM (GMT -6)   
www.healingwell.com/community/default.aspx?f=35&m=1889361

Here's the link to the thread.
James C. Age 63
Gonna Make Myself A Better Man tinyurl.com/28e8qcg
4/07: PSA 7.6, 7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS6
9/07: Nerve Sparing open RRP, Path: pT2c, 110 gms., all clear except:
Probable microscopic involvement of the left apical margin -GS6
3 Years: PSA's .04 each test until 04/10-.06, 09/10-.09- Uh-Oh
ED continues: Bimix .30cc & Trimix .15cc PRN

daveshan
Regular Member


Date Joined Jan 2010
Total Posts : 363
   Posted 11/8/2010 3:26 PM (GMT -6)   
Optimist,
With a G-6 and a good pathology you may never have to worry about it, this is my sincere hope for you.

In my case (stats in sig') since I had an initial un-dectable PSA my Dr wanted to wait 'till healing was complete before even thinking about Adjuvant/Salvage. At 8 months out I'm in good shape as far as ED and continence goes so she said Adjuvant "might give me a better chance of a long term cure", a meeting with a rad' oncologist said pretty much the same thing. With a <0.04 PSA as of 10-27 and a healthy fear of side effects I am leaning toward waiting and doing salvage if it becomes necessary.

Treatment after surgery seems to be a total roll of the dice, no one says the same thing, studies are all over the map and nothing is guaranteed. Just my layman's opinion but I'd urge you to do lots of research before jumping into anything unless you have an immediate PSA rise in which case hit it hard.
Best of luck to you
Dave in Durango CO
Diagnosed 12-09 age 55
07-06 PSA 2.5
01-08 PSA 5.5 (PCP did not tell me of increase or schedule follow-up!!!!)
09-09 PSA 6.5 Sent for consult with Urologist
11-09 Consult, scheduled for biopsy, found out about PSA from '08 (yes I was pissed)
12-09 Biopsy, initial Gleason 9 (4+5) later reduced to 8 with tertiary 5, ain't much but I'll take it.
01-10 Bone Scan, "appears negative"
03-01-10 RRP in Durango CO by Dr Sejal Quale and Dr Shandra Wilson, no naked eye evidence of spread, Vesicles and lymph nodes taken for microscopic exam.

03-16-10 Removal of cath' and pathology results of samples.
Multifocal carcinoma with areas of Gleason pattern 3, 4 and 5, Overall Gleason grade 4+4 with tertiary 5, Bilateral involving 21% of left lobe, 3% of right lobe, Invasion of left Seminal vesicle, Tumor focally present at left resection margin, 9 lymph nodes removed all negative, Tumor staging pT3b NO MX

04-23-10 PSA <0.04....... 06-07-10 PSA <0.04..... 08-03-10 <0.04
05-03-10 1 week without pads
06-28-10 ;-)

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2461
   Posted 11/8/2010 7:17 PM (GMT -6)   
Optimist,
You should change your "optimist" name if you are worrying about SRT with a Gleason 6 and without a pathology report yet. Enjoy your recovery and hope for the best. Good luck.
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 : 25393
   Posted 11/8/2010 8:47 PM (GMT -6)   
Dave in CO, considering your post surgery pathology, for being 8 months out and still pulling decent zeros, I agree with your decision to hold off on radiation until there is hard evidence that its going up. The longer you can put it off safely, and continue to heal, I feel the better you will do, if you have to go that route. Just my opinion.

David in SC
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

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3893
   Posted 11/8/2010 9:17 PM (GMT -6)   
Optimist, you should be able to get a copy of your pathology now if you ask for it...

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 11/9/2010 9:20 AM (GMT -6)   
James, thanks for adding the URL to the thread (your thread) yesterday.  I have a forum application question...
 
I had highlighted the thread's title, and used the "Insert E-Mail or URL Hyperlink" feature (from the first row above of buttons above the Post Reply's open text box) thinking that this would allow the link to work for others.  Doesn't this step activate the link in the text for other readers?  (It works fine for me.)  If not, is there something I can I do differently to create a hyperlink from selected text?
 
thanks in advance
Casey
 
PS -- If I see a response to this inquiry here from you, James (or Tony), I'll go back later and delete this post so as to not detract from Optimist's original posting; you could post a response here and delete it later when you see mine gone...tks

bsjoplin
Regular Member


Date Joined Feb 2010
Total Posts : 308
   Posted 11/9/2010 9:26 AM (GMT -6)   
optimist, i'm hopin you never have to go that route....took me a year and a half to need the zaps, but before that, my doc was pretty clear that he didn't recommend putting your body through radiation or hormone treatments, unless there was a good reason for it (for me, it was PSA at 0.4)
take it easy, learn what you can, and enjoy the ride !
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

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 11/9/2010 11:04 AM (GMT -6)   
Casey59, I have never been able to get that function to work, either. I either click the URL box just above this area, type or copy/paste the link then click the URL box again to manually create a link. i also will go back, if I forget, and type in the coding, that coding is this: square bracket( right of the P key), then URL and square bracket, no spaces, then the link, then square bracket, backwards slash (under the question) and another square bracket. There, now you are writing HTML code, and am now a master of one more skill. tongue

You can leave your question here, it may help others in the future who wonder how to make clickable links. I don't think Optimist will mind.. wink
James C. Age 63
Gonna Make Myself A Better Man tinyurl.com/28e8qcg
4/07: PSA 7.6, 7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS6
9/07: Nerve Sparing open RRP, Path: pT2c, 110 gms., all clear except:
Probable microscopic involvement of the left apical margin -GS6
3 Years: PSA's .04 each test until 04/10-.06, 09/10-.09- Uh-Oh
ED continues: Bimix .30cc & Trimix .15cc PRN

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 11/9/2010 12:46 PM (GMT -6)   
tks...how many of these links are "hot"?  In other words, if you click on any of these, do they take you right to the page?
 
 
(2) -- coded
[URL]http://www.healingwell.com/community/default.aspx?f=35&m=1889361[/]
 
(3) -- using the app's tool
 
 
...both (1) and (3) work on my end

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7087
   Posted 11/9/2010 1:11 PM (GMT -6)   
Casey,
1) and 3) link out correctly for me. 2) does not show as a valid link

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 11/9/2010 1:21 PM (GMT -6)   
#2 would work fine if the code at the end was /url inside the brackets instead of just the "/"...i.e.:
www.healingwell.com/community/default.aspx?f=35&m=1889361

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

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 11/9/2010 2:11 PM (GMT -6)   
Optimist...sorry

Tony & James...thanks, haven't quite mastered it yet, but will try again, here:

www.healingwell.com/community/default.aspx?f=35&m=1889361


Although, 142's note (thanks, by the way) confirmed that both (1) and (3) worked for him...(3) was the same thing I did above in my original posting.
 
 
 
edit later:  Looks like it works now.  Thanks!  New skill mastered (sort of).

Post Edited (Casey59) : 11/9/2010 12:17:13 PM (GMT-7)


142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7087
   Posted 11/9/2010 3:50 PM (GMT -6)   
Casey,
 
May just be coincidental, but I have better luck with links when I use the Post Reply button instead of the Quick Reply box at the bottom of the thread.
Also seems to help if I put them on their own line, broken from any other text.
 
I have not had any luck with links in the Quick Reply window.
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