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3 Month PSA post DaVinci is rising

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Posted 12/14/2011 8:15 PM (GMT 0)
Hi guys,

Well I guess igrt will be sooner than later. My 3 month PSA is .47 up from .039 from the 1 month post DaVinci. How worried should I be? What should I do from here? Radiation to prostate bed and Lymph nodes as well? Do I start HT as well? Your insight is greatly appreciated. I'm worried about the wife's reaction later...

Thanks, Mike

Posted 12/14/2011 8:46 PM (GMT 0)
I didn't say you could join my club - you're supposed to be a Zero guy!

OK, I did adjuvant IGRT, link below has the "journey". There isn't much difference in timing between us - my path was so bad we just decided to do it.

What to ask? Wouldn't we all like to know. I guess the big question I never asked, and had to figure out, was what they actually targeted. Since my lymph nodes were clear, it was just the prostate bed. Eighteen months later and a rising PSA, that might prove to have been inadequate, or the micromets were already out. No way to know.

Just be sure you have as much healing done as possible, since my RT pretty much set where I was in stone.

I did not do HT with mine, and there is equal disagreement about that. The uro/surgeon felt then, and still believes that it would not have helped. The RO wanted me to do it, but didn't give any statistics that it really might help.

Dang, got to make room for another member in this club.

Posted 12/14/2011 9:52 PM (GMT 0)
Mike,

From a fellow T3b: 142 hit on the right questions .. two big ones really:

1. HT or not?

2. Lymph nodes or not?

I chose adjuvant HT and had my lymph nodes included as adjuvant treatment .. both on my radiation oncologist's advice. The Bolla study (and a few others) offer a compelling argument for HT combined with RT.. but that is with radiation as a definitive therapy. There are no clear-cut studies on HT with salvage or adjuvant radiation. My philosophy was to be aggressive and go for a cure .. go all in so to speak .. my PSA was in the 50s and I am a Gleason 9 T3b -- not the best prognosis.

If at possible, you should be be completely dry before starting radiation.

Posted 12/14/2011 10:33 PM (GMT 0)
Dr. Myers states that the lymph nodes are the most logical place for the PC to go. Makes sense to me. For me, I have decided that if salvage RT is necessary, that i will do full pelvic.

Good luck. Hope you are successful in keeping your wife calm. It really is a kick in the gut. Perhaps reviewing the cases of many guys on here who have found success with ART will help.
Posted 12/14/2011 11:26 PM (GMT 0)
Mike -- i'd say with your numbers you should be very aggressive,  and ASAP!  good luck to you.

ed

 

Posted 12/15/2011 12:34 AM (GMT 0)
Thanks guys,

I'm pretty dry. I wear a lady pad for the occassional tiny squirt. I'd say 95%. Good enough?

I'll tell the wife in a few minutes. Oh boy...

Thanks, Mike

Posted 12/15/2011 2:24 AM (GMT 0)
Mike,

Good luck talking to your wife. My wife has been with me every step of the way. She even goes to many of the dr appts with me to listen in, ask questions, etc.

On how dry is dry: my rad onc has me fill out a urinary questionaire every so often. One of the questions -- "rate how happy you would be if your urinary control remained this way the rest of your life." I think it is a 1-10 scale or something like that. You can ask yourself that question .. is an occassional tiny squirt ok if that is good as it ever gets?

Posted 12/15/2011 2:39 AM (GMT 0)
You are in a fight for your life, so you hit it as hard as you can..Start the HT ASAP. Figure two years..But they may have mercy and let you off with one..Then aggressive SRT . Full pelvic with a "Boost" to the prostate bed at the end..Try to be treated on a modern machine, something less than 10 years old..Ask if there is a Varian RapidArc available, that will get your R-docs attention.. The radiation will stop any further progress with the incontinence so work on improving that..

Your wife is NOT going to like the HT.....it will affect her more than you...But it's pretty certain it increases your chances by about 30%...Best of luck to you...
Posted 12/15/2011 2:30 PM (GMT 0)
I am in the aggressive camp and that is what all my doctors prescribed from the start. Those of us that have the "tiger" type of PCa must not let our guard down.....once this stuff takes hold it is tough to shake. I am 15 months into HT and the main problems are hot flashes and weight gain. Diet and exercise have helped with both. I expect to be on another year. I would definately include Avodart in the ADT mix as it supresses the very powerful DHT. I use Jalyn that includes Flomax. Good luck and be sure to jump on this.
Posted 12/15/2011 6:06 PM (GMT 0)

Hi Mike and guys. I'm fairly new here but have an interesting story to say the least. My psa was 6.7 before

robotic at Henry Ford in Aug. and seven weeks later was 6.9. Many questions but only HT for now. Had my first shot six

weeks ago and so far no side affects whatsoever. We will do an early check of psa in Jan. just to make sure. We will

go anywhere for the right treatment. Don't like our urolsgist here in central Illinois. Can anyone recommend a good

oncologist? Chicago, St. Louis-anywhere?

Jim

Posted 12/15/2011 7:57 PM (GMT 0)
Thanks everyone,

My HT therapy starts this Tuesday. What shot should I expect? Is there a choice? Should I insist on Avodart as well? My oncologist referred me back to the Uro for the HT. The Uro isn't real explanative in nature.

Also, is it normal for the Radiation Oncologist to send me back to the Uro?

Thanks, Mike

 

Posted 12/15/2011 8:16 PM (GMT 0)
Mike -- my urologist administered my three lupron shots while i was being treated by the radiation oncologist.  so for me it was normal.  my situation was a bit different because i was receiving combination treatment.  i'm really happy to hear you are getting your first shot soon! best of luck to you.

ed

 

Posted 12/15/2011 8:22 PM (GMT 0)
Thanks Ed,

So Lupron is the drug?

Posted 12/15/2011 8:30 PM (GMT 0)
Mike -- it's one of the main drugs used in hormonal treatment.  in your case i'm not sure but they may use two or three drugs.  the good thing is you are in "action" but i'm just not sure of the details of your case.  i was given lupron to halt and shrink my cancer while it was being zapped by seeds and IGRT.

ed

 

Posted 12/15/2011 9:53 PM (GMT 0)
Mike,

My uro administers the shots. It is likely Lupron or Zoladex .. same thing really .. different injection methods. There are different interval formulations .. 1 month, 3 months, 6 months. If it is Lupron, expect a sore butt for a few days.

Posted 12/15/2011 10:28 PM (GMT 0)
Thanks SC and Ed. How long after first shot would you say the IGRT should start? Is there an optimal wait period or is sooner better than later for the IGRT to start?

Thanks, Mike

P.S. i'm glad to see the libido did not disappear SC. The total ED is bad enough but I'm hopeful the libido will still be there.
Posted 12/15/2011 10:31 PM (GMT 0)
Jim:  Just curious-- who did your surgery at Ford. Dr. Menon did mine.

Mike: It seems it might be worthwhile to consult with a good medical oncologist, preferably one who specializes in PC, once you get to the HT stage.

If I do the HT, my urologist will administer the shot (actually, her nurse). But it will be after I reach a decision after consulting with an oncologist.

Mel

Posted 12/15/2011 10:35 PM (GMT 0)
Mike,

I think you can start IGRT concurrently with HT. It is probably more of a logistics issue .. you will need to have a planning/simulation session, get scheduled, etc for treatments. That takes a little time.

Posted 12/15/2011 10:35 PM (GMT 0)
Hi Mel,

I think the radiology oncologist I have is great. People rave about him and he does almost all pc now. I trust him. The uro will inject what the oncologist suggests I assume but will find out for sure.

Thanks, Mike

By the way, how do I update profile?

Posted 12/15/2011 10:57 PM (GMT 0)
Never mind...Figured out the profile thing. The My Profile button must have been too big.
Posted 12/16/2011 2:17 AM (GMT 0)
Mike, my Uro gives me the Eligard shots each six months. My med-onc is on board and talks every few months with my uro and rad-onc as they track my progress. I am on Eligard for 2-3 years (about 15 months so far) and will be on Jalyn (Avodart and Flomax) indefinately. I would strongly suggest Avodart as it supresses the very powerful DHT and has minimal side effects.

The LHRH drug (Lupron/Eligard type) will lower testosterone and will give you hot flashes and weight gain. Take a good look at your diet and exercise to offset the side effects. I found that eliminating caffine and exercising every day has been very beneficial. Get the book by Dr Snuffy Meyers "Beating Prostate Cancer with Hormone Therapy and Diet". A great guide and very optimistic even for us high risk guys.
Posted 12/16/2011 2:45 AM (GMT 0)
mike -- i had BT before IGRT.  my doctors wanted to give the HT a chance to work so there was a lapse of about two months from the first shot of lupron to the implantation of the seeds.

the nurse that gave me my shots was very good.  i always complimented her on her compassion and she liked that.  the lupron came pre-loaded in a syringe which came in a plastic jewel case. oh, it's a big syringe and the needle is huge.  it reminded me of the penicillin cartridges my dad used to hit me with when my tonsils were swollen (he was a nurse).  anyhow the nurse always rolled the syringe between her palms to "warm up" the lupron and then she injected the stuff slowly.

i never felt any pain during or after the injections and i am a coward!  the last two flu shots i got at the drug store hurt alot more and for days.  i really believe the nurse's diligence paid off.

ed

 

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