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Posted 8/28/2012 10:42 PM (GMT 0)
Would like information.
What to do with this. What to do???
Age 70
1-4-11 first appt Mayo AZ.
1-6-11 Biopsies 12 of 12 core positive
1-18-11 appt with Doctor
PSA before surgery 7.6 dbl in a year
bone scan unremarkable CT mildly enlarged abdominal
2-10-11 robot assisted radical prostatectomy
Gleason 4+5+9 right base and 5+4+9 plus in the left apex
invaded the seminal vesicles
lymph nodes removed no cancer
stage T3b adenocarcinoma of the prostate
PSA 0.01 for 18 months 0.13 now. Retake at another lab 0.10
Would like to hear what your thoughts are.
Thank you
Posted 8/28/2012 10:46 PM (GMT 0)
Please let us know what the side effects are for any treatments you know about.
Posted 8/28/2012 10:53 PM (GMT 0)
TomDi,

Welcome to HW from a fellow T3b patient. You are clearly high risk and seem to being having a biochemical recurrence (BCR). A couple of thoughts:

1. Have you had a recent DRE? The doctor may be able to feel something localized. In that case, radiation therapy could be a good choice. Radiation therapy is the standard approach for a local recurrence after surgery .. if there is a reasonable probability the recurrence is actually local and not systemic. Unfortunately, T3b and G9 has a high systemic probability.

2. You might want to track your PSA for a couple of more readings. Get a sense of the doubling time to determine how urgently you need to address this and to verify a recurrence is really happening.

What type of doctor are you seeing? A consultation with a medical or radiation oncologist is in order.

SC

 

Posted 8/28/2012 11:07 PM (GMT 0)
I am scheduled to visit with an Oncologist in early September. I expect radiation as a minimum but will let you know. Thank you for your response. Be well.
Posted 8/28/2012 11:21 PM (GMT 0)
OMG, I am the wife. if you guys have any suggestions on what should be done please step in here. Mayo says wait three months but this is our life we are dealing with here. I have taken so many deep breaths!!!! Yicks!
Posted 8/29/2012 12:10 AM (GMT 0)
Also, don't be surprised if they recommend hormone therapy along with the radiation.

Relax and don't panic. Early September is coming quickly for your visit with an oncologist. Both of you should attend the appointment and take notes or even record it (with permission.) A second set of ears is very helpful.

 

Posted 8/29/2012 12:13 AM (GMT 0)
Thank you so much. That is so helpful!
Please take care.
Hugs
Posted 8/29/2012 12:22 AM (GMT 0)
I am scheduled to visit with an Oncologist in early September. I expect radiation as a minimum but will let you know. Thank you for your response. Be well.

sounds like you are on the right path.  like SC said HT is likely too.  Good luck to you.  keep us posted.

ed

 

Posted 8/29/2012 12:36 AM (GMT 0)
Thanks. Will do
Posted 8/29/2012 12:57 AM (GMT 0)
TomDi and Mrs.,

Sorry that the bear returned in just 18 months.  Same thing happened to me.  Treatment options that I know about are some combination of:

Salvage Radiation (SRT) of the "prostate bed" for 40 consecutive sessions. 

Radiation to the pelvic lymph glands at the same time as the radiation to the prostate bed.

Hormone Therapy (HT) which usually starts a few months before the SRT, and may continue for some time after.

Some practitioners just prefer to do what I call the basic radiation treatment to the prostate bed.  Some men on this Board, including me, opted for all three.  This is an "all-in" approach; an attempt to crush the bear at the outset.  I thought you should know about these three options before you sit down with your oncologist.

Your oncologist can brief you on side effects (SE).  Radiation is not difficult if the practitioners are good:  fatigue, irritable bowels during and afterwards, sometimes (not often) urinary problems.  Once you start radiation, just think of it as going to work each day as it is easier that way.

Hormones are no walk in the park, nor are they horrible.  Notable side effects are:  fatigue; weight gain; loss of muscle mass; and complete loss of sexual libido.  My wife had chemo for breast cancer nine years ago (we just celebrated her 68th birthday this weekend!), and my view is that chemo is a lot tougher than HT.  You can get a lot of replies on this Board if you ask about the side effects of HT and SRT.  The experiences will vary a lot.

Get a good oncologist, hopefully a practitioner who is part of a larger team and organization that is deeply experienced in prostate cancer.  Best wishes to both of you.

Newspaper Lover

Age 68

DaVinci surgery 11/09. Clean margins, clean seminal vessels.

Rising PSA noted 06/11

Gleason 8

Time to recurrrence 18 months

Three month doubling time (summer 2011).

PSA rose from .07 on 06/11 to .17 on 11/11.

MRIs and bone scans negative so far.

Started hormone therapy Lupron/Casodex 12/11

Began radiation (SRT) 02/20/12.

Finished SRT 04/16/12

Last Lupron shot 03/12

PSA and testostorone "undetectable"  07/12

Next PSA and testostorone test early January

 

Posted 8/29/2012 1:02 AM (GMT 0)
Thanks so much for the info. Looks like you are on the right track. Stay well. Stay "undetectable"
Posted 8/29/2012 1:27 AM (GMT 0)
We have been married for 21 years and they are the best years of my life! I am not letting it end any time soon. We are going to fight this beast whatever it takes. The more information the better! Thank you so much for sharing.
Posted 8/29/2012 1:53 AM (GMT 0)
I'm also T3b and have had salvage radiation. You are still at 0.10, which does suggest that you are in or approaching BCR, but you still have time to investigate and consider your options. The advice I received when I crossed that threshold was that it would be reasonably safe to wait until 0.4 before seriously considering salvage radiation but to by no means wait until the PSA got anywhere 2.0. Based on this advice, I began SRT with a PSA of 0.44 and also had 3 months of Casodex during and after the SRT. My results have been good so far -- 2 1/2 years since SRT and now barely-measurable hint that something might be recurring, but too soon to know for sure.

You asked about side effects. My side effects from SRT were some urinary urgency from about week five after start of SRT which returned to near normal within a couple of months, though I still get some leakage (as I had before SRT) if I have a severe cold with heavy coughing and sneezing. Also about 8 months after the SRT ended I developed some rectal bleeding, which is not unusual. This resolved within about a year and I no longer have any signs of bleeding. Hope this helps, but please ask if you have any further questions about side effects, etc. Best wishes,
Jim
Posted 8/29/2012 1:55 AM (GMT 0)
I agree too with the others, recurrance may have had happened, but most doctors would want one or two more readings showing the current level and a couple of rise to confirm. With his stats, however, its a pretty serious diagnosis. I would expect full radiaition and probably some hormone therapy thrown in to boot.

Please keep us reported on how things are going. Wishing the best for the both of you.

David in S.C.
Posted 8/29/2012 1:57 AM (GMT 0)
Attack! Attack! Attack! Looks like it is working for you. That is definitely our approach to this (and everything else we do). Thanks again
Posted 8/29/2012 6:58 AM (GMT 0)
I would point you to the series of 4 videos, very important videos, in my opinion, about PC growth arrest by Dr. Charles Myers, one of the leading experts in the field of advanced PC. He basically explains how he tries to slow the cancer recurrence after surgery (your husband fits this category perfectly) with diet and supplements. When PSA reaches 2.0 he sends his patients for very accurate scanning to try to locate the cancer (usually in prostate bed or one of the lymph nodes), and subsequent radiation to that place. But what he attempts first, is to arrest or slow down the cancer with other means. He claims he has had great success with this. Videos are titled "PC growth arrest". All the best.

http://askdrmyers.wordpress.com/page/2/
Posted 8/29/2012 5:48 PM (GMT 0)
Another T3b here.
When my PSA got to 0.1 at 18 months post surgery I began planning on radiation. When it hit 0.2 I pulled the trigger. I didn't see any point of waiting any longer. I knew my PSA wasn't going down and the longer I waited the more work the treatment had to do.
Posted 8/29/2012 6:04 PM (GMT 0)
Another his risk guy here. PSA 23, doubling time <6 months. Bx 7/12 EPE, PNI ...

I had surgery 3 years ago and my PSA has been <0.02 ever since. My internal threshold for action is 0.05. I will do everything I can to kill that bugger while it is still weak. Radiation, HT, both -whatever is best at the time.
This is War. It is no place for a fair fight. I am not beyond kicking it in the nuts even when it is down and waving the white flag.

Another guy here has the same "action threshold" and unfortunately needed to act upon it. Maybe he will chime in.

Jeff

I am not a doctor. You are doing all the right things.
Posted 8/30/2012 12:46 AM (GMT 0)
Thanks for the comments and reassurance. Arrangements are being made for HT and RT. Attack! Attack! Attack!
Posted 8/30/2012 12:52 AM (GMT 0)
TomDi

HUGS HUGS HUGS!!

Yes Attack attack attack! Crush the beast! No mercy! Kick its a** !

My email is in my profile (just click on my name) if you ever want to contact me.

Hugs!

Bud

We will beat this crap!
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