Saw the radiology/oncology guy today

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7205
   Posted 1/12/2011 2:49 PM (GMT -6)   
Just an update. I had seen him way back when my PSA went form 0.02 to 0.06. I saw him again today to go over my discussion with the Ford doctor and see what he thought. Again, he is very pleasant/personable and I think is very knowledgeable, but how do I really know? He is certainly experienced.
 
He did state that it obviously looks like radiation is in my future. Whether I have it now (PSA at 0.13) or wait until it is 0.20 is not crucial. That's what Ford said, too, although one mindset of mine says to do it right now before it's too late. However, he says my original plan is fine. That plan is to do another PSA on 2/15. Unless I get a very pleasant surprise we will do the SRT. He said I do not have to schedule it now. He made a note on my file that as soon as I call with the results and directions to proceed, they will schedule me to get started the following week at the latest.
 
I asked how many GY I would be getting. He said 68.4 total (1.8 per day; 38 days). I will probably experience zero side effects for the first 3-4 weeks. Then I will probably have a lot of urinary urgency. I will have to go like...very soon or even...right now... or else. That will diminish after the SRT and should go away. I have hemmroids that generally don't bother me (maybe once a year and they bleed maybe once every 4-5 years). He says they will probably get very irritated and will bleed. Again, supposedly that will get better. Also, I was thrilled to hear that I will not need a catheter as part of the set-up. There will be a dye/barium contrast put in my rectum through a tube. It will be uncomfortable, but not nearly as bad as a barium enema. They don't put much in, just enough to see where everything is. There is no preparation  needed for the set-up or for the treatments other than drinking some water and he said it would just be a glass of water. It didn't sound like much. I do have constipation problems. He said that would NOT be a problem.
 
The machine used is the Varian Trilogy RapidArc.
 
So, I guess we have a plan.
 
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. PSA on 3/10/10-: 0.01. PSA on 6/21/10--0.02. 9/21/10--0.06; 1/4/11-0.13 CRAP!

bsjoplin
Regular Member


Date Joined Feb 2010
Total Posts : 308
   Posted 1/12/2011 2:59 PM (GMT -6)   
just having a plan usually adds a layer of peace to the whole experience....hoping the plan all works out AOK
bob
 
Age@dx:55
5/05 PSA:1.8
12/07 PSA:3.7
7/08 PSA:4.7
8/08 Biopsy#1:3 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 Path: PCa on 10%, lymph & SV benign, Gl:3+4=7,stage T2c
2/13/09 PSA:0.1
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
11/10 PSA: 0.1

60Michael
Veteran Member


Date Joined Jan 2009
Total Posts : 2222
   Posted 1/12/2011 3:22 PM (GMT -6)   
Mel,
It does sound like a plan. Some studies say hit it with SRT at or by.2. What is the dye/barium for? I missed that part.
Michael

LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 1/12/2011 3:25 PM (GMT -6)   
Excellent Mel,

I won't have my consultation until probably next week. So when I will get the info from him I will share likewise.

Best of luck to you.
You are beating back cancer, so hold your head up with dignity

Les

Robotic Surgery Sept 2008
PSA increasing since January 2009
Current PSA .44 (29 months)
PSA Doubling time 7 months

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/12/2011 3:26 PM (GMT -6)   
What did you think about Dr. C's (surgeon) response on PPML to another guy looking into SRT? Do you remember his words of wisdom???? He claims no evidence(empiracally) exist of improvement or worthiness and yes 'ask your doc about all the new side effects you will get'. (sweet words were his, not mine). If you remember reading that thread, how is your opinion on this particular doc now? He was just as wonderful talking about drug protocols awhile back and how all of them were unproven and literally junk (even casodex), and endorsing only one....Lupron....of which he is affiliated with directly. open minded? You decide. Looks like his opinions being thrown out on a patient forum, are meant to stunt others sharing there journey and knowledge and choices or desires and has elected himself as the Messiah of PCa and has all the answers. I hope some people decide for themselves or elect him dog catcher for some humble pie dinning. smilewinkgrin

Post Edited (zufus) : 1/12/2011 2:30:08 PM (GMT-7)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/12/2011 3:30 PM (GMT -6)   
Mel,

I wonder how he calculated the exact ammount of gys. of radiation, when he hasn't officially started with you, and worked up the exact plan for you? I didn't know how much I was getting, until a week after the radaition oncologist did tests, got results, did the scans, etc, then she calculated the dosage based on my particular numbers. I was told, and what would I know, Im not a radiation doctor, that the best results are if a person having SRT can be given 70 gys or more, as its a one time shot as a curative attempt. Seems like a lot of guys get SRT at between 70 and 72 gys, some higher. I had 72. Perhaps if you pull the actual trigger, the rad. dr. will re-evaluate your entire case.

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 : 3747
   Posted 1/12/2011 3:42 PM (GMT -6)   
Mel, I had # 18 out of 40 today on the same machine..Before I started, I had to pee every 4 hours..Now it's down to 2-2.5 hours...Kind of a pain at night..I can still control the "urgency" issue, hold it for an extra half hour if I have to..No other side-effects so far..Each dose takes about 15 minutes from beginning to end..The actual "beam on" time is maybe one minute. The gantry is in motion, moving in an arc around your body, the target area staying constant..The only thing that hurts is your wallet..

Bob
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 NOW

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 1/12/2011 4:37 PM (GMT -6)   
zufus, could you elaborate a little so we can tell what or which doctor you are talking about? The ppln doc or Mel's doctor? Honestly, I am confused as to who and what you are discussing. Can you be a little less cryptic?
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 RP, Path: pT2c, 110 gms., clear except:
Probable microscopic involvement-left apical margin -GS6
3 Years: PSA's .04 each test until 04/10-.06, 09/10-.09, 01/11-.09
ED-total-Bimix 30cc

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7205
   Posted 1/12/2011 4:41 PM (GMT -6)   
Let me try and answer some of the questions/comments.
 
David: You asked some great questions. I got the impression that he felt the best results for SRT with the equipment he had with reasonable minimization of morbidity was 68.4. I think the new machine (Trilogy Varian RapidArc) is supposed to do a better job of concentrating the beams on the target and minimizing the beam at places you want to minimize (urethra, bladder, rectum). So, maybe they can get by with less GY. I don't know, so I did post a new topic to see what others have experienced in terms of SRT dosage and when it was determined. My understanding is that his "plan" will involve how to best direct the beams and minimize collateral damage. So far, reading the answers, others have gotten 66-70.2 GY. Maybe you got too much?
 
Zufus: I definitely did notice the comment from Dr. C. I actually did email him. He responded something to the effect that radiation compared to NO RADIATION was only 10% more effective. I'm not at all sure how he determined that. I asked because the MSK nomograph seems to give me figures of 30%-50% probability of 6-year non-progression for SRT (depending on the numbers I put in), so how could SRT only give me a 10% advantage. I'm still not sure I understand his answer. How could I NOT do SRT with my numbers (unless I choose some alternative tx., which I'm not convinced would be the best in my situation).
 
Michael:
The dye/barium is put into the rectum for the scans to help him identify the rectum for planning purposes.
 
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. PSA on 3/10/10-: 0.01. PSA on 6/21/10--0.02. 9/21/10--0.06; 1/4/11-0.13 CRAP!

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/12/2011 4:53 PM (GMT -6)   
They were worried that anything under 70 would not be effective for me. Again, case by case, patient by patient.
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

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/12/2011 6:36 PM (GMT -6)   
Glad to see you are using all your comparisons Mel, I think Dr. C. should keep his own thoughts to himself, hopefully nobody will hire him...and he is not an oncologists. I would take your doc Mel over him in a heart beat, regardless of predictions differences.

James- I see your point I did not want to you names, it could spark more fire than I wish to play with....ya know what I'm sayin'. Anyway got your drift.

Good luck Mel
Dx-2002 total urinary blockage, bPsa 46.6 12/12 biopsies all loaded 75-95% vol.; Gleasons scores 7,8,9's (2-sets), gland size 35, ct and bone scans look clear- ADT3 5 months prior to radiations neutron/photon 2-machines, cont'd. ADT3, quit after 2 yrs. switched to DES 1-mg, off 1+ yr., controlled well, resumed, used intermittently, resumed useage

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/13/2011 12:05 PM (GMT -6)   
Mel:
The remarks from Dr. C. might not be as far as you think. My original 40% chance of SRT of working for me was reduced to 20% tops by the radiation oncologist, due to my own numbers and issues.
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
New Topic Post Reply Printable Version
Forum Information
Currently it is Friday, June 22, 2018 4:43 PM (GMT -6)
There are a total of 2,974,366 posts in 326,171 threads.
View Active Threads


Who's Online
This forum has 161253 registered members. Please welcome our newest member, Now UC It, Now You Don't.
277 Guest(s), 15 Registered Member(s) are currently online.  Details
Flying gal, notsosicklygirl, hennaheather, Kent M., Dahlias, Gunner823, readingmom, Undecidedtx, Girlie, BBN!!, Saipan Paradise, onceitfreeze66, joe99, Szabo246, U.C.Me?