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Posted 4/23/2010 11:18 AM (GMT 0)
I am still looking to hook up with an oncologist; in the meantime something continues to go through my mind that I just don't quite understand:

Many of you have have radiation following surgery. (1) Have any of you had radiation following surgery where nothing more was noted other than a high GS (ie, no perineral invasion, clean lymphnodes)? To me that is a giant-sized crap-shoot but one which I would take, if the onco suggested it AND if insurance covered it. I would assume that the radiation would cover the entire prostate bed and as many adjacent lymphnodes, as possible. So that brings me to question 2. (2) if your answer to question 1 is yes, did insurance cover the radiation treatment?

Thanking yinz in advance.

Joey G

 

Posted 4/23/2010 11:28 AM (GMT 0)
Hi Joey...sure you'll be hearing soon from many who have gone (or are going through) salvage radiation after surgery.

PCa is a crap shoot. While a high Gleason score indicates a more aggressive form of PCa, not having any adverse pathological findings (EPE, positive margins) is NOT a guarantee against recurrence. Likewise, having one of these does not mean you face recurrence down the road.

Checking out the signatures of some of our guys who faced SRT after surgery, you will see some good surgical pathology reports and some not so good.

The extent of radiation (prostate bed only vs. a wider area) would be determined by the radiation oncologist based on numerous factors, including the surgical pathology report. I do not know how it would work with a patient who had cryo as the primary treatment. I wonder if bracytherapy (seeds) would be possible for you at this point? Others will chime in so stay with us.
Posted 4/23/2010 11:42 AM (GMT 0)
Sephie,

Thank you for your thoughts!

As to brachy, that would not work. The prostate gland is both very tiny and very dead. The only possibility would be to radiate the area. Ah,somehow I think, its more of a crap-shoot than winning the lottery. Its really too bad scanning cannot give better results; that would take a lot of guess-work away.

Posted 4/23/2010 11:56 AM (GMT 0)
Joey, I was a gleason 8. Which I found out from the pathology report. I went into surgery with a biopsy result of (3+4). Needless to say that I was pretty bummed out. I went to my surgeon and a medical oncologist to see what additional treatment I could have. Both said that since my tumor was fully contained in th prostate that I should wait to see if the PSA rises. I found out later that unless you are clearly at high risk for a recurrence (positive margins, lymph nodes, epe...) then it is best to let youself heal from surgery and get some function back than go straight to radiation. Frank
Posted 4/23/2010 12:05 PM (GMT 0)
Joey

I live in Holland so the insurance aspect of your question is not relevant as all my treatment is covered.

Even though my post op pathology showed seminal vesicle invasion, and I was upgraded from Gleason 6 to 7, they did not want to give me radiation therapy straight away after surgery.
They said they would wait till my PSA showed signs of rising and that only when it went over 0.2 would they want to use RT.

That is what happened and so I start RT on Monday morning, which will be nearly 9 months after surgery.

Alf
Posted 4/23/2010 12:22 PM (GMT 0)
Joey, hopefully some of our more experienced members will chime in soon. As to further tests, I've read about the ProstaScinct (not sure of the spelling) but is not always accurate.

Have you spoken with a medical oncologist yet? They may give you some insights that will help you make as informed a decision as possible.

As to insurance coverage, in the U.S. our insurance carrier would have covered my husband's salvage radiation if he needed it so there were no issues there. You may want to give your insurance company a call and chat about what they'll cover including further tests and second/third opinions.
Posted 4/23/2010 4:00 PM (GMT 0)
Joey,
The only thing they can do is take a biopsy of the prostate bed to see if it is still local. I would also look into a color doppler ultrasound and this may be able to distinguish some remaining tumor. With a low psa there is no scan that will pick up PC anywhere else in your body, so don't waste your time or money. They may want to radiate the pelvic area along with the prostate bed; I would ask you oncologist about this. If they can identify a local reoccurrance then salvage would be a good option. It they can't then it is a crap shoot with your only other option being HT.
JohnT
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