Next Stage, Salvation Radiotherapy

PSA started rising 10/08 aged 59.

Hi all, I have been browsing this forum for a while now but thought I would be past the need to join up once I underwent RP in Feb 2011 and PSA went down to 0.07 by 04/12, but sadly by 06/12 my PSA started to rise 0.14, 08/12 = 018, which probably indicates I have residual prostate cancer.

Post Radical prostatectomy results were good, catheter removed 3 weeks after the op and blader control returned to normal soon after with ongoing pelvic floor exercises, altho erections are still a bit slack, only reaching about halfmast .

Now for the next stage, I have a visit scheduled in a couple of day's with my Doc/surgeon where we will be discussing the last PSA results (unknown) and then the next stage, which no doubt will be a referal to an oncologist for salvation radiotherapy and maybe a bit of hormone therapy.

This is where it all gets a bit more serious to me, not only the mere thought of the return of the cancer but also the possible side effects/damage from the radiation treatment and the end results.

My internet research has indicated that the cancer after failed RP is not always in the "bed" of the prostate and radiotherapy can become a bit of a hit and miss, although hopefuly my diagnosis post op would show a more likelyhood of it being located in this region.

Sorry if it appears as a bit of a rant, but as always this is not what I (or anyone) wanted in the prime of my retired life.
So I guess what I am looking for is other peoples results and or complications, or what is my prognosis.

Thanks for listening and for your responses in advance.



MACROSCOPIC
Prostate gland measuring 50mm apex to base, 45mm left to right, 35mm anterior to posterior with up to 13mm of attached seminal vesicles. The specimen weighs 47.9 grams. The posterior aspect of the specimen is inked with a black stripe, the left lobe inked blue and the right lobe inked yellow. Resection margins of seminal vesicies are submitted in Al, bladder resection margin in A2. The apex is amputated and perpendicularly sectioned from left to right and sequentially submitted in A3 and A4. The specimen is sliced from apex to base and sections taken in A5 -A20 as per diagram. Tissue reserved. HW

MICROSCOPIC
Sections taken from the radical prostatectomy specimen confirm the
presence of prostate tissue with the presence of an invasive
adenocarcinoma of which the description is as follows:
1. Histologic Type - Invasive acinar adenocarcinoma
2. Gleason Score - 3 + 3 6 out of 10
3. location and Size of Tumour - The tumour involves both left and
right sides of prostate and apex. The following blocks are involved -
A4, A5, A6, A7, A9, AlO, Ai3, Ai4, Ai6 and A17. The tumour involves
approximately 10 - 2O%. The dominant nodule measures ii x 14mm.
4. Surgical margins status - The tumour involves an right apical
margin in section A4 which has been inked yellow over a distance of
2mm.
5. Seminal Vesicle Involvement - Absent
6. Vascular and/or Perineural involvement - Absent
7. Regional Lymph Nodes - N/A
8. Additional Pathologic Findings - No other significant
histological abnormalities.

DIAGNOSIS
RADICAL PROSTATECTOMY SPECIMEN - INVASIVE ACINAR
ADENOCARCINOMA, GLEASON SCORE 3+ 3 = 6 OUT OF 10 WITH
INVOLVED APICAL MARGIN

Thanks for the response Jeff, it's the type of onfo I'm looking for.

Cheers

Colin

Aotearoa,

I had surgery and adjuvant radiation (see below) yet my psa continued to rise so I am now involved with medical oncology treatment. Ironically, I have been treated with casodex for a short time with good results so far and that has led, (surprisingly) to the possibility of some additional radiation treatment, (pending a meeting this coming week).

Everyone is different - everyone - yet my suggestion would be to due your due diligence and research the latest findings on this next step in your treatment. Adjuvant radiation could effectively bring about great results for you - in my case it did not yet I have no regrets having had that treatment. There were side effects but not terrible ones and I managed through them fairly well...

Something that is apparently becoming a theme among doctors at present is that there is radiation and then there is radiation, meaning some treat a smaller area than others; and radiologists are now debating the best approach - some now considering a wider area of post-prostatectomy radiation treatment vs. "traditional' treatment.

This is apparently a current topic under review by many prostate docs - and a controversy. Here is a decent link to get started on looking all this over: www.pcf.org/site/c.leJRIROrEpH/b.5838551/k.6D69/PSA_Rising_PostTreatment.htm There are other links out there regarding the treatment approaches for post-surgical radiation so look around and you will find them...

Point is do the research yourself then meet your doctor armed with info and questions, discuss and then make your decision.

Hope this helps.



_

Age 63, dx age 60, PSA 2.9 ; detected by dre
Stage t3b Gleason 7 (4 +3) tertiary pattern 5
11/09 Post-prostatectomy path: extensive extra-prostatic growth 60% tumor both lobes; perinural + l seminal vesicle and lympho-vascular tumor invasion; Lymph nodes:14 right obturator; 9 left pelvic (no regional lymph node metastasis)
10/11 adjuvant IGRT radiation 8 weeks
4/10/12 psa rise from 0.3;0.5;0.9 indicated ineffectiveness of SRT – on to medical oncology
5/30/12 negative bone scan; ct scan showing enlarged adrenal gland and 1 pelvic lymph node "involvement"...
6/5/12 initial meet with med oncologist began daily use of pomegranate extract; need baseline psa w/same protocols
6/5/12 psa rising to 1.5…then again on 7/10/12 psa 2.0
7/17/12 doc confirmed diagnoses of “aggressive metastatic” pc;
Prescribed 50mg Casodex (Bicalutamide) for 6-7 weeks + pomegranate extract before new psa blood test + ctscan
9/4/12 ctscan and psa blood tests first since casodex treatment began
9/11/12 results indicate psa drop from 2.0 to 0.2; ctscan shows significant improvement in lymph gland...to continue same regimen for next 90 days.
9/27/12 heading back to radiation team for a review and possible additional treatment.

Hi Aotearoa

I had surgery in Feb.05 and had recurrence and started SRT starting 11/08. I finished mid Jan. 09 with 38 treatments if I remember correctly.

I had some tiredness toward the end of my sessions but worked in construction every day.

It is about time for my annual psa and it has been <0.04 from the 1st psa on.

I had negative margins but evidently it was in the prostate bed.

Good luck and drink plenty of water !!

David

How great and supportive this forums is, I feel almost fully healed from the support so far and realise the importance of positive thoughts, it's just so easy to start thinking that the end is near, but my road is just beginning in comparison, with many years of enjoyment ahead of me (now to get out the bucket list).

Since receiving the news regarding recurrence PC I started taking "modified citrus pectin" so it will be interesting to see what my last blood results are, I'm also keen to try pomegranate after reading some reviews of it's "limited" success.


Cheers from down under in NZ

Colin