I saw the radiation oncologist today in Washington DC. Actually, saw two of them, and they spent a lot of time with me in an orientation and answering all of my questions. I'll pass on key points I jotted down, and avoid things that have already been extensively discussed such as the actual procedure.
First, my ultrasensitive PSA came in at 0.05, same as it was a month ago. I know it's only been a month, but that tells me that it wasn't a lab error, but at least it hasn't continued to go up. The radiologist told me I'm very early and am not in need yet of SRT, but they would offer it to me if I wanted it. He told me my PSA might stay at 0.05 forever, or it might stabilize for a while then start going up. He did say since I was at 0 after surgery, and .05 now it's likely to be from some spot that is still in the prostate bed. If they radiated they would recommend just the prostate bed and pelvic lymph nodes, not the wider radiation.
He did say that the ultrasensitive numbers are a fairly new thing for them, and they are more used to the older 0.1 sensitivity tests. They said they are seeing more men come in now with ultrasensitive numbers and they are still trying to figure out how to interpret them with respect to SRT.
On SEs they said, of course, they're usually very well tolerated and the most they see are urgency in urination, loose bowels, etc. I mentioned, without name, Purg's severe SEs and they told me they've never experienced that type of severity in the 7 years they've been there.
On success rates, they said that unlike adjuvant, there have been no randomized trials for SRT. But a couple of things they don't like to see are PSADT <10 months and PSA level >0.5 before starting SRT. But they said in all the studies that have been done, the conclusion is always that the earlier SRT is started the better, but you have to trade off against possible SEs.
Interestingly, even though my pathology had me as a G 4+3 with a small amount of 4+4, they consider me a G8, which is not good. However, they also said that my pathology report, with negative margins and negative EPE and SVs would not have qualified me for adjuvant radiation. They usually reserve adjuvant radiation for positive margins, SVI, ECE, T3, etc. However, when they pulled out a decision tree type of chart for SRT progression free results, it made a huge difference if I went in with a G7 or a G8.
The problem is that the chart lumps together Gleason 8,9, and 10, and if went in with a G8 and followed it down it only showed something like a 16% chance of SRT working vs almost 60% for a G7. The doctor said that was too pessimistic, and thought those numbers included a lot of men who probably already had metasticised cancer. I tend to agree that for me, with a Gleason 4+3 with a minor 4+4 component, I should not be in the same category as someone with a solid 10, but who knows?
They have brand new IMRT and Tomo Therapy machines in a new building, and even though they didn't think I needed SRT at this point, they gave me the impression that they would like to have more patients to get hours on the new machines.
All in all it was a good appointment, and has set my mind at ease somewhat. I decided to wait and get another ultrasensitive test in 3 months, and go from there.
PSA: 7 tests over 2 years bounced around from 2.6 to 5.6
Biopsy 8 of 12 positive, Gleason 3+4, T2a
DaVinci August 2009, pathology Gleason 4+3, neg margins, T2c
Continent right away, ED
Viagra, Cialis did't work, Trimix works well
3, month: undetectable <.1; 6 month: undetectable <.014 (ultrasensitive); 9, 12, 15 month: undetectable <.1; 18 month detectable .05