Radiation before PSA rises

Bill,
I don't remember your statistics. What was your Gleason, path report etc?

I had the same advice based on a pt3b N0 MX path, I was/am afraid of the possibility of radiation side effects (had GREAT recovery from surgery) and am crossing my fingers and waiting.

Post up your stats it will probably help folks know where you're coming from.
Dave in Durango CO

EDIT: Just checked your profile and found a post with a sig', With T3b and positive lymph nodes (2 of 9 it looks like) I'd be on the table so fast my head would spin.

Sorry I forgot my signature. I couldn't beleive post surgery PSA either.  I always thought once it was in the nodes that PSA would not go to 0.00.  Here is signature. 

Mr. Bill,

I vote for radiation now. I would also consider HT.

Jerry L.

Dave,

May I ask what side effects led to you veto?  I have read some possible side effects, but feel as if I have missed some.  The  thing that amazes me is the Surg and Rad doctors saying they where going by gut feeling.

Thanks,

Bill

 

Post Edited (mr bill) : 1/10/2011 5:26:58 PM (GMT-7)

mr bill said...
Dave,
May I ask what side effects led to you veto? I have read some possible side effects, but feel as if I have missed some. The thing that amazes me is the Surg and Rad doctors saying they where going by gut feeling.

Thanks,

Bill

Sure Bill, keep in mind this is just my views/fears and since our path is a bit different you may want to be more aggressive.

1. ED, I am lucky enough to be regaining function fairly well, radiation can cause problems down the line, especially if the nerves are already banged up (supposedly). The rad oncologist was quite up front about this, said percentage was 30-50% with a decrease in function (for salvage).

2. Strictures, my rad oncologist was quite honest (the 2nd one, first one was a total %i@@) about the chance of either taking a hit in the continence area or oddly going the other way and causing blockages, seems like it can go either way.

3. The percentage advantage of Adjuvant vs. Salvage is supposedly about 10% better long term survival. For me (given the lack of lymph node involvement and undetectable PSAs) just wasn't enough to do something that may not be necessary.

4. Both my Uro' and the rad guy said there was a chance that the surgery (cauterization) may have killed the cells on the small positive margin, and if it hadn't spread already the surgery would be the end of it.

Now, your pathology is worse than mine was, I was 8 with tertiary 5 (not much less than a 9 but some) and I had 12 clean nodes. This plus a possibly unrealistic opinion of my immune system (kill that positive margin dude) lead me to wait and see. If I'd have had lymph involvement it would have been a different story.
Dave in Durango CO

EDIT: I like doctors that go with their guts, and are honest about it. The gut is usually hunches based on experience, not just books/studies.

Post Edited (daveshan) : 1/10/2011 9:03:44 PM (GMT-7)

I would hit it hard while it is at its weakest. If you give it a chance to regroup and start growing again there will be more to kill and potentially in areas that the radiation won't reach.

Two weeks ago I just finished 25 IMRT sessions and did not have any side effects. No skin burning or urinary or bowell issues. They hit the gland plus about 5mm margins and the lymph nodes. I also had two HRD sessions (which you won't have due to the surgery) and apart from some tenderness, swelling, and bruising, all is fine. I am also on Eligard and Jalyn. My Gleason was 3+3, 3+4, and 4+3 and T2b.

My team all agreed to be aggressive and get it all now and not worrying about whether or when to do salvage work. This is very much in line with Snufffy Meyers in Virginia, who appears to be very guided by studies, but clearly practices from his own views and experiences....the gut factor. I think the best docs use both.

Bill,

Have a look at the daily update thread I did during my IGRT (see sig. below).
My pad use has stabilized now at 2-3 per day (it was 1, sometimes dry at the end of the day, before RT started).
Stream is unchanged.
Bowels - yeah, that too, up from 1 bm per day to 3, sometimes 7 or 8. Not diarrhea, just frequent, as if the colon just can't stretch.
Fatigue - has gotten a little better, but still have to take a midday break.

mr bill,
my experience with rt after rp has been almost problem free. i understand perhaps there is a chance of dealing with some not so pleasant stuff later on, but for now the only real issue is ed. my rt ended about eight months ago. incont. never got so bad that i needed pads and bowel movements are a little more frequent. like almost everyone else, i did have some fatigue during and after for a while.
i also chose to go the aggressive route and opted for rt after rp when psa was very low. first psa after rp was 0.02 and second test was 0.05. both docs agreed to not give it a chance if we don't have to.
good luck whatever you decide.