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Radiation Therapy after DaVinci

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Posted 2/29/2012 10:03 PM (GMT 0)

Hi all, haven't posted in a long while... but recently I was involved in a discussion. I was wondering, what are the thoughts on radiation therapy after surgery.  There is no rise in PSA 18 months post op and gleason score was downgraded to a 6 after surgery. There was a 1mm focal postitive margin at the bladder neck. Would there be any benefit to getting radiation or does the risk out weigh the possible benefit at this point since there is no rise in PSA?

Posted 2/29/2012 10:35 PM (GMT 0)
If I were you, I would monitor my PSA closely and have a plan in place for radiation should it rise. IMHO, there's not a whole lot of difference in outcome between adjuvant and salvage radiation when the salvage is done early enough. (before PSA reaches 0.5 optimally, and if you miss that mark, 1.0).

Since you can end up with additional side effects--or even be injured--from the radiation, and you apparently are low on the aggression scale, I would not do radiation now. There's not enough of a statistical edge to be gained by radiation now, weighed against the likelihood that a.) you may very well never have a recurrence and b.) your quality of life could take a hit.

I know the positive margin is ominous, and others may differ in their opinions. I would listen to them. Since our cases were not too dissimilar, I thought I would comment. I am, of course, not qualified in any way to give medical advice, so don't take this for more than it's worth.

Best wishes.
Posted 2/29/2012 11:12 PM (GMT 0)
Thanks brother..... appreciate the reply.  So far PSA still <0.01 ... been checking it every 4 months or so.

 

Posted 3/1/2012 12:52 AM (GMT 0)
Galileo put it quite well.

Michael

Posted 3/1/2012 2:40 AM (GMT 0)
Without any demonstrated need for radiation, your insurance company will certainly have something to say...
Posted 3/1/2012 3:20 AM (GMT 0)
If your uro/oncologist suggests it, you would want to consider it. Otherwise ....

I've done both, and only after careful consideration and a reality check on side effects, most of which happened to me.

 

Posted 3/1/2012 3:51 PM (GMT 0)
142,

When you had yours.. was your PSA going back up after the surgery?  One of my other concerns is... what if the cancer would not be isolated to the prostate bed but actually travels elswhere?  Guess that'a another question for the Rad. oncologist.

Posted 3/1/2012 5:51 PM (GMT 0)
Just my opinion...

As stated earlier, I would closely monitor PSA going forward and save Radiation till needed if ever. Your numbers would suggest to me that there is a good chance they got it all. Down the road, if the PSA creeps up, you and RO could make decision on treatment options. In my case, 1 month post-op PSA was .037 which I thought was pretty good.  2 months later, it had risen to .49...not good. Indicated my cancer was certainly aggressive and on the move. With my numbers, the SVI and the quickness of PSA rise, HT and IMRT decision for me was a no-brainer. The potential SE of any adjuvant treatment is real and for some here, very severe. Most most, the SE are thankfully much more tolerable than in the past. I am certainly not an expert as I still have more questions than answers. Just wanted you to get another opinion and observation. FYI, after 3 months of HT and 2 weeks of IMRT, I am doing well with both procedures with very little SE except for the occassional hot flash.

Best of luck to you and hoping you'll never have the need for future treatment of any kind!

Mike

Posted 3/1/2012 6:35 PM (GMT 0)
I was a Gleason 9 (4+5), and had multiple extra-prostatic extensions (i.e. positive margins, out of the capsule). My first post-op PSA was <.1 (undetectable), and the one a few weeks before starting RT was also undetectable. However, my uro, and all the several other doctors I talked to about it, were insistent that it was needed.

 

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