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Initial consult today RT

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Posted 1/20/2011 3:41 PM (GMT 0)
Had a consult with Uro surgeon on 12/1/2010 after RP on 9/8/2010.  PSA was 0.00 on 12/1/2010. It was 32.0 pre-surgery. However, onc. surgeon recommended RT within one month. Consulted with Rad. Onc. at Cleveland Clinic (great guy and easy to talk to).  He felt comfortable with therapy being done local at Regional Cancer Center in Erie, Pa.  I don't know if it was the fear or the low PSA that caused me to drag my feet.

 I go for initial consult today 1/20/2011.  Hopefully they will get simulation done and then start up the machinery asap.  As I am a little late in starting.

My question:  Can anyone offer any questions that I should ask Rad. Onc.?  I have a few but somehow feel they are lacking. 

Posted 1/20/2011 5:13 PM (GMT 0)
What is your radiating target area.
How many Gray's will I get and over how many sessions.
What prep will I have to do each day before treatment?
How many, if any days can I miss?
What type machine will you be using?
Will you use any inserted marker system?
What is your experience with this treatment, how many have you done.

That's a start., good luck, sorry you are having to do this so soon after surgery.
Posted 1/20/2011 5:18 PM (GMT 0)
James,

I guess that is my concern after looking at PSA. However, I am basing my decision on what uro surgeon said.

Thanks for the questions.

Posted 1/20/2011 5:41 PM (GMT 0)
hey, Mr. Bill !  looks like James gave you a good starting point...most of us didn't do the RT until we saw increase in PSA after the RP, but with your statistics, the docs want to get right on it....you'll find Rad to be no big deal for the most part, usually not too taxing to fit into your schedule.  keep checking in, and keep us posted on your progress..take care

bob

Posted 1/20/2011 9:02 PM (GMT 0)
Mr. Bill -

The timing seems ok based on what I was told - being that my surgeon wanted 18 weeks of healing time after DaVinci.

It will take them a week or so to do the radiation plan. If they implant markers (meaning something akin to a biopsy procedure), that will also have to heal a bit.

James' list looks good.

Don't let it scare you, as mine was fairly uneventful, but my "daily blog" is in the thread in my sig.

 

Posted 1/20/2011 10:30 PM (GMT 0)
Just got back from local rad. onc.  he wants to do hormone and rt because of positive nodes.  I was hoping he would say wait on RT. Nope, wrong again, now he wants to toss in HT.   The surgeon at Cleveland said RT without HT.  Same with the rad. onc. at clinic. 

Now this guy, who seems to know what he is talking about, wants me on HT for two years.

I think I am going with just the RT.  They do have the trilogy equipment, even though it is not rapidarc it is real time scan.

Anybody got any ideas?

Posted 1/20/2011 11:14 PM (GMT 0)
mr. bill, don't laugh, but these are good questions to ask, since I have been through 2 bad RT's in my life

do you have many alignment problems with the machine i will be on?

will i have mostly the same operators each time?

is your machine up to current codes and mods?

if he offers you less than 70 gys, ask him why?

david
Posted 1/21/2011 1:31 AM (GMT 0)
Those all sound like good questions, to the point.

Thank you
Posted 1/21/2011 4:51 AM (GMT 0)
I had my initial consult on IMRT this Tuesday after my RALP about 3 weeks ago. I was a little surprised that the Radiation Oncologist was a little indifferent about me starting RT right away and he definitely stated that I don't need hormone therapy. I'm now in the dilemma of deciding about RT...however leaning that direction. I will have my 6 week followup with my ureo and should get my PSA tested.

Bobr
______________________

Age: 54
Routine Physical on 10-20-2010 DRE Normal
PSA 4.3, up from 0.6 5 years prior
PSA 0.6 on 10-25-2005
PSA 0.4 on 7-30-2004
PSA 0.5 on 5-9-2002
Followup with Urologist on 11/10/2010 after elevated PSA; DRE noted slight bump
November 30th, 2010 had prostate biopsy.
December 9th, 2010, Biopsy results 3 of 12 cores positive.
LLB: Gleason's 4+3=7, 11 MM Tumor Length/15MM Core Length (73%)
LLM: Gleason's 4=4=8, 12 MM Tumor Length/15MM Core Length (75%)
LM: 0.1 MM Tumor Length (1%)0.1 MM Tumor Length
Urologist recommended robotic removal using da Vinci method.
RALP Surgery 12/27/2010 Released: 12/30/2010
Thunderbird Banner Hospital, Glendale, AZ
Post-Surgery Pathology: GS 4+5=9
Pathologic Staging: pT3a, N0, MX; location: Left Side; Volume: 10%
Margins: Left posterior inked margin focally involved
Extraprostatic Extension: Observed
Seminal vesicles: Not observed
Lymphatic/Vascular Invasion: Not observed
Catheter: Removed 15-days after surgery
Posted 1/21/2011 5:58 AM (GMT 0)
The lymph node + and the Gleason 9 means you are high risk. My post op PSA was 0.9 but they still think it's localized.. I'm getting 73 Gy, 1.8 per dose, 40 treatments, Eligard (Lupron) for 2 years..

I talked with 3 doctors, 4 actually, and they ALL agreed that RT + HT started as soon as I was able gave me my best chance for survival...My R-doc says that when HT is combined with RT, the success rate for the SRT goes up almost 20% for guys like us...I just had treatment #23 today, so far a piece of cake...
Posted 1/21/2011 6:06 AM (GMT 0)
Fairwind - thanks. My lymph nodes (4 node sampling) were negative/not observed. Does that change anything in your opinion? I am definitely leaning toward RT...but was a little surprised that my R-doc didn't recommend HT for me at this time.
Posted 1/21/2011 6:50 AM (GMT 0)
I would hit your R-doc with this: "Several good studies have shown that by adding HT to the radiation treatment the success of the treatment is measurably improved. Do you disagree with this finding?"..

In my case, I RESISTED my R-docs insistence on 2 years of HT..I wanted no part of it..So I got second opinions from my U-doc, my surgeon, my family doc and talked with a recognized expert at a large university research center..They all agreed. For high-risk (Gleason 9) with a positive margin following surgery, radiation and hormones was was the way to go as soon as possible after surgery...Their viewpoint: "You have the most aggressive form of this disease and you need the most aggressive treatment we can provide"..
Posted 1/21/2011 6:58 AM (GMT 0)
Fair wind,
I'm in total denial about HT also. Have you had any side effects?
Posted 1/21/2011 11:06 AM (GMT 0)
Fairwind and Brampy,

Much like Brampy I am in denial also. Getting a little paranoid about the HT. I guess I see the Treatment Center looking at the "business" end of cancer treatment. 

I find it very confusing.  RT scares me a little, but HT has me talking to myself.

 

Posted 1/21/2011 12:00 PM (GMT 0)

Mr. Bill,  I went through the same HT questions that you are asking.  For me it was an age related decision.  I am 74 and there simply isn't any data that suggests that I will live longer by starting HT now or waiting until later.  Here is a paragraph and link to a recent study that reviews everything we know about SRT:

"There has been a paucity of data in the literature examining the efficacy of a combined approach of salvage RT plus androgen ablation therapy. Furthermore, there has been no published phase III study demonstrating the benefit of adding androgen ablation therapy to salvage RT for patients with post-RP PSA relapse." The link: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2848745/. 

Like Fairwind, I just had treartment #24 and no problems so far.

Carlos

Posted 1/21/2011 12:43 PM (GMT 0)
Carlos,

Glad to hear your RT is going well. That is encouraging.

Then you did consider HT before starting the radiation?

Have you ever heard of having a colonoscopy beforen RT?  Erie onc. wants to do one.  Even though I have no symptoms of a problem.

Mr Bill

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