Finally-- made a decision

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Veteran Member

Date Joined Nov 2009
Total Posts : 7269
   Posted 3/9/2011 12:08 PM (GMT -6)   
I FINALLY got a call this morning from Dr. Hussein's office.
As most of you know,, I had my surgery and now a BCR. The SCARY part, still, is the degree of the last rise resullting in a PSADT of 2 months. So, it is time for SRT.  I have that in place, set to start with the set-up (they call is a "simulation") on Tuesday. They then map it all out. It takes about a week. Then I think they do a trial run and then the real thing.
But the question was: given the obvious aggressiveness of my PC, do I hit it harder via adjuvent HT. There are definite studies showing it increases the probability of a cure by a very significant amount. That's the pro argument. There is a con argument questioning whether it masks the effectiveness of the SRT (it definitely does). So, are you using up another bullet, albeit a delaying one, quicker than otherwise. The other main drawback is the SE of the HT in itself, and also coupled with the radiation. I REALLY DIDN'T want to do that.
Anyway, I don't want to dredge up those arguments. The recommendation from Dr. Hussein's office was NOT TO DO ANY SCANS (that was another question I had) OR HT. She recommends I do the SRT only. Hopefully, I'll catch a break and be in the small percentage that get cured (or a decent remission). If that doesn't work, we will have a consultation and most likely I'll go the HT route.
It is truly a relief to have this decision made.
One vent. I sent an email on Friday asking the aforementioned question. I did a follow-up telephone call Monday afternoon and was told they would get back to me after asking Dr. Hussein either later that day or for sure on Tuesday. Well, Tuesday afternoon, hearing nothing, I called again. They assured me they would get back to me later that day. They called today, late morning. You know, this was kind of important, especially with the SRT set to start the process next week. I really get annoyed when they SAY they will get the information by XXX and they don't. Cancer is a high-tension situation and they should be much more sensitive to the needs of their patients. Vent over.
(David: I know you are going through the exact same thing. Hope you get results quickly)
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

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Date Joined Nov 2008
Total Posts : 697
   Posted 3/9/2011 12:10 PM (GMT -6)   
Mel, sounds like a good plan. Best wishes.

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

Veteran Member

Date Joined Jan 2010
Total Posts : 2845
   Posted 3/9/2011 12:13 PM (GMT -6)   
MEL- sometimes having made a decision helps cope with what is ahead - wishing you all the best in this part of your journey.
Age: 55 - gay with spouse of 14 years, Steve
location: Peterborough, Ontario, Canada
PSA: 10/06/09 - 3.86
Biopsy: 10/16/09- 6 of 12 cancerous samples, Gleason 7 (4+3)
Radical Prostatectomy: 11/18/09
Pathology: pT3a -Gleason 7 -extraprostatic extension -perineural invasion -prostate weight -34.1 gm
PSA: 04/08/10 -0.05 -Zero Club
PSA: 09/23/10 -0.05 -Zero Club
PSA: 03/24/11 - TBA

Regular Member

Date Joined Aug 2009
Total Posts : 374
   Posted 3/9/2011 12:34 PM (GMT -6)   

Mel..just like finally making the decision on first line treatment, this has to be a big relief to be off the spinning wheel and on a path forward (paralysis by analysis, as they say)-----we'll be pulling for a knockout punch in the 2nd round!

Arnie in DE


Forum Moderator

Date Joined Sep 2008
Total Posts : 4271
   Posted 3/9/2011 12:41 PM (GMT -6)   
Mel, I'm glad you have the decision behind you and it makes a lot of sense.  Best of luck with your treatment plan and let's hope that this time it kills the beast.
Tudpock (Jim)
Age 62 (64 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Everything continues to function normally as of 12/8/10. PSA: 6 mo 1.4, 1 yr. 1.0, 2 yr. .8. My docs are "delighted"! My journey:

Veteran Member

Date Joined Jul 2010
Total Posts : 3887
   Posted 3/9/2011 12:47 PM (GMT -6)   
Yeah, the communications issues with doctors can really be bothersome..

Mel, when you start getting the bills for your upcoming treatments, it will make you wonder why they don't give you their personal cell number so you can call them anytime you want..My first R-doc did indeed do this. He used that fact as one of his selling points..

Te "simulation" is fun, here is where you meet your technicians who will the ones who actually administer the treatments..Any "issues" get sorted out here. They will probably make some sort of positioning mold so your position on the table can be duplicated exactly every day..Your R-doc will write a treatment plan, a program for the Linac to follow everyday..Then a "dry run" on the real machine, mainly to acquire the base CAT scan and fine-tune your positioning. Your R-doc and the Techs will work together to fine-tune the program and resolve any issues..

The next day, (or whenever) you get your first treatment..The CAT scan arms swing out and the gantry rotates around you..The arms retract. The table makes some fine movements..The gantry swings into position. You might hear a feint thump as the cooling pump starts and the accelerator is activated. At the same moment, the gantry begins it's rotation around you..(RapidArc)..In my case, it made a return pass. Techs return, get you off the table and you are done..Ten minutes total time on the table.

For me, they wanted my bowels as empty as possible and my bladder as full as possible, but not "too full"..No accidents on the table please..

Personally I like the fact they are not combining HT with you. That way you know for sure whether the $100K was money well-spent or not... Helps keep the R-docs honest...
Age 68.
PSA age 55: 3.5, DRE normal.
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 3rd biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA 0.0

Regular Member

Date Joined Oct 2010
Total Posts : 424
   Posted 3/9/2011 12:57 PM (GMT -6)   

Glad you came to a decision comfortable for you Mel.  I followed that same path.  It will be  a piece of cake I'm sure.


Veteran Member

Date Joined Aug 2009
Total Posts : 2448
   Posted 3/9/2011 1:00 PM (GMT -6)   
Congratulations on making a decision Mel. I know that this one was weighing heavy on you.

There was mention of the possibility of a mold being made to position you each time. Depending on the equipment used, there may be no mold but instead 3 smalls tattoos. That is the way mine worked. Gave me a chance to bond with my son also. Told him I finally got three tattoos that matched his number. LOL

He did not consider it an even match, but we got a lot of laughs out it.

Good luck Mel,

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

Veteran Member

Date Joined Feb 2011
Total Posts : 713
   Posted 3/9/2011 1:02 PM (GMT -6)   
Good Luck brother!
Every minute you fish or ride,adds an hour to your life!

Age 52 Dx age 53 daVinci surgery
prostate volume 24gms
Biopsy 12 cores with 7 positive- left base,right base,left mid gland,right mid gland, left apex.
Gleason score of 7
First PSA 38.7 on10/05/2010
Second PSA 49.9 on11/23/2010
CT negative
Bone scan Negative
daVinci RRP on 01/25/2011 by Dr Mark G Delworth at Bethesda North Hospital.

Veteran Member

Date Joined Nov 2009
Total Posts : 7269
   Posted 3/9/2011 1:04 PM (GMT -6)   
I think there will be a mold AND tatoos.
P.S.: I'll certainly post about it!

Regular Member

Date Joined Oct 2009
Total Posts : 314
   Posted 3/9/2011 1:07 PM (GMT -6)   

Best wishes.


Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 3/9/2011 1:09 PM (GMT -6)   

I am glad you came to a decision that you can live with. I would have fully supported you either way. But personally, I think you have been given sound medical advice on not adding the HT at this point. For the record, it matches up the best consensus of opinion on that subject that I gleaned in my area.

Now you got to get pycshed up for your SRT ride, which I hope will be smooth sailing for you.

David in SC
P.S.  I had 7 tattoos  (none of which I can find 15 months later) and a cast.

Post Edited (Purgatory) : 3/9/2011 11:29:56 AM (GMT-7)

Veteran Member

Date Joined Sep 2009
Total Posts : 664
   Posted 3/9/2011 1:15 PM (GMT -6)   

Best of luck !


Veteran Member

Date Joined Oct 2006
Total Posts : 1211
   Posted 3/9/2011 1:34 PM (GMT -6)   
Hi Mel,
Glad to hear that you made the decision to go ahead with SRT only. I did the same and have no regrets to date. Wishing you an easy completion of the process and for a VERY low PSA in a couple of month. Best of luck, Mel.

Born 1936
PSA 7.9, Gleason Score 3+4=7, 2 of 8 positive
open RP Nov 06, T3a, Gleasons 3+4=7, Seminal vesicles and lymph nodes clear
Catheter out 15 Dec 06, Dry since 11 Feb 07
All PSA tests in 2007 (4) <.04
PSA tests in 2008: Mar.=.04; Jun.=.05; Sept.=.08; at SRT Start=0.1,
Salvage RT completed (33 days-66Gy) 19 Dec 08
PSA: in Jan 09 =.05, all tests to date (Jan 11) <.04

Regular Member

Date Joined Dec 2008
Total Posts : 235
   Posted 3/9/2011 1:53 PM (GMT -6)   
Best of luck with the plan, Mel.
age 52
RALP 10/08
One nerve spared
Gleason 7 - T1c
Pre op PSA 8.2 -- first PSA ever taken at age 50 physical
Most recent PSA 0.02 (12/10)

Regular Member

Date Joined Nov 2009
Total Posts : 254
   Posted 3/9/2011 2:49 PM (GMT -6)   

Best wishes.



Regular Member

Date Joined Jan 2010
Total Posts : 363
   Posted 3/9/2011 3:07 PM (GMT -6)   
Glad to hear a tough decision has been made.

Best of luck to you.
Dave in Durango CO

Regular Member

Date Joined Sep 2010
Total Posts : 309
   Posted 3/9/2011 3:31 PM (GMT -6)   
For what it's worth, I think you made a wise decision. I know you are just so glad to have gotten there. Good luck with the SRT!


Veteran Member

Date Joined Jan 2006
Total Posts : 654
   Posted 3/9/2011 3:39 PM (GMT -6)   
Mel, I hope you have excellent results with the SRT. It seems a lot more of us than they say have to go on the further treatment and in my case that is why I chose surgery as the first, although RT looked to be the easist at that time. This is something that has been bounced around here as well as recent news articles, they really don't have PCa treatment nailed down, what to do first, second and so on and some still say, do nothing even for moderate cases. It is left up to us to made somewhat educated guesses. Even you, after all the dicussions, still it was very much up in the air till now. All this scares the crap out of me and I know I'm not alone in this regard. Having made your choice, I know that would give me peace of mind and I hope you have that now.
Wishing you the best.
06-08 1st biopsy neg psa 4
10-09 psa 5.5 2nd biopsy 1/12 pos. 10%, G(4+3) age 65
12-15-09 RRP Tulane NOLA Dr Lee
Path, 1%, clr marg, no EPE, no SVI, nodes cl, G(4+3)
100% incontinent @ 12 months
ED, pre-op severe, post op total
10/10 Dr Boone, Methodist recomended AUS
AUS/ IPP performed 1/11/11 Methodist Houston
post op psa's 0.04,<0.1,<0.1,<0.01@12 mo.

Veteran Member

Date Joined Feb 2010
Total Posts : 3984
   Posted 3/9/2011 3:47 PM (GMT -6)   
Mel -- i'm with you 100%.  the mold is sack of pellets that they draw the air out of to conform to your legs.  your mold is attached to the table each day and they'll probably flash your picture on an LCD screen and ask you:  "is that you?"
age: 55
PSA on 12/09: 6.8
gleason 3+4 = 7
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl

Veteran Member

Date Joined Feb 2010
Total Posts : 3984
   Posted 3/9/2011 3:50 PM (GMT -6)   
Personally I like the fact they are not combining HT with you. That way you know for sure whether the $100K was money well-spent or not... Helps keep the R-docs honest...
wow really?
age: 55
PSA on 12/09: 6.8
gleason 3+4 = 7
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl

Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 3/9/2011 4:00 PM (GMT -6)   
Mel if it were me I would do some HT a month prior to starting SRT but that is such a personal decision. I think your plan is a good one and I wish you the very best as you continue on...

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

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


Regular Member

Date Joined Aug 2010
Total Posts : 154
   Posted 3/9/2011 4:42 PM (GMT -6)   
Ah yes, the good ole tattoo's. Dot on L hip, dot on R hip, and the center dot at the base of my p****, which was a big surprise..... the location not the other. The dots and lasers were used to align the body, so every treatment (40) the staff got to look for the dots........
PSA at Dx 105 at age 68, 4/04. ADT (Lupron only), RRP, 5/04. Gleason 4+5=9, Staged pT3bc NO MO, 3D rad, 40 treatments, 8/04. PSA 1/05 <0.01. ADT till 7/07. PSA 0.03 12/08, 0.07 4/09, 0.13 8/09, 0.19 12/09, 0.30 4/10, 8/10 0.42, 12/10 0.47. Will start ADT3 after PSA reaches 1.2.

Veteran Member

Date Joined Nov 2009
Total Posts : 7269
   Posted 3/9/2011 5:51 PM (GMT -6)   
I debated that and made my decision. It helped me a lot psychologically that Dr. Hussein recommended ONLY SRT for now.
When I researched it, there were top doctors on either side.

Ed C. (Old67)
Veteran Member

Date Joined Jan 2009
Total Posts : 2460
   Posted 3/9/2011 11:29 PM (GMT -6)   
Mel, Making a decision gets a heavy load of your mind. Best of luck moving forward. If I get BCR I'll probably follow the same path as you. At my age (almost 70) I don't want to deal with the double dosage of SRT and HT.
Age: 67 at Dx on 12/30/08 PSA 3.8
2 cores out of 12 were positive Gleason (4+4)
Davinci surgery 2/9/09 Gleason 4+4 EPE,
Margins clear, nerve bundles removed
Prostate weighed 57 grams 10-20% involved
all PSA tests since (2, 5, 8, 11, 15, 18, 21 months) undetectable
Latest PSA test (2 years) <.008 ?
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