If you are considering salvage radiation

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Purgatory
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Date Joined Oct 2008
Total Posts : 25380
   Posted 2/9/2011 11:11 PM (GMT -6)   
I thought this was an excellent guide for someone considering whether to undergo salvage radiation or not.
 

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/10/2011 11:27 AM (GMT -6)   
bump - at least i thought it would be interesting
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

Sonny3
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Date Joined Aug 2009
Total Posts : 2447
   Posted 2/10/2011 12:08 PM (GMT -6)   
David, you are right it is a great read and filled with many salient points for those who may have to face radiation. It answers a lot of questions that are posed here by folks looking for radiation guidance.

Does a real good job of laying it out about Adjuvant versus SRT.

Thanks for the find,

Sonny
60 years old - PSA 11/07 3.0 PSA 5/09 6.4
da Vinci 9/17/09
Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5% positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT completed 1/15/10 35 treatments- 70Gy
2/23/10 Post IMRT PSA 1.0
3/22/10 PSA 1.5
4/19/10 PSA 1.2
5/22/10 PSA 1.3
8/9/10 Completed Radiation for MET
9/7/10 PSA 2.2
1/5/11 PSA 3.9

James C.
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Date Joined Aug 2007
Total Posts : 4462
   Posted 2/10/2011 12:23 PM (GMT -6)   
Not trying to steal your thunder, but I just watched some of the Dr Snuffy Meyers videos this morning and learned more in 15 minutes about the intricate details of possible cancer reoccurance than I have in a year otherwise. This link here, along with viewing Dr. Meyers videos should be required reading for every radiation oncologist and every patient who suspects they have a reoccurance. Listen closely to the 2 videos where he discusses his ideas on what reoccurance is.

askdrmyers.wordpress.com/?utm_content=amyson%40comcast.net&utm_source=VerticalResponse&utm_medium=Email&utm_term=here&utm_campaign=Cancer%20%3Cstrong%3E%3C/strong%3E%3Cstrong%3E%3C/strong%3E%3Cstrong%3E%3C/strong%3E%3Cstrong%3E%3C/strong%3ERecurrence%20%3Cstrong%3E%3C/strong%3E%3Cstrong%3E%3C/strong%3E%3Cstrong%3E%3C/strong%3E%3Cstrong%3E%3C/strong%3EAfter%20%3Cstrong%3E%3C/strong%3E%3Cstrong%3E%3C/strong%3E%3Cstrong%3E%3C/strong%3E%3Cstrong%3E%3C/strong%3ERadical%20%3Cstrong%3E%3C/strong%3E%3Cstrong%3E%3C/strong%3E%3Cstrong%3E%3C/strong%3E%3Cstrong%3E%3C/strong%3EProstatectomycontent

PS: my goodness, what an Url. Must be a record here.lol turn
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

Zen9
Regular Member


Date Joined Oct 2009
Total Posts : 314
   Posted 2/10/2011 1:43 PM (GMT -6)   

Thanks, James.  That's a very interesting video.  This is why I visit this board (plus I heard it's a great place to meet single women .... shakehead )

Sorry, Purg, haven't had a chance to read your article yet.

Zen9


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/10/2011 2:53 PM (GMT -6)   
No problem, glad my thread made it easy for the other link to be seen.
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

DJBearGuy
Veteran Member


Date Joined Dec 2008
Total Posts : 761
   Posted 2/10/2011 4:13 PM (GMT -6)   
There's a lot of overlap between the paper and the video, but each includes lots of other information. Very timely information for me!

Thanks to both Dave and James.

DJ
Diagnosis at 53. PSA 2007 about 2; 2008 4.3
Biopsy Sept 2008: 6 of 12 cores pos; Gleason 4+3 = 7
CT & Bone scan neg
Da Vinci at City of Hope Dec 8, 2008
Rad prostatectomy & lymph node dissection
Cath out on 7th day, in on 8th day, out again 14th day after neg cystogram
Path: pT2c; lymph nodes neg; margins involv; 41 grams,
PSA 1/08, 4/09,7/09, 10/09, 11/09,2/10 <0.01, 10/10 0.1, 2/11 0.08

Galileo
Veteran Member


Date Joined Nov 2008
Total Posts : 697
   Posted 2/10/2011 4:31 PM (GMT -6)   
Yes, it's just as good as the last time we discussed it!
www.healingwell.com/community/default.aspx?f=35&m=1835105



devil

just kidding. I'm glad to see it resurface, as it really is worthwhile, and I put it on my salvage radiation knol.
Galileo

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NX MX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) Jan-Mar 2007
PSA 9/2007 and thereafter <0.1
pcabefore50.blogspot.com

An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1149
   Posted 2/10/2011 4:43 PM (GMT -6)   
I notice that they believe that if the PSA is detectable with an ultrasensitive test at 45 days after surgery then this means that there may be cancer left behind. So a reading of 0.03 for example when the ultrasensitive can do <0.01 is scary.

Also they believe that negative margins when the PSA is rising is bad news.

This article makes me scared. I hope my husband's next test is flat or lower.

An
Husband's age: 52. Sydney Australia.
Family history: Mat. grandfather died of PC at 72. Mat. uncle died of PC at 60. He has hereditary PC.
PSA: Aug07 - 2.5|Feb08 - 1.7|Oct09 - 3.67 (free PSA 27%)|Feb10 - 4.03 (free PSA 31%) |Jun10 - 2.69. DRE normal.
Biopsy 28Apr10: negative for a diagnosis of PC however 3 focal ASAPs “atypical, suspicious but not diagnostic” for PC. Review of biopsy by experienced pathologist, 1/12 core: 10% 3+3 (left transitional), 1/12 core: ASAP (left apex)
Nerve sparing RP, 20Aug10 with Dr Stricker. Post-op path: 3+4 (ISUP 2005). Neg (margins, seminal vesicles, extraprostatic extension). Multifocal, with main involvement in the fibro-muscular zone. T2C.
Post RP PSA,
Lab 1: Sep10 – 0.02|Nov10 – 0.03|Dec10 – 0.03
Lab 2: Nov 10 - 0.01|Dec10 – 0.01

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 2/10/2011 5:29 PM (GMT -6)   

David,

A very timely post for me.  I am still wrestling with the slow vs fast doubling time study.  I also am not sure when to start calculating the doubling time. Is it from the time of surgery, or from the time of the beginning of the rise ?

Goodlife


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/10/2011 6:17 PM (GMT -6)   
An - it was interesting that both my uro and my radiation oncologist both stated that they felt that a PSA reading post-surgery of .05 or higher, was definitive proof that there was still cancer left. Even though there is no connection between their practices. When my original post-surgery reading was .05, my uro was already very concerned.

Goodlife - my doctors figured the doubling time based at the start of the rise, not from the time of surgery. Sure like all things PC, there's no one straight agreement among the experts.
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

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 2/10/2011 8:29 PM (GMT -6)   
Galileo said...
Yes, it's just as good as the last time we discussed it!
www.healingwell.com/community/default.aspx?f=35&m=1835105

 

Galileo, sorry, but that link was not the last time we discussed the "9 Things" paper...I think that this was, though.
 
It appears that we are on a every-4-months "bump" cycle...that's better than a "bump" every day.
 
 
 
 
 

Post Edited (Casey59) : 2/10/2011 6:39:23 PM (GMT-7)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/10/2011 8:50 PM (GMT -6)   
Excuse me for being senile. Didn't realize that it was a "repeat", but then again, we have had dozens of new folks come through here since last June.
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

Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 2/10/2011 11:17 PM (GMT -6)   
Hey David, I've been around for about two years, and I've not seen your link before! Fact is there are so many threads here that I only manage to look at a small fraction of them and I'm sure I miss a lot of good stuff. And, I'm sure that's true for many members.

As great a forum as this is, the limitations of the softwear, (which seems to be a pretty generic one used by a number of different groups from bird watchers to rock hounds,) mean that good information can be difficult to locate. Accordingly a timely "bump" is always a good idea for important information.


Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
From "knock out" to wake up in recovery less than two hours.  Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
 
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
 
First post op PSA Sept 09  less than 0.02
PSA on Oct 23, 2009 less than 0.02
PSA on Jan 8, 2010  less than 0.02
PSA on April 9, 2010 less than 0.02 
PSA on July 9, 2010 (one year) less than 0.02
  

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/10/2011 11:20 PM (GMT -6)   
I think so too Sheldon. The previous link was started last June, thats 8 months ago, I can't possibly remember every one Ive seen or read either, and it wasn't even my link or thread before. Still a good beginner's guide to SRT I think.
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

MarkMyWords
Regular Member


Date Joined Dec 2010
Total Posts : 55
   Posted 2/11/2011 12:08 AM (GMT -6)   
Purgatory -

Thank you for posting this. Your timing couldn't be better. I met and an RO today to discuss adjuvant radiation - the benefits and the draw backs.
I am so torn on what to do - My surgery was in Nov and I suffered bladder spams up until 2 weeks ago. While they were not as severe in the last
month and a half, they still hurt like heel for a brief minute or two when I emptied my bladder. I understand the benefits of doing adjuvant radiation,
but the risks of aggravating the bladder and waking that monster again scares the life out of me.

My Urologist is torn on what to do.
My family Physician sent me to an Oncologist.
Oncologist felt waiting would be the right road, but recommended seeing a Radiologist Oncologist.
Radiologist Oncologist said - you need to weigh the pro's and con's and make the best decision for you.
Me - totally confused and scared crapless.

Thank you for posting this.

Mark

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 2/11/2011 11:05 AM (GMT -6)   
Mark, remnind me-what's your numbers, psa after surgery, Gleason, cancer classification, treatment, etc?
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

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/11/2011 12:13 PM (GMT -6)   
Mark, I feel for you.

Due to my complications, I had to deal with dozens of bladder spasms per day for nearly 2 years. I was on the drug ditropan the entire time. The meds helped some, but never prevented the spasms from happening. Hopefully that part is behind you.

It will be a tough call for you to make, as it were for me. With all my stricture problems, I knew that radiation would only make things worse. I didn't expect the radiation to go wrong, like it did, and in the end, destroyed my bladder and bladder neck, which required me to have the last operation which left me with a urinary stoma for life.

Good luck to you as you weigh out the pro's and con's of such a major decision.

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

MarkMyWords
Regular Member


Date Joined Dec 2010
Total Posts : 55
   Posted 2/11/2011 6:00 PM (GMT -6)   
Hi James -

Not sure why my signature stats didn't come through on this post.

PSA pre surgery 10.6 - post surgery .003
Gleason 7 (3+4)
Biopsy - 12 of 12 core samples positive.
Clear Margins
Post surgery pathology stage - pT3aPn0
Prostate was 45 grams size 5x3.5x3.4 cm - 32% of the prostate involved and tumor was 2.7 cm.
Extraprostatic extension present
No lymph node involvement
Negative Seminal Vesicles
One other comment on the pathology report - "High grade prostatic intraepithalia neoplasia".

Purgatory -

Thank you - my biggest fear is not the radiation - but the spams coming back.

Mark
Age 45
Jul 2010 - PSA 10.1
Aug 2010 - Biopsy - 12 of 12 cores positive - Gleason 7 (3+4 on the right, 4+3 on the left)
Sept 2010 - CAT and Bone scans negative.
Nov 2010 - da vinci RP with negative margins. nerve bundles were not spared. negative lymph nodes. Pathology Stage pT3c.
Jan 2011 - PSA undetectable

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/11/2011 7:42 PM (GMT -6)   
Well, I don't have to worry about bladder spasms or taking ditropan anymore, as my bladder is totally detached from my urinary systems, dry as a desert, and never will be used again. I do, however, still have some phantom spasms pains on a daily basis, but nothing like the constant pain I had for so long.
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

MarkMyWords
Regular Member


Date Joined Dec 2010
Total Posts : 55
   Posted 2/11/2011 9:54 PM (GMT -6)   
So sorry to hear that Purgatory -

Those spasms are probably the worst pain I have ever felt in my life. I feel for ya bud. =(
Age 45
Jul 2010 - PSA 10.1
Aug 2010 - Biopsy - 12 of 12 cores positive - Gleason 7 (3+4 on the right, 4+3 on the left)
Sept 2010 - CAT and Bone scans negative.
Nov 2010 - da vinci RP with negative margins. nerve bundles were not spared. negative lymph nodes. Pathology Stage pT3c.
Jan 2011 - PSA undetectable

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/11/2011 10:15 PM (GMT -6)   
The constant spasms were terrible enough before I underwent radiation, but once the radiation did all the damage to the bladder, they were 10 on the pain scale, and happened as often as 4 dozens times aday. Will never miss that horror in my life.
I hope you can stay away from any more of them too.

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
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