Need Some advice on whether to pursue radiation

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Pelahatchie
Regular Member


Date Joined Jul 2007
Total Posts : 86
   Posted 11/7/2007 11:29 AM (GMT -7)   
I just got my 26 month psa result at .06.  I know this is below the .1 threshold many doctors use as undetectable but my doctor uses <.04.  The .06 is my highest reading to date and the trend is my concern.  As all of you know generally, the sooner you go after cancer the better in most cases and I just don't know if I am cut out for all this psa testing and waiting to see if it continues higher.  I know the radiation is no guarantee of success and I might sacrafice my current situation of no negative side affects from the surgery but it is honestly a concern that I may wait too long and miss the chance to say goodbye to this disease for the rest of my life.
 
This is a tough call, I would just like to hear your thoughts.
 
Thanks
 
 
DX 8/05 Gleason 5, Mayo clinic Second Opinion Gleason 6, PSA 2.8
 
Da Vinci surgery Dr. Dasari, Centennial Nashville 9/24/05
 
Pathology Report Gleason 6, 15 % on left side only very near to the edge of capsule, too close to call on margins, doc's said to watch it very closely, final decision T2A
 
PSA's have basically ranged from <.04 to .05 for two years.
 
no E.D. and no Incontinence, feel very blessed


Dutch
Regular Member


Date Joined Feb 2007
Total Posts : 400
   Posted 11/7/2007 11:53 AM (GMT -7)   
Pelahatchie:
Radiaiton will, of course, have to be YOUR decision, but with all of the new radiation treatments available the side effects are quite tolerable - both the proton and the photon.  I have never heard much about any incontinence from radiation and most of the products like Viagra work good if and when ED becomes a problem. 
Good luck on YOUR decision.
Dutch


Diagnosed Feb 2001  (Age 65)  Currently 72
PSA 4.8      Gleason 3+3=6      Stage   T2b
Completed Proton Therapy @ Loma Linda - Aug 2001 - No side effects.
6yr PSA - 0.19
Our responsibility now is to educate men about Pca, PSA and the importance of early detection. 
 
 
 


Pelahatchie
Regular Member


Date Joined Jul 2007
Total Posts : 86
   Posted 11/7/2007 11:57 AM (GMT -7)   
Thanks Dutch, Is Proton available as a salvage option.  I had been told it was not but that doesn't make sense to me.  M.D. Andersen just started Proton which would be my closest option.

DX 8/05 Gleason 5, Mayo clinic Second Opinion Gleason 6, PSA 2.8
 
Da Vinci surgery Dr. Dasari, Centennial Nashville 9/24/05
 
Pathology Report Gleason 6, 15 % on left side only very near to the edge of capsule, too close to call on margins, doc's said to watch it very closely, final decision T2A
 
PSA's have basically ranged from <.04 to .05 for two years.
 
no E.D. and no Incontinence, feel very blessed
 
PSA Nov 07 = .06


CaPCa
Regular Member


Date Joined Aug 2007
Total Posts : 118
   Posted 11/7/2007 11:57 AM (GMT -7)   
Although not specific to my case (yet - still waiting to do the first post-surgery PSA) one urologist told me that statistically it was not worth pursuing adjuvant therapy if/until a PSA level of 0.4 (not 0.04). Some on this board have heard otherwise. Radiation is apparently only recommended if cancer spread is localized to the area of the prostate. The idea behind waiting for a clear rise in PSA is that if cancer has metastasized to other parts of the body, waiting to do radiation will not make a difference even if done early. However, if the spread is local to the prostate bed, some waiting can be beneficial to hopefully avoid unnecessary adjuvant therapy, assuming that the cancer does not spread beyond the prostate bed while waiting. Again, you will also hear different cogent opinions on this board.
Age:44
Father diagnosed and cured at age 52.
08/21/07: Diagnosed with T1c cancer
1 of 12 biopsy cores positive; 10% tissue
Gleason score: 3+3=6
PSA level prior to biopsy: 4.3 (velocity < 0.4ng/ml)
10/19/07: da Vinci prostatectomy by Dr. Vipul Patel at OSUMC.
              Difficult surgery due to prostate inflammation.
              Both nerve bundles spared.
              Spongy erections began within 24hrs of surgery!
10/24/07: Catheter out; down to 1 Serenity pad/day next day.
              Final pathology: neg margins, no capsular penetration,
              Gleason 3+3=6, 5% tumor involvement, multi-focal.
 
 


CaPCa
Regular Member


Date Joined Aug 2007
Total Posts : 118
   Posted 11/7/2007 12:20 PM (GMT -7)   
Please discount my previous comments as I have not personally had to delve into adjuvant therapy. There are others here that can better address this than myself
Age:44
Father diagnosed and cured at age 52.
08/21/07: Diagnosed with T1c cancer
1 of 12 biopsy cores positive; 10% tissue
Gleason score: 3+3=6
PSA level prior to biopsy: 4.3 (velocity < 0.4ng/ml)
10/19/07: da Vinci prostatectomy by Dr. Vipul Patel at OSUMC.
              Difficult surgery due to prostate inflammation.
              Both nerve bundles spared.
              Spongy erections began within 24hrs of surgery!
10/24/07: Catheter out; down to 1 Serenity pad/day next day.
              Final pathology: neg margins, no capsular penetration,
              Gleason 3+3=6, 5% tumor involvement, multi-focal.
 
 


flippin out
Regular Member


Date Joined Mar 2006
Total Posts : 137
   Posted 11/7/2007 2:08 PM (GMT -7)   
Interesting I too have had my last PSA tests in the detectable range (.1 /.2) My Surgeon has recommended radiation and I have been trying to get a second opinion at the Loma Linda facility but the earliest Appointment is in March my radiologist has strong opinions about waiting beyond thanksgiving and I am making a decision as we Type !

Dutch
Regular Member


Date Joined Feb 2007
Total Posts : 400
   Posted 11/7/2007 4:08 PM (GMT -7)   

Pelahatchie:

Yes, proton is used as surgery salvage quite frequently. Tony has a "Videos" thread that I believe has some MD Anderson clips on it.  Also the www.protonbob.com site has some testimonials by men who had proton for salvage.

MJR:

I know there is quite a wait to get into Loma Linda - one of the gantries is closed for upgrading to new equipment, plus they never have a shortage of men wanting to go there.  If at all interested, ask to be put on a cancellation list.

Dutch


Diagnosed Feb 2001  (Age 65)  Currently 72
PSA 4.8      Gleason 3+3=6      Stage   T2b
Completed Proton Therapy @ Loma Linda - Aug 2001 - No side effects.
6yr PSA - 0.19
Our responsibility now is to educate men about Pca, PSA and the importance of early detection. 
 
 
 


lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 664
   Posted 11/7/2007 4:34 PM (GMT -7)   

Partin and Walsh have indicated that they do not recognize post surgical reoccurence until you have two or more psa readings of more than ( .2) .

I just had my nine month psa come up at a .02 .  My urologist suggests that we do nothing until my psa has at least two readings over .1 . 

Like you I start asking the question of when to seek follow up treatment.  I can be an alarmist, so my wife is essential in keeping me calm.

I read an article last night from Phoenix 5. Titled "What happens if PSA comes back after surgery?"

 http:// www.phoenix5.org/Basics/psaPostSurgery.html

Interesting reading and answered many of my questions.


 
Biopsy 10/16/06
T2A,  PSA 4.7
Gleason 4+4=8 right side
adrenocarcinoma of prostate
DaVinci Surgery 01/16/07
Post op report,confirms Gleason4+4=8
no extra extension/invasion identified
age 65
no continence problems
Back on the golf course...
90 day PSA  less than 0.01 (undetectable)
Six Month PSA still undetectable
Dealing with ED problems with Caverject/Viagra
nine month psa slightly elevated <0.02
 
 
 


Dutch
Regular Member


Date Joined Feb 2007
Total Posts : 400
   Posted 11/7/2007 5:05 PM (GMT -7)   

Lifeguyd:

Good article - should be put on PCDave's thread "Recurring Prostate Cancer after Surgery" if you can find it.

Dutch


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8122
   Posted 11/7/2007 6:11 PM (GMT -7)   
Hi Pelahatchie,
You would be receiving adjuvant, and not salvage therapy, but it doesn't really matter, you can use Proton or IMRT treatment for both. I did may post operative IMRT about 4 months after the surgery. I have heard others use the 0.4 number as the marker for when to delve into adjuvant therapies, but with my pathology me and my team decided to go on the attack and even without a PSA climb I am on hormone deprevation and completed IMRT in August. I feel fine. My RT was a breeze. The adjuvant use of RT is about 22% less exposure of the dose than as a primary treatment so either Protons or Photons will usually suffice. But if you are worried about side effects, perhaps review Protons or Tomo Therapy. But I have heard that you can wait a while, but my logic is..Why? If you have three readings that indicate a climb in PSA then why wait for a forth? Get another test and see if is climbing then make the call? Good luck in your decision.

Tony
Age 45 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007
Post-Op Pathology was poor: Gleason 4+3=7, 4 positive margins, Stage pT3b (Stage III)
HT began in May, '07 with Lupron and Casodex 50mg
IMRT radiation for 38 Treatments ending August 3, '07
 
My PSA did drop out after surgery to undetectable.  It has not returned and I will continue HT until January '08.
 
My Life is supported very well by family and friends like you all.
 
STAY POSITIVE!


Dutch
Regular Member


Date Joined Feb 2007
Total Posts : 400
   Posted 11/7/2007 6:28 PM (GMT -7)   

Tony:

For my benefit (and maybe others) please explain why this would be adjuvant and not salvage.  Thanks and glad all is good with you.      Dutch 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8122
   Posted 11/7/2007 8:19 PM (GMT -7)   
Hi Dutch,
Glad to. Adjuvant treatment is done in conjunction with another primary treatment(s) in search for a cure. Slavage therapy is done to improve the quality of life when a cure is improbable.

For example, All of my treatments after surgery have been done because I chose to add them in hopes I would beat the statistics and not ever have the disease relapse. They have been done as adjuvant treatments.

In the case of an individual with advanced prostate cancer in a great deal of pain, say in the hips or legs, they can elect to have radiation performed where an accumulation is identifiable in hopes that the pain will reside or that the treatment will add time to ones life. That is salvage treatment. At any time during an incurable disease can be made less painful or more manageable, the treatment would be considered salvage treatment.

In Pelahatchie's case, he is surely hoping by adding radiation he can stop any progression from leaving the local area and return to remission, which by the way he may still be in. I would also suggest that he consider talking to his medical oncologist about a brief stint on hormone deprivation to shrink the target before hitting it with RT. This logic is common when considering adjuvant RT.
 
From the Journals:

Salvage therapy: A final treatment for people who are nonresponsive to or cannot tolerate other available therapies for a particular condition and whose prognosis is often poor.


Adjuvant therapy: Treatment that is given in addition to the primary (initial) treatment.

Adjuvant treatment is an addition designed to help reach the ultimate goal. Adjuvant therapy for cancer usually refers to surgery followed by chemo- or radiotherapy to help decrease the risk of the cancer recurring (coming back).

In Latin "adjuvans" means to help and, particularly, to help reach a goal.

Tony


Age 45 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007
Post-Op Pathology was poor: Gleason 4+3=7, 4 positive margins, Stage pT3b (Stage III)
HT began in May, '07 with Lupron and Casodex 50mg
IMRT radiation for 38 Treatments ending August 3, '07
 
My PSA did drop out after surgery to undetectable.  It has not returned and I will continue HT until January '08.
 
My Life is supported very well by family and friends like you all.
 
STAY POSITIVE!

Post Edited (TC-LasVegas) : 11/7/2007 9:41:44 PM (GMT-7)


Dutch
Regular Member


Date Joined Feb 2007
Total Posts : 400
   Posted 11/7/2007 9:34 PM (GMT -7)   

Tony:

Thanks alot - I have been using the wrong term and will correct that in future postings.  I too have read that HT along with RT is one of the new formats that are being suggested.

Thanks again.   Dutch



sterd82
Regular Member


Date Joined Sep 2006
Total Posts : 187
   Posted 11/8/2007 6:25 AM (GMT -7)   

Here's another two cents worth....

A lot of Docs consider <.1 as undetectable because the older PSA tests (and some still use them) only go that low.   THe newer tests go lower.

I had IMRT, and the line in the sand I drew was .2 on post-RP PSA (it hit .24)....I didn't wait around for another rise at that point.  THe best I've read was that you want to get the treatment as long as you are south of .5.

My doc seemed to think the bouncing around under .1 was was just testing noise.   With a YOUR moderate Gleason, and good pathology---this could well be thye case.

I got on well with HT and RT combined, but I DO have lingering side effects --- some stress incontinence and some rectal problems.  I already had ED, so I can't tell you anthing there, except that radiation sure won't HELP you in that area.

You might want to set up a consultation with a good radiologist/oncologist and get their take on at what point they would want to treat you ---can't hurt!   GOOD LUCK.......


Sterd82
Age 47
Open Radical Prostatectomy 6/9/2006
Pathological Stage T3a, Positive Surgical Margin
Gleason 3+4
PSA rose to .24 in November of 2006
6 month hormone therapy initiated December 1. 2006
36 sessions of IMRT Ended Feb 1, 2007
PSA as of May 25, 2007 undetectable
Next PSA November, 2007


Pelahatchie
Regular Member


Date Joined Jul 2007
Total Posts : 86
   Posted 11/8/2007 7:05 AM (GMT -7)   
Thanks for the responses guys.  I have another test Dec. 10th.  I am off to the Missouri/Iowa border from here in Mississippi for some whitetail deer hunting for the next week so hopefully I can keep PSA off my mind.  I'll keep you posted and it does help to discuss these things.  Thanks again.

DX 8/05 Gleason 5, Mayo clinic Second Opinion Gleason 6, PSA 2.8
 
Da Vinci surgery Dr. Dasari, Centennial Nashville 9/24/05
 
Pathology Report Gleason 6, 15 % on left side only very near to the edge of capsule, too close to call on margins, doc's said to watch it very closely, final decision T2A
 
PSA's have basically ranged from <.04 to .05 for two years.
 
no E.D. and no Incontinence, feel very blessed
 
PSA Nov 07 = .06


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8122
   Posted 11/8/2007 12:49 PM (GMT -7)   
Good luck on the hunt. It's great excersize, and it keeps my mind on track. I will be heading North near Idaho in about two weeks. I don't have the tag but I will be a spotter for my buddies. Funny though, they are mostly cops and I have to be the designated driver...Talk about the fox watching the hen house... :-)

Tony


Age 45 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007
Post-Op Pathology was poor: Gleason 4+3=7, 4 positive margins, Stage pT3b (Stage III)
HT began in May, '07 with Lupron and Casodex 50mg
IMRT radiation for 38 Treatments ending August 3, '07
 
My PSA did drop out after surgery to undetectable.  It has not returned and I will continue HT until January '08.
 
My Life is supported very well by family and friends like you all.
 
STAY POSITIVE!

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