Radiation or other options

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Sparky9
Regular Member


Date Joined Aug 2007
Total Posts : 31
   Posted 12/21/2010 11:04 PM (GMT -6)   
Hello all, it's been a while since I've been here. I've been a combination of busy with my business and I guess I just got comfortable that I had totally beaten cancer. That's what brings me back.
 
I had DaVinci 3.5 years ago. PSA was <.01 until 3-1/4 years. It went up to .1. Did another PSA 3 months later (December). It had risen to .13. My urologist is referring me to an oncololgist for radiation. I'm going to see his referral but I also made an appointment for a second opinion with a family friend who is an oncologist/hematologist and used to be at MD Anderson in Houston.
 
I want to nip this in the bud if I can but am a little nervous about jumping into radiation if I don't need to do that yet. I have had very small problems with incontenance (only when I move unexpectedly and even then, I've learned to tighten up and catch it). I'm really concerned with what radiation will do in that regard. But, again, I'll do whatever is best to fight the cancer.
 
Any advice or opinions on this?

Sparky9
Regular Member


Date Joined Aug 2007
Total Posts : 31
   Posted 12/21/2010 11:07 PM (GMT -6)   
By the way, I just edited my signature to show my statistics but it's not showing up for some reason.
I had a post op Gleason of 3 + 4 = 7 T3a, N0, Mx
Prostate cancer diagnosed 6/19/07
DaVinci prostatectomy 8/20/07
Pre Op PSA: 11.63
Pre Op Gleason: 3 + 3 = 7
Post Op Gleason: 3 + 4 = 7
Post Op PSA: 3 years < or = .01
Recent PSA @ 3.25 years - .10 @3.5 years - .13

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3738
   Posted 12/21/2010 11:20 PM (GMT -6)   
Post op, did you have clean margins? Radiation has a better chance of success if you had positive margins...How old are you?
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
" 61: 5.2
" 64: 7.5, DRE "Abnormal"
" 65: 8.5, " normal", biopsy, 12 core, negative...
" 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
" 67 4.5 DRE "normal"
" 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 SRT, HT, Dec

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/22/2010 12:13 AM (GMT -6)   
You and I have similar original stats. I had recurrance in less than a year after surgery, you have made it pretty far out without a problem. Without knowing all your situation, I would reccomend that you consider salvage radiation of some variety while that PSA at .13 doesn't continue to rise.

Please keep us posted.

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

Sparky9
Regular Member


Date Joined Aug 2007
Total Posts : 31
   Posted 12/22/2010 12:44 AM (GMT -6)   
Fairwind said...
Post op, did you have clean margins? Radiation has a better chance of success if you had positive margins...How old are you?
Not sure what the clean margins means?

Sparky9
Regular Member


Date Joined Aug 2007
Total Posts : 31
   Posted 12/22/2010 9:45 AM (GMT -6)   
@ Fairwinds - I'm 56. If clean margins means escape from the capsule, this is my situation. It had escaped the right posterior lobe but had showed no signs of seminal vesicle or lymph node invasion. Both came back negative after post op.
Prostate cancer diagnosed 6/19/07
DaVinci prostatectomy 8/20/07
Pre Op PSA: 11.63
Pre Op Gleason: 3 + 3 = 7
Post Op Gleason: 3 + 4 = 7
Post Op PSA: 3 years < or = .01
Recent PSA @ 3.25 years - .10 @3.5 years - .13
T3a, N0, Mx

Sparky9
Regular Member


Date Joined Aug 2007
Total Posts : 31
   Posted 12/22/2010 10:37 AM (GMT -6)   
From what I can see on my pathology report, I had positive surgical margins:

Final Diagnosis:
Prostatic adenocarcinoma, gleason score 3 + 4 = 7, involving both prostate lobes, with focal extraprostatic extension.

Tumor extends focally to inked margin of resection.

Seminal vesicles free of tumor.

Lymph nodes free of tumor.
Prostate cancer diagnosed 6/19/07
DaVinci prostatectomy 8/20/07
Pre Op PSA: 11.63
Pre Op Gleason: 3 + 3 = 7
Post Op Gleason: 3 + 4 = 7
Post Op PSA: 3 years < or = .01
Recent PSA @ 3.25 years - .10 @3.5 years - .13
T3a, N0, Mx

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/22/2010 10:54 AM (GMT -6)   
Sparky,

Due to you having positive margins, would be more of a reason to undergo salvage radiation. I had one small positive margin, and it was enough to cause the cancer to come back quickly.

David
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

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 12/22/2010 10:58 AM (GMT -6)   
Sparkey, sounds like your cancer is growing very slowing and also is likely to be local. Radiation may well provide you with a cure.
 
I know a person that had a recurrence of cancer that was very slow growing. He took a watchful waiting approach. It took 10 years for PSA to get to 10 when he starting SRT. He got the 10 years without radiation side effects, but now it is possble that his prostate cancer is systematic.
 
It's a dificult decision. good luck. BB
Dx PCa Dec 2008 at 56, PSA 3.4
Biopsy: T1c, Geason 7 (3+4) - 8 cores, 4 positive, 30% of all 4 cores.
Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%, nerves spared, no negitive side effects of surgery.
PSA's < .01, .01, .07, .28, .50. HT 5/10. IMRT 9/10.
PSA's post HT .01, < .01

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6945
   Posted 12/22/2010 11:08 AM (GMT -6)   
Sparky9,
 
I also had EPE (multiple places), but was a Gleason 4+5. My uro and I decided early on to do adjuvant IGRT (i.e. not waiting for PSA rise after my DaVinci surgery).
 
My "journey" through IGRT is linked in my signature below.
 
I still have side-effects at 6 months out from last session, but no definitive reason to regret doing it so far. My opinion at 6 months is probably not worth much, hopefully the folks a few years out will speak up.
DaVinci 10/2009
My IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808

Rolerbe
Regular Member


Date Joined Dec 2008
Total Posts : 235
   Posted 12/22/2010 1:23 PM (GMT -6)   
Fairwind (et al), can you give more info on the relative chances of SRT with/without postive margins? I had all negative margins, but just had my first PSA bump. (yes, its only to 0.02, yes its 'insignificant', yes I said in another thread I wasn't going to worry about it -- yes, I lied about the worry bit).
 
What's the recommended course with negative margins and psa increase? 

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 12/22/2010 2:47 PM (GMT -6)   
Rolerbe, with negitive margins there is a greater chance that your PCa my already be systematic. With positive margins clearly some PCa cells are still local and can be killed with SRT.BB
Dx PCa Dec 2008 at 56, PSA 3.4
Biopsy: T1c, Geason 7 (3+4) - 8 cores, 4 positive, 30% of all 4 cores.
Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%, nerves spared, no negitive side effects of surgery.
PSA's < .01, .01, .07, .28, .50. HT 5/10. IMRT 9/10.
PSA's post HT .01, < .01
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