Here's my logic stepping in.
If they cut out the prostate and find a positive margin, then it is possible that there is cancer where the prostate used to be. Hormones alone only slow the growth of this stuff not kill it. Radiation kills it. Why would one not want to kill what is likely present? Even if the cancer is systemic, A targetable area is a potential reduction of cancer cells. I had four positive margins so multiply that logic by four. Why wouldn't radiation be a benefit? Dr. V and I discussed this. He said that studies show that radiating the area has PSA benefits but long term studies show little change in mortality and the timeline. I talked to Dr. P (the radiaologist) and he says forcing recurrance is better than living with continuation. In other words if it's present and in a targetable area, hit it. I know Dr. V's information is true, and logic agrees with Dr. P. Also stated in many studies, as Dutch points out, recurrance can be targeted with radiation. OK. Logic again, What's the difference between recurrance and remnants?
Hormones or no hormones? As Susan points out, when the cancer does not have PSA rise, then why hormones now? If the disease shows no PSA at all after removal of the prostate, then could HT cause a "safe" level of cancer microplasms to becom refracted when there was no potential danger? Wouldn't that mean once the recurrance happens after HT you have no gernerally accepted tool to use? Dr. V states that whether or not you choose to do HT now or later, there is some refraction by the mear rise in PSA at recurrance. Dr. P. says "shrink it and I'll shoot it". Logic agrees with both perspectives. Dr. V's states the studies consistantly show that the earlier you use systemic treatment the better chance the bodies immune system can attack remaining cancer cells. Hmmm. That sounds logical.
Chemotherapy now or later. Over previously used chemo drugs, Taxotere adds a couple extra months. The timeline appears to be 19 versus 16 months for mortality. But Taxotere also carries an additional benefit when combined with radiation. Radiated docetaxyl molecules are stronger than non-radiated molecules at killing cancer cells. The doctors do not agree 100% on this.
The shotgun attack says all three combined, but in what order? The answer appears to be chemo, then radiation, then HT. Now we are talking severe side affects. I may not have broken this down 100% correctly as it is alot of information to digest.
Early systemic treatment appears necessary to allow the body to attack back. Radiation appears logical when residual cancer may be present through positive margins.
I am leaning torwards HT and radiation but if someone has an argument, by all means. Speak up. Please note the radiologist I have interned at Loma Linda. He believes that IMRT and Proton is about
equal at stage three or four. (yes, NCI has an IMRT system and not a proton accelerator). I spent two and a half hours examining the equipment and some of the computer images from a subject. (no names were used) Since I was his last patient to see him last night he stayed with me for a very long time and went into great technical detail. He obviouly liked to talk about
his science and I am a technical person so we actually went well beyond a patient/doctors visit. He convinced me to consider IMRT. Then he gave the name Rossi at LL and said go there and talk to him. Try to get the last window the in schedule of the day and he would tell him I was coming and get real technical. Interesting offer. Yup, Dutch, and PCDave, I'm going to LL.
Post Edited (TC-LasVegas) : 3/29/2007 11:06:28 PM (GMT-6)