HealingWell
Search Close Search
☰

What do I need to look into?

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 3/16/2012 1:45 PM (GMT 0)
Well, I have an onco appointment next month and before I go I need a baseline of issues I should look into. Should I seek savage radiation or hormones? Seeing that my surgery failed, psa 2.9 on march 1, does it make any sense to try SRT radiation? Seems like a far shot for psa reduction but I am open for thoughts. I am waiting to take another psa test in april. after Easter before seeing the Onco. lastly, if the onco starts talking hormones, which he probably will, what am I to ask about it. Totally lost and alone here other than you guys. Thanks from the bottom of my heart.
Posted 3/16/2012 1:58 PM (GMT 0)
Pax,

Sorry that apparently the surgery failed to get all the prostate or cancer cells. From the brief pathology in your signature nothing indicates that any of the cancer was found in the margins or outside of the organ. I am not an expert but I would think some prostate tissue is still in the prostate bed and a round of SRT may be called for to clean them out. But only your doctors can be sure on your future but as in any case get more than1 opinion on treatment.  Good luck on your journey.

Terry

Posted 3/16/2012 2:00 PM (GMT 0)
From what I read/understand, without a positive margin there's not a lot of point in SRT as there's no particular reason to expect that the escaped cells are hanging around the prostate bed, as would be the case if you had a positive margin. You don't have a logical place to point the thing at.

I don't claim to be particularly expert, just what I pick up as things go by - and radiation can cause negative effects that you might do better to skip and head right for hormone blockade, with less total damage.

Look into everything, so you can have an intelligent discussion with the doctor, but also leave some room for the doctor to work.
Posted 3/16/2012 2:08 PM (GMT 0)
Hi PaxNova

Ok brother, take a breath. You have time and there is nothing to say the PSA will not go down in April.

For Hormone Treatment - there are basically two approaches

1. Casodex plus Lupron (Eligard)
2. Casodex plus Lupron (Eligard) plus a 5-alpha reductase inhibitors - finasteride/Proscar or dutasteride/Avodart

You will want to start with the Casodex for about 2 weeks prior to the first Lupron (Eligard).

There are a number of 'myths' floating around on HT. I found this paper by Dr. Snuffy Meyers to be very interesting

www.prostate-cancer.org/pcricms/node/203

Are there side effects to the HT? - Ayup - hot flashes is fairly common - but you may never encounter that.
A sudden want to go shoe shopping has been reported by one of our brothers who will remain nameless but we all know its Todd (livingwell) (just goofing on you Todd! hugs!) - I've yet to experience that side effect.

My suggestion - put the PCa crap out of your mind, go enjoy life, when you have your PSA test in April than start thinking about this crap again.

Bud
Posted 3/16/2012 2:26 PM (GMT 0)
You definitely are in the market for a secondary treatment. I too had a fast failed surgery. I went through SRT, and for me - it was a major disaster that has left me with severe chronic pain, a urostomy, etc - rare, perhaps, but bad things can happen with radiation.

Due to my circumstances I was only given a 20% chance that SRT would even help. As someone spoke above, exactly what are they aiming for with the radiation. In my case, the remaining cancer wasn't even in the prostate bed, and the radiation failed as fast as my surgery.

In hindsight, wished I had never had the radiation, the low odds of sucess were not worth the hell and damage that it caused my body.

As the result, I have a fast rising PSA at 14.0 (12/11) and no easy course of action to slow things down.

You need to see a very good oncologist and get an opinion from a good radiation oncologist. You really need to think this next move through very slowly and carefully.

The trouble with radiation after a failed surgery, is that they really don't know where the cancer is located. They hope its in the prostate bed, but it could be a lot of micro-mets going on in your body way out of the prostate bed.

I wish you the best ,as you contemplate your next move.

David in SC
Posted 3/16/2012 2:47 PM (GMT 0)
In light of my earlier post about SRT, Purgatory is unfortunately for him, the resident expert in this forum on failed surgery and failed SRT so I would give his opinions a lot of credibility. The key thing for you will be finding a good radiation and/or medical oncologist with a vast success in dealing specifically with prostate cancer.

Terry

Posted 3/16/2012 3:23 PM (GMT 0)
Terry, David, Bud and others. Thanks for your input. You guys are incredible. Working to be an optimist - Jimmy
Posted 3/16/2012 3:32 PM (GMT 0)
PaxNova: I really feel for you brother. My stats are very similar to yours, and I'll be getting my first PSA in a couple of weeks. I have a few thoughts. According to your path report you should be good to go, but according to your PSA you had a failed surgery. I think someone screwed up, and I hope and pray it is the PSA test. I would try to get as much enjoyment out of life for the time being and wait for the next test. Just my thought on your situation.
Posted 3/16/2012 3:53 PM (GMT 0)
Pax, I had failed surgery and when my psa reached .20 at 7 months, I had the SRT however,  my psa was .40 about 4 months after SRT so it also failed.  I had one the best Rad Onc at Mayo who told me before the SRT that it was 50% chance of success so I did it but it failed.  Now on HT.  I would wait another few months, get another PSA and if upward trend, consider HT because following SRT, I had some bowel and urinary problems and still do to some extent,  but nothing like David's problems.

Worst problem for HT so far is hot flashes a couple times a day.  The Old Sailor.

Posted 3/16/2012 4:30 PM (GMT 0)
Paxnova,
I dont know anything about surgery. I still have a prostate. It was way too late for that by the time I was diagnosed. I am one of many experts here about hormones. I wish I was not on them but glad they were there. Its a catch 22 really. Guys like purgatory believe in waiting. Let the cancer progress a bit. Stay off of h/t as long as possible. The reason behind it is some day it will fail. The logic is get as many years without it as you can and then get as many years on it as you can. Then there is the whack a mole approach. Use ht to beat it down and take a break. When it pops up again smack it in the head again. Keep the cancer at bay so when ht stops working you have less tumor mass to deal with with the other drugs. For the strong who can tolerate the idea of cancer growing inside i can see davids point. The down side is that you never know where it will strike next. Gleason score also enters the equation. More aggressive cancer calls for more aggeessive measures. You have time my brother. Do as you are. Educate yourself. There is a lot of power in knowledge.
Bud is rigbt about the shoes.....
Side effects of ht are weight gain, bone mass loss, loss of libido, hot flashes, fatigue, and other minor ones.
Non published
Need to shop for shoes
Love of chick flicks
Sudden urge to watch richard simmons
Kenny G will be your favorite artist
If you want to play with boobies you have a set of your own
You start asking if your jeans make you look fat
Hahahaha been on it so long that I really do think this is funny stuff wink wink
Posted 3/17/2012 12:35 AM (GMT 0)
Thank you Todd. We are never alone with people of this forum.
Posted 3/17/2012 9:30 AM (GMT 0)
Agree with soem of the above comemnts about "where to aim RT".
Your pathology doesn't indicate a reason for anything being nearby.
With me it was clear that the PCa making PSA could be nearby as there was seminal vesicle invasion and some cancer in the bladder neck, thus targetting SRT at the prostate bed made sense.

Unless you can have some kind of scan to locate the PCa that is producing the PSA then HT is the treatment to choose, and the timing regarding when to start is complex. Not had to make that decsion myself yet so reluctant to suggest ghow to do it, but perhaps wait till you've had anopther PSA test to see if the PSA is stable or rising, and if it is rising, then how fast it is going.

Not sure what scans exit that would to the locating, but I had an idea that one of the HW guys had had something involving the use of markers that attached themselves to the tumour cells which makes them show up on an MRI. If for instance a san like that revealed that all the PCa was clustered in say a lymph node, then it might be possible to do some targetted SRT afterall.

Alf
Posted 3/17/2012 10:18 AM (GMT 0)
Hi Pax, there was some talk lately about benign prostatic tissue left behind after surgery, so this needs to be considered before you start thinking about BCR. Just wanted to make you aware of the procedure that Dr. Charles Myers does for patients with BCR and that is different than radiating the prostate bed "blindely". When PSA is over 2, he will send these patients to the Sand Lake imaging facility in Florida to see if the Feraheme scan can locate the PC. Often, the cancer is confined to 1 or 2 lymph nodes. Then these nodes will be taken out surgically or irradiated. Some patients may even be cured with this procedure, although this would not be considered a standard protocol in most hospitals. Feraheme MRI is not approved by FDA, but it works pretty well in visualizing these positive nodes if PSA is over 2. Not saying your cancer is in the nodes, just wanted to bring this to your attention.
✚ New Topic ✚ Reply