Questions regarding HT and SRT

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compiler
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Date Joined Nov 2009
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   Posted 3/5/2011 9:01 AM (GMT -6)   
Well, as I posted before, I was shocked to find my PSA doubling in less than 2 months (signature below). This is flat out BAD. My next adventure is SRT. The set-up will start on the 15th and I guess the zapping starts the following week. I have been getting emails urging me to consider adjuvent HT. I know I had asked my doctors, but they said no (this was before my last PSA figure). Is this still a grey area, or is HT just before SRT now considered standard of care? I THINK it is still controversial.
 
Any thoughts?
 
Also, I've raised the question and I've seen it in another topic: How do you know if SRT fails. I think David said ANY PSA increase after SRT is a mark of failure. I find this hard to believe. We KNOW that radiation takes some time to work. Also, in my case, by the time I actually START SRT my PSA might actually be 0.33 rather than 0.27. So if it says 0.35 2 months after SRT, that is a big jump from 0.27 but might not indicate a failure. In fact, SRT could be working. Thoughts?
 
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- yes.. PSA on 3/10/10-: 0.01. PSA on 6/21/10--0.02. 9/21/10--0.06; 1/4/11-0.13,3/1/11--0.27

don826
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   Posted 3/5/2011 10:13 AM (GMT -6)   
Hi Mel,
 
HT prior to RT is given to shrink the prostate in some cases. If your's has been removed I am not sure it would make a difference. HT is also given concurrently, as in my case where radiation was primary treatment, as it has been shown to yield more duraable results. In the case of PSA rise after SRT I would say that is an indication of faliure. Where RT  is primary that is not the case as one still has viable prostate tissue.
 
Good luck with the SRT.
 
Don
Diagnosed 04/10/08 Age 58
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan and chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
IGRT/IMRT with adjuvant HT (lupron) 2yrs
PSA:
02/08 21.5
07/08 0.82
10/08 .642
09/09 0.32
03/10 0.32
06/10 0.32
07/10 0.10

Purgatory
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Date Joined Oct 2008
Total Posts : 25393
   Posted 3/5/2011 10:57 AM (GMT -6)   
Mel, it doesnt matter if you believe what my doctors (3 in this case said about a rise after SRT), ask your own doctor.

Most people will see a drop after it ends, and it may or may not be close to what they started with, depending where the PSA stopped climbing just prior to the radiation working. And then readings after that should continue to go down to reaches the lowest level for that patient.

With RT as primary treatment, with a prostate in place, it is coming to go down, then have the PSA bounce, and then it should go down to some level and hover in that new range.

I had 2 going downs, and now, technically 3 upwards - including this latest 2000% increase.

I would go into your SRT assuming it will work, as the SRT is a long drawn up endurance race, so you need to think and feel positive going through it.

The HT and SRT together? You will drive yourself crazy figuring that one out, I couldnt even get a consensus of opinion from rad oncologists at the same clinic. Both arguments have merits, but you alone will need to make that choice.

I went with the school that said let the SRT do its thing, not muddled with the masking effects of the HT, and see if it works.
Kind of a mute point, now that my SRT has failed.

Sure you will make the wisest choice for your self in the end.

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

F8
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Date Joined Feb 2010
Total Posts : 3984
   Posted 3/5/2011 11:05 AM (GMT -6)   
mel -- i'd hit the cancer with everything you've got.  you've got a chance for a cure. fairwind had combination HT and SRT and i'm sure there are others.  good luck to you brother.
 
ed
 
 
age: 55
PSA on 12/09: 6.8
gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl

Tony Crispino
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   Posted 3/5/2011 11:12 AM (GMT -6)   
i had combination HT (28 months) and RT started a month later.

The HT was a lot more inclusive of side effects. But again it was tolerable. I mentioned walking before, and I believe if helps to do it.

The question for you would be how long to take on HT? Talk to your medical oncologist. The RO might say 6 month, but the medical oncologist will likely longer or don't do it depending on where he sits with it...

Tony
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:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

Casey59
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   Posted 3/5/2011 11:13 AM (GMT -6)   
Hi Mel, I wanted to provide 3 comments in this reply...
 
First, I wanted to express that I'm truly sorry to hear about your results.  I did not get a chance to reply earlier, but wanted to know that I'm thinking about you.
 
Second, please do recognize that large measurement variation can and often does exist at all ranges of PSA testing.  The ultrasensitive range is particularly fraught with inaccuracy, but there have been studies published showing day-to-day and measurement variation outside that range as well.  Calculation of PSADT with such low values as yours can lead to broad error ranges.  I've seen examples of >5X differences in PSADT results based on just relatively small amounts of PSA variation.  For this very reason, the AUA recommends that calculations of PSA dynamics be based on 3 data points spread over 18 months.  I realize you'll immediately say "I don't have 18-months to wait", and that's not my point.  My point is that I'm sure that the math-whiz that you probably are that you can visualize in your head the vastly different slope of curves that could occur when measured so close together in time and at such low values...the projections are very "sensitive" at low values.  Bottom line, I would encourage you not to laser-lock on your initial PSADT result with your values.  Kinda complicated discussion, but I'm confident you followed along...
 
Third, about your question on radiation failure, the AUA says this:

Following radiation therapy, the PSA value should fall to a low level and then remain stable. PSA values <0.2 are uncommon after external beam radiotherapy, which does not ablate all prostate tissue. A consistently rising PSA level usually, though not always, indicates cancer recurrence. The number of rises needed to define a failure has been a matter of debate, but a consensus is emerging in support of the American Society for Therapeutic Radiation and Oncology (ASTRO) definition of failure: three successive rises above nadir.

Hopefully this helps...

Post Edited (Casey59) : 3/5/2011 9:18:45 AM (GMT-7)


Fairwind
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Date Joined Jul 2010
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   Posted 3/5/2011 11:53 AM (GMT -6)   
Here are some links dealing with adjunct HT. I hope you find them helpful..

esciencenews.com/articles/2008/09/22/radiation.added.hormone.therapy.increases.survival.men.with.prostate.cancer

www.ncbi.nlm.nih.gov/pubmed/16378903

www.prostate-cancer.com/radiation/survival-rates/survival-rates-radiation-hormone-therapy.html[[

compiler
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Total Posts : 7269
   Posted 3/5/2011 12:06 PM (GMT -6)   
Casey:
 
Regarding your last paragraph, remember that I am talking about SRT, not radiation as a primary tx. It appears there might be a difference regarding the definition of TX failure.
 
I hope you are right in your first point regarding doubling time. I kind of told myself that when I went from 0.06 to 0.13. But with this new data point of 0.27, it appears that my PSADT is in fact a very small number.
 
Fairwind-- yes, I suspect HT + SRT MIGHT give me a better chance. But I also worry that I am using up the HT delaying bullet also and that it masks the RT impact. But I have sent an email to Dr. Hussein at Umich. I hope she answers me soon. My feeling is that if this is still a very grey area, I would NOT do HT. But it may not be a grey area any more.
 
Crap. It is so much easier when a decision is at least made.
 
Mel

F8
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   Posted 3/5/2011 12:08 PM (GMT -6)   
>>But I also worry that I am using up the HT delaying bullet also and that it masks the RT impact.<<
 
oh no Mel you've bought into the BS!  what does that even mean?
 
ed
age: 55
PSA on 12/09: 6.8
gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl

compiler
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Date Joined Nov 2009
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   Posted 3/5/2011 12:17 PM (GMT -6)   
Ed:
 
I thought it was clear, but let me elaborate. I said two things:
 
1) Masking RT.
 
If RT works, then it is curative (last curative bullet). However, doing HT and RT and then getting an undetectable PSA does not tell me if the RT worked.
 
2) Using up one of my delaying bullets. Let's assume you are no longer curative. Still, we know HT is the first attempt at the next best thing, which is delaying the inevitable. In fact, the hope really is that you can delay it for many years, perhaaps up to your regular life expectancy or where you'll die of something else. Also, a good long delay might result in a cure if something new is discovered. But, eventually, the HT will no longer work. I seem to recall that many doctors advocate waiting as long as one can before starting HT. The idea is that HT will work for X years no matter when you start it (up to a point, let's say PSA <20). So, starting early uses up that valuable time. It could be a difference of a few years. Also, you are delaying the miserable SE. The other school says hit it with everything you've got, although the QOL might be crap.
 
Ed, I'm honestly not trying to be argumentative. I am trying to find my own way. It may be that based on the latest studies, the latter argument wins the day. I don't know, but I have to make a decision PDQ!!!
 
Mel

F8
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   Posted 3/5/2011 12:29 PM (GMT -6)   
Mel -- you're thinking delay and i'm thinking cure.  like i said once before, of course it's your call.  just trying to add a little clarity from my perspective.  whether PSA is "masked" or not you have a better chance for a cure with HT/SRT.  or at least that's what i think.  the cancer will keep progessing until the radiation starts working and i think that takes awhile.  HT will stop and weaken the cancer and shrink it. 
 
i'd give that sucker both barrels if it were me.  screw the side effects.  F the job.  gimme the full monty.
 
ed 
age: 55
PSA on 12/09: 6.8
gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl

Fairwind
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Date Joined Jul 2010
Total Posts : 3887
   Posted 3/5/2011 12:40 PM (GMT -6)   
When I asked my R-doc why I had to go back to my U-doc for the Eligard injection, his reply was instantaneous..

"Because they don't want to give up The Money!!" That's why they hate us, we make four times what they do!

I love it when these little insights slip out. I'd like to go out and do some serious drinking with these guys and see what they have to say about each other in a relaxed setting...There certainly is no love lost between U-docs, R-docs and M-docs..Unless of course they are partners in the same building...

142
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Date Joined Jan 2010
Total Posts : 7078
   Posted 3/5/2011 1:11 PM (GMT -6)   
As I have been told (the simple version) in the decision process as to using HT or not with my adjuvant RT -
 
HT starves PCa. If it is starved to death, HT could be curative. The problem long term is what happens if/when the PCa survives and finds something other than T to feed on.
 
If the remaining PCa is small and limited to the prostate bed, and you use both, the RT should kill the PCa, and the HT may or may not have contributed in a significant manner. If it was important, it is because the PCa is of larger scope, and the weakening by the HT helped.
 
If the PCa is not limited to the prostate bed, and you use both, the RT will kill some, and the HT will weaken and possily kill that in other parts of your system. Your PSA will still go down, then come back up later (months, years?) if the PCa outside the prostate bed survives.
 
So, the thread of logic was this - if I use both, but it isn't all killed (i.e. it was out of the prostate bed, and that was only weakened), that reality may be hidden for a while, and I will be hit with BCR sometime down the line.
If I use just RT, I avoid the side effects of HT, but, if there was PCa outside of the prostate bed, I also will not see a flat undetectable PSA immediately . If that happens, the RT failed, and HT remains the alternative.
 
One RO doctor suggested HT first, then the RT. I think they are trained to prefer that position rolleyes , but that is not part of the discussion here.
 
Two others suggested RT alone, and avoidance of side effects (combined with personal and work considerations) led me to go that route.
 
Down side - if the RT fails (we really don't know why until something shows up on a scan), and you wait, at that point HT will have to be more aggressive. Not starting HT early may have been an error in that case.
 
Thus, if you are of the 'kill it now at all costs' school, HT followed by RT sounds good. I felt like the adjuvant RT puts me in the 'kill it now' school. I may be wrong, time will tell.
 
So, once again, no definitive answer.

Post Edited (142) : 3/5/2011 7:31:13 PM (GMT-7)


Casey59
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   Posted 3/5/2011 1:51 PM (GMT -6)   
compiler said...
Casey:
Regarding your last paragraph, remember that I am talking about SRT, not radiation as a primary tx. It appears there might be a difference regarding the definition of TX failure.
 
 
Yes, I recalled.  It's my belief that concept is exactly the same...but I'm no doctor.  Your SRT goal is to hit a nadir some weeks/months after treatments (everyone's nadir could be different), and then stay there (monitor for signs of a rise from nadir).  Signs of a rise have to account for some allowable naturally occuring test variation; thus, the requirement for three consecutively rising values.
 
You said "It appears there might be a difference...".   Where does this appear?
 
 

compiler
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Date Joined Nov 2009
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   Posted 3/5/2011 5:12 PM (GMT -6)   
Casey:
 
I'm saying it appears there might be a difference in terms of the definition of recurrence with RT as a primary vs. SRT.
 
I don't know.
 
David is saying that his doctors tell him ANY increase post SRT means failure. I know with RT as a primary, there might well be an increase, then a nadir, and then they look for an increase of say 2.0 above this nadir.
 
Anyway, I just haven't been able to get that answer.
 
Mel

compiler
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   Posted 3/5/2011 5:17 PM (GMT -6)   
I42:
 
Right now I am leaning towards your thinking. But I hope I get a response back from Dr. Hussein at Umich.
 
The next agonizing decision could be this:
 
Suppose SRT fails (increasing PSA).
You say you wait until the PC shows up on a scan.
 
But I think there are again two schools of thought:
 
Hit it immediately with HT (not a cure-- that chance is gone) or wait until the PSA goes to 10 and hit it with HT.
 
IF the PC shows up on a scan, they hit it with radiation again, but here again I don't know if they wait for clinical symptoms (pain) or not.
 
I don't think there are definitive answers.
 
Mel

Casey59
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   Posted 3/5/2011 6:18 PM (GMT -6)   
compiler said...
... I know with RT as a primary, there might well be an increase, then a nadir, and then they look for an increase of say 2.0 above this nadir.
 
Mel, if you don't mind me saying, I believe you are mixing a few of the definitions...if I can explain...
 
 
Disease progression after external beam RT or SRT is whether PSA increases after it hits nadir (the objective is the same for RT or SRT).  The guideline (perhaps not all doctors follow the guideline...we've certainly seen that) is to have subsequent, consecutive tests performed at least 2-weeks apart show an increase.  This is what I previously described in the post above.
 
What you pulled-in in your quote, above, is related to the "Phoenix Definition."  ASTRO (American Society for Therapeutic Radiation and Oncology) recognizes that PSA tracking brachytherapy (after primary) is different than external beam because of "benign bounce."  As a result, a committee formed in 2005 to develop one definition for recurrence which fit both types of radiation therapy.  What they came up with is worded this way:
"...that any rise in PSA level of 2.0 ng/mL or more, over and above the nadir, predicted true failure with great sensitivity and specificity after both external beam radiotherapy and interstitial prostate brachytherapy, irrespective of whether either of these treatments was accompanied by androgen deprivation."   [This is the "Phoenix Definition"]
So, the definition I previously provided was the agreed-upon definition specifically for external beam, and the one immediately above was a compromise which would alternatively cover both radiation methods. 
 
I hope this helps clarify...
 
 
 
 
On another of your comments, I think you should read some Dr Myers material.  He is quite strong in his comments that the notion that HT doesn't kill PC cells is a myth.  The results vary from person-to-person, but in HT clinical trials up to 30% of patients enter complete remission...he calls that a cure.  Now, 30% is not a huge number, and some men simply do not respond to HT at all, but you should read Dr Myers book...

Purgatory
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Date Joined Oct 2008
Total Posts : 25393
   Posted 3/5/2011 6:34 PM (GMT -6)   
Mel, I think one of your points is still being missed. I am not the doctor or any kind of expert, but the results after RT as a primary treatment and SRT are very much difference. The factor is with SRT you no longer have a prostate. Post RT as a primary treatment, some decrease is usually seen, then later, the "bounce", then hopefully as time goes by, a steady decline to the nadir for that person. With SRT, no prostate of course, and no reason for any PSA rise post SRT, unless it fails, or simply means any runaway cancer cells are long gone out of the prostate bed and/or pelvic area if zapped there too. When you talk again to your radiation doctors, ask them the same way. My failed results have been pretty consistent to what I am saying here, but again, I am not anyone's doctor, only repeating what I have been told and taught.

You are right on the HT plus SRT vs SRT, there is no clear way to know this ahead of time, so it makes a tough tough call.

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

Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 3/5/2011 6:55 PM (GMT -6)   
David, we should recognize that we are a couple of non-doctors, but we are saying essentially the same thing. PSA should not rise after reaching nadir. They usually do a subsequent confirmation test (or two) at least 2-weeks apart to make sure they rise further, because there is known test variation and PSA sources from other parts of the body.

Again, not all doctors follow the guideline, but best thing is probably to be "aware" of the guideline while listening to your doctor.



You guys who have undergone SRT...do the docs use ultrasensitive test, or just the standard test?

Purgatory
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Date Joined Oct 2008
Total Posts : 25393
   Posted 3/5/2011 7:25 PM (GMT -6)   
Casey, based on my case, only the ultrasensative, that was the choice of the radiation clinic I used, and my uro/surgeon under whose care I still am. I was at high risk for SRT failure, so I believe that made a big difference in the two testing choices. Goes back to every case is different.

I wish there were a sure and fool proof way to answer the SRT alone, or the SRT/HT debate. A person's ultimate outcome could make a big difference, but from all I have read (probably not as much as you) and the doctors I am in contact with, the opinions even at the professional level rage on.

Mel, if you read this, and only my opinion (not a qualified one, based on following your journey only), I think I would still go for the SRT alone, and let it see what it does for you on its own leg. I know this is a tiring subject to you, but still surprised they don't want to use at least 70.2 gys with your PSA rise and numbers. Again, not trying to outthink your doctors.

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

compiler
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   Posted 3/5/2011 9:03 PM (GMT -6)   
David and Casey:
 
I don't think you two are saying the same thing. David is saying that any increase post SRT is a SRT failure.
 
Maybe I don't understand the nadir concept. I thought if the PSA goes up for a bit and then levels off, the nadir was the maximum and that's our new benchmark. Am I perhaps incorrect? This is really an important point for those of us at the SRT stage.
 
Now, David. Yes, you are belaboring the point and of course you really are questioning the doctors. But you raise a VERY GOOD POINT. So, let me answer you this way. First, remember way back I posted that question asking people about their SRT, to wit: how many GY they had. I remember that it varied but 68.4 came up quite a bit. It was the mode (most frequent response) and the median. (I'm saying this from memory; it is approximately correct and I am too lazy at this moment to dig up the actual thread). MORE IMPORTANT, I JUST NOW PUT SOME DATA IN THE MSK NOMOGRAPH. Guess what, David. When I put in 68.4, I got a 45% probability of success. When I put in 72 it dropped to about 32%. Even 70 gy was less. In fact, changing the GY by 0.2 at a time above and below the 68.4 resulted in a lower probability of success. So, David, what can I say? After looking at the HW responses and the MSK nomograph and noting that the radiology guy seemed pretty sure that 68.4 was the magic number, why should I question it further? David, have I convinced you at all? Incidentally, just a thought regard your litigation situation. Maybe you can put your figures into that nomograph. You might find that the amount of GY you received was not optimum. I can give you the link if you need it.
 
Mel 

Purgatory
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Total Posts : 25393
   Posted 3/5/2011 9:19 PM (GMT -6)   
Mel,

Wish I could remember either a thread here way back, or the source that was quoted, but it seemed like the nomograph has some kind of secondary reason with the stats, on why the higher dose srt showed poorer results than the <70 gy dose. Seemed the answer had nothing to do with the radiation but in how the nomograph caclulated something.

Also, have you personal read the studies that show that 70-72 can be more effective (for some agressive cases) than the under 70 doses. Probably still have the link for that.

Dont read too deep, not interstested in this subject just because I was given 72 (it didnt work anyway for me, did it), but I care about your situation, and like our surgeries, we only get one shot at this secondary and hopefully, curative attempt for you in SRT.

One of the alleged advantages of even doing IMRT, is that supposedly they can aim the plus 70 doses in a safe manner (again, I am a terrible example of that theory, lol).

Just want to see you get the most bang for the buck out of your SRT trip. I preach compliancy by patients to their doctors, so I am certainly not suggesting in any manner, that you don't go by your doctor's advisement. All we are doing is discussing this one point in particular.

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

142
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Total Posts : 7078
   Posted 3/5/2011 9:27 PM (GMT -6)   
Mel,
 
I didn't say you can't start HT until you see something on a scan. I meant to suggest that you would be expected to start HT just as soon as the PSA starts back up, but that you may not know where specifically it is coming from. Yes, if you wait until you find it on a scan, things are too far down the line. Let me rephrase:
 
"Down side - if the RT fails (we really don't know why until something shows up on a scan), and you wait, at that point HT will have to be more aggressive. Not starting HT early may have been an error in that case."
 

Purgatory
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Date Joined Oct 2008
Total Posts : 25393
   Posted 3/5/2011 9:41 PM (GMT -6)   
142 - your point is also a distinct possibility in Mel's case as well, as that is a legitmate point in the great debate on the HT/SRT subject. That needs to be weighed into a decision as well.
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 2/11 1.24
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 9/10,

Piano
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Date Joined Apr 2008
Total Posts : 847
   Posted 3/5/2011 11:13 PM (GMT -6)   
Previous thread on why cure rate apparently falls off with increasing radiation:
www.healingwell.com/community/default.aspx?f=35&m=1995111
According to John T, it is a statistical aberration caused by not enough data at those higher rates.
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