Radiation before PSA rises

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mr bill
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   Posted 1/10/2011 4:56 PM (GMT -6)   
At last check on 12/1/2010 PSA was 0.00. However, surg. onc. said radiation might be a good idea. I think given my PSA, Gleason, path report, etc.  Radiation onc. says he could go either way. Wait for an uptick, or do it now.  Both say they have no studies, facts, etc. to go on, only going on gut feeling.
 Several folks on forum say wait for a reason. Others say do it now.  I have an appointment for simulation on 1/12/2011.   Any opinions out there? 
Not totally sure what I am in for regarding side effects.  Better read Walsh a little more. 

daveshan
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Date Joined Jan 2010
Total Posts : 363
   Posted 1/10/2011 5:08 PM (GMT -6)   
Bill,
I don't remember your statistics. What was your Gleason, path report etc?

I had the same advice based on a pt3b N0 MX path, I was/am afraid of the possibility of radiation side effects (had GREAT recovery from surgery) and am crossing my fingers and waiting.

Post up your stats it will probably help folks know where you're coming from.
Dave in Durango CO

EDIT: Just checked your profile and found a post with a sig', With T3b and positive lymph nodes (2 of 9 it looks like) I'd be on the table so fast my head would spin.
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 ;-)

BB_Fan
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Date Joined Jan 2010
Total Posts : 1011
   Posted 1/10/2011 5:19 PM (GMT -6)   
Agree Dave. If you have positive nodes, I would hit them with radiation. I wouldn't wait. PCa may have gotten loose already, but if not you can knockout what is still local. Are you currently on HT. I am surprised your PSA is undetectable.
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

mr bill
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   Posted 1/10/2011 5:47 PM (GMT -6)   
Sorry I forgot my signature. I couldn't beleive post surgery PSA either.  I always thought once it was in the nodes that PSA would not go to 0.00.  Here is signature. 
Age 66
BPH since 1996. at least three negative biopsies Erie. Uro did not prescribe finasteride
2007 acute urine retention photovaporize Clev. Clinic prscb finasteride
8-9-10 PSA rose to 10.14 with finasteride positive biopsy Cleveland gleason 9, cat & bone scan negative
9-8-10 RP at Cleveland. Biopsy 9 nodes 2 positive, 2 positive,seminal & vas deferens
PSA 3 wk .06, 6 wk <.03, 12wk 0.0

daveshan
Regular Member


Date Joined Jan 2010
Total Posts : 363
   Posted 1/10/2011 6:00 PM (GMT -6)   
The Dr may have gotten the only 2 nodes that were "infected", I probably (hard to say unless faced with it) would not be up for gambling that this was the case.

Just as an aside in case you haven't seen me post our (Dr, wife and my) decision. The Dr suggested radiation as soon as I was drip free and "functional" I was up for it at first then with a few <0.04s under my belt and more research into side effects decided that the risk of side effects was higher than the gain of Adjuvant vs. Salvage so we all talked and decided to hit it as soon/if it stuck its nose into detectable territory. I pretty much had veto power and my wife wasn't exactly happy about it but understood once I explained the possible downsides other than impotence. My next (~11 month) test is next week so I may be singing a different tune then.

Best of luck whichever direction you choose to go.
Dave in Durango CO

Jerry L.
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Date Joined Feb 2010
Total Posts : 3072
   Posted 1/10/2011 6:30 PM (GMT -6)   
Mr. Bill,

I vote for radiation now. I would also consider HT.

Jerry L.
Nov. 2009 Dx at Age 44
Dec. 2009 DaVinci Robotic Surgery
Jan. 2010 T3b, Gleason 9
Feb. 2010 Adjuvant Radiation

PSA History:
-----------------
Nov. 2009 4.30
Feb. 2010 <.05
May 2010 <.05
Aug. 2010 <.05
Nov. 2010 <.05

livinadream
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Date Joined Apr 2008
Total Posts : 1382
   Posted 1/10/2011 7:06 PM (GMT -6)   
with the positive nodes and gleason 9 I too think it would be wise to go with radiation. The side effects are not that bad and it just might nuke the enemy forever.

peace to you
Dale
I was 45 at diagnosis with PSA of 16.3
http://www.caringbridge.org/visit/dalechildress

My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's. Scheduled to have a radical on July 11th, 2007, surgery was aborted when it was discovered it had spread to the lymph nodes.
I was on Lupron, Casodex, and Avodart for two years with my last shot March 2009.
My Oncology hospital is The Cancer Treatment Center of America in Zion IL
PSA July of 2007 was 16.4
PSA May of 2008 was.11
PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
PSA July 28th 2009 is .01
PSA OCt 15th 2009 is .11
PSA Jan 15th 2010 is .13
PSA April 16th of 2010 is .16
PSA July 22nd of 2010 is .71
PSA Sept of 2010 is .71
cancer in 4 of 6 cores
92%
80%
37%
28%

mr bill
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Date Joined Sep 2010
Total Posts : 709
   Posted 1/10/2011 7:07 PM (GMT -6)   
Dave,
May I ask what side effects led to you veto?  I have read some possible side effects, but feel as if I have missed some.  The  thing that amazes me is the Surg and Rad doctors saying they where going by gut feeling.
Thanks,
Bill
 
 

Post Edited (mr bill) : 1/10/2011 5:26:58 PM (GMT-7)


zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted 1/10/2011 7:53 PM (GMT -6)   
You would love reading a reply made recently today by Dr. ?? n/a?? (surgeon) on PPML(forum) concerning an SRT situation. Seemed biased against doing any SRT radiations as not worthy(supposedly no studies show extended life etc.), and 'get ready for complications'....not my words or thinking. But, this comes from an appointed 'expert' whos pretty well known, too. Your choice to decide on your personal expert of course, last I checked under free choices we still have. Myself would fire this guy immediately as being too arrogant and self appointed as the only righteous one(even if he might be correct, but his attitude isn't), naturally his profession of surgery is all perfection (lol)...others are all junk and that includes what he thinks about oncologists in general, too. Hey remember the Soup Man on Seinfeld...made great soup!

Post Edited (zufus) : 1/10/2011 5:56:07 PM (GMT-7)


daveshan
Regular Member


Date Joined Jan 2010
Total Posts : 363
   Posted 1/10/2011 10:59 PM (GMT -6)   
mr bill said...
Dave,
May I ask what side effects led to you veto? I have read some possible side effects, but feel as if I have missed some. The thing that amazes me is the Surg and Rad doctors saying they where going by gut feeling.

Thanks,

Bill


Sure Bill, keep in mind this is just my views/fears and since our path is a bit different you may want to be more aggressive.

1. ED, I am lucky enough to be regaining function fairly well, radiation can cause problems down the line, especially if the nerves are already banged up (supposedly). The rad oncologist was quite up front about this, said percentage was 30-50% with a decrease in function (for salvage).

2. Strictures, my rad oncologist was quite honest (the 2nd one, first one was a total %i@@) about the chance of either taking a hit in the continence area or oddly going the other way and causing blockages, seems like it can go either way.

3. The percentage advantage of Adjuvant vs. Salvage is supposedly about 10% better long term survival. For me (given the lack of lymph node involvement and undetectable PSAs) just wasn't enough to do something that may not be necessary.

4. Both my Uro' and the rad guy said there was a chance that the surgery (cauterization) may have killed the cells on the small positive margin, and if it hadn't spread already the surgery would be the end of it.

Now, your pathology is worse than mine was, I was 8 with tertiary 5 (not much less than a 9 but some) and I had 12 clean nodes. This plus a possibly unrealistic opinion of my immune system (kill that positive margin dude) lead me to wait and see. If I'd have had lymph involvement it would have been a different story.
Dave in Durango CO

EDIT: I like doctors that go with their guts, and are honest about it. The gut is usually hunches based on experience, not just books/studies.

Post Edited (daveshan) : 1/10/2011 9:03:44 PM (GMT-7)


mr bill
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Date Joined Sep 2010
Total Posts : 709
   Posted 1/11/2011 7:26 AM (GMT -6)   
I guess when I think about it, gut feeling is good.  I have regained about 95% continence. Just a light day pad to catch any dribbles that may occur. Pretty much dry, unless I would strain or pick a heavy object up.
 
The continence issue is a big concern. Did you get any % on the strictures, etc.?
 
I guess with my pathology I really do not have a choice.
 
 
 
 

JNF
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Date Joined Dec 2010
Total Posts : 3888
   Posted 1/11/2011 8:38 AM (GMT -6)   
I would hit it hard while it is at its weakest. If you give it a chance to regroup and start growing again there will be more to kill and potentially in areas that the radiation won't reach.

Two weeks ago I just finished 25 IMRT sessions and did not have any side effects. No skin burning or urinary or bowell issues. They hit the gland plus about 5mm margins and the lymph nodes. I also had two HRD sessions (which you won't have due to the surgery) and apart from some tenderness, swelling, and bruising, all is fine. I am also on Eligard and Jalyn. My Gleason was 3+3, 3+4, and 4+3 and T2b.

My team all agreed to be aggressive and get it all now and not worrying about whether or when to do salvage work. This is very much in line with Snufffy Meyers in Virginia, who appears to be very guided by studies, but clearly practices from his own views and experiences....the gut factor. I think the best docs use both.

daveshan
Regular Member


Date Joined Jan 2010
Total Posts : 363
   Posted 1/11/2011 8:46 AM (GMT -6)   
He (the good rad' oncologist) said up to 20% "will evidence a slowing of stream" he also said it was "easily fixed".

He also mentioned rare instances of bowel issues, forgot about that one.

Realistically the percentages/issues aren't any worse than the ones an honest surgeon will mention before an RP, but after having a good outcome after one procedure and a slim glimmer of hope I just didn't want to roll the dice again.

HOWEVER
There are many guys on here that have had Adjuvant/Salvage with very minimal or no side effects, don't let my fears and/or the small possibility of a side effect sway against doing something that may well save your life if you and your doctors feel it is needed.

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7087
   Posted 1/11/2011 9:02 AM (GMT -6)   
Bill,

Have a look at the daily update thread I did during my IGRT (see sig. below).
My pad use has stabilized now at 2-3 per day (it was 1, sometimes dry at the end of the day, before RT started).
Stream is unchanged.
Bowels - yeah, that too, up from 1 bm per day to 3, sometimes 7 or 8. Not diarrhea, just frequent, as if the colon just can't stretch.
Fatigue - has gotten a little better, but still have to take a midday break.
DaVinci 10/2009
My IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808

mr bill
Veteran Member


Date Joined Sep 2010
Total Posts : 709
   Posted 1/11/2011 9:03 AM (GMT -6)   
Dave,
Thank you for your candor. That's what it is all about. We can learn a great deal from others, if we take the time to listen.
Age 66
BPH since 1996. at least three negative biopsies Erie. Uro did not prescribe finasteride
2007 acute urine retention photovaporize Clev. Clinic prscb finasteride
8-9-10 PSA rose to 10.14 with finasteride positive biopsy Cleveland gleason 9, cat & bone scan negative
9-8-10 RP at Cleveland. Biopsy 9 nodes 2 positive, 2 positive,seminal & vas deferens
PSA 3 wk .06, 6 wk <.03, 12wk 0.0

tigre
Regular Member


Date Joined Sep 2010
Total Posts : 69
   Posted 1/11/2011 9:51 AM (GMT -6)   
mr bill,
my experience with rt after rp has been almost problem free. i understand perhaps there is a chance of dealing with some not so pleasant stuff later on, but for now the only real issue is ed. my rt ended about eight months ago. incont. never got so bad that i needed pads and bowel movements are a little more frequent. like almost everyone else, i did have some fatigue during and after for a while.
i also chose to go the aggressive route and opted for rt after rp when psa was very low. first psa after rp was 0.02 and second test was 0.05. both docs agreed to not give it a chance if we don't have to.
good luck whatever you decide.
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