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Posted 3/5/2013 7:51 AM (GMT 0)
First, let me sayGod bless you all, pray for your health,and healing. Perhaps someone can help me make sense with hormone therapy. The medical community says testosterone is a factor in having prostate cancer, yet men by the age of 50 have more estrogen in their system than woman do. The most testosterone any male has in their system is between the ages of 18 to 24 years of ages, yet you never here of anyone in that age group of having prostate cancer. From what I understand, not much study has been done in this area either. I had my prostate removed and am 2weeks post op. only 15 percent of my prostate was infected, margins were clear, however my seminal vesicles were involved, and had most of the cancer in them. Nothing in the bone, or lymphatic clear. If there is anyone else out there in the same boat I,m in I,d appreciate your advise as to what to expect, or kind advice. God Bless us one and all. Jim
Posted 3/5/2013 8:14 AM (GMT 0)
Webupp,
Sorry to hear about your seminal vesicle invasion. Unfortunately, that's a serious adverse feature. It can still possibly be cured with immediate (adjuvant) radiation therapy along with hormone therapy as soon as you are healed enough from your recent surgery. The hormone therapy will help shrink any cancer left behind, keep it from growing, and sensitize it to the radiation. I hope you've already been referred to a radiation oncologist.

- Allen
Posted 3/5/2013 8:43 AM (GMT 0)
Hi Jim, one of the biggest risk factors for PC is age, so as age increases, so does the possibility of getting PC. Nearly 50% of men over 70 have PC, most will never know or be diagnosed. Having said this, there are many younger patients in their 40s with PC, and for breast cancer there was a disturbing statistic published earlier this week that says, more younger women are diagnosed with advanced breast cancer today than 20 years ago.

Testosteron fuels PC but does not cause it. Reduction of testosterone to castrate levels (which would happen if your doctor put you on hormonal therapy) will put your cancer in remission if it was not all taken with surgery. Sometimes doctors recommend adjuvant radiation in order to kill the stray cancer cells, followed by hormone therapy. Not sure what your doctor recommended for you, but my advice, since your cancer was in seminal vesicles is to go after your cancer agressively, provided your age and your general health allows for that. Many will also tell you that it is extremely important to find a good oncologist with a specialty in PC. Good luck to you.
Posted 3/5/2013 3:13 PM (GMT 0)

Webuppp,

I am 72. Was diagnosed in January with possible seminal vescicle invasion (SVI). This was shown by a Telsa3 endorectal coil MRI which showed indistinct margins at the SV location. The RO recommends hormone treatment followed by IGRT

and HDR brachytherapy. Guess the seminal vescicle possibilty is very

serious. Do not know much at all about this, but maybe one of the long time knowledgeable guys will chime in and explain its seriousness. By

looking at the SV location it looks like it could invade the rectum and/or bladder. My advice would be to do the hormone and radiation treatments.

Best of luck,

Phil

Posted 3/5/2013 3:41 PM (GMT 0)
Webuppp,

Prostate cancer is associated with various derangements of the DNA in prostate cells. These changes happen gradually and accumulate over time. That's why older men tend to have more PC. They have had longer for this process to continue. Prostate cells need testosterone to grow. When they become cancer cells they lose some other processes that are intended to control and limit that growth but they continue to need testosterone, usually at first. They may eventually lose that control too and thus hormone therapy tends to eventually fail in many cases.

But, for most men HT will work for a while, sometimes a long while. That's one of the reasons why we all want to know how old you are. The younger and otherwise-healthier you are, the more time your cancer will have to rebound during your life expectancy, and the more urgent it is to have aggressive follow-on treatment. If you are older it might be that hormone therapy will be all the treatment you will ever need since it takes a long time for prostate cancer to become "castrate resistant" and learn to grow without testosterone.

We will also want to know your Gleason score. Mine is 9(4+5) meaning that my cancer is mostly type 4 cells (bad) with a minority of type 5 (worst). Because my cancer is aggressive my doctors are throwing everything at it as fast as they can. I am on HT for two years and had adjuvant radiation to my prostate bed four months after surgery. But that is because of my high Gleason score. If your Gleason score is 6 (3+3) then the stakes are lower and more options may be available to you.
Posted 3/5/2013 5:36 PM (GMT 0)
It is my understanding that seminal vesicle invasion is a pathway to the lymphatic system, that's why it is serious, even more serious than extra capsular extensions.
There were studies done in Holland and Germany a few years ago that showed that there was a high percentage of patients with seminal vesicle invasion that had lymph node invasion and to a different nodes set that are usually not involved in surgical sampling. This was discovered during the Combidex trials.
Posted 3/5/2013 5:46 PM (GMT 0)
Webuppp,
Seminal vesicle invasion with no detectable lymph node involvement is staged as T3bN0. There is a high recurrence risk with T3b prostate cancer. You can see my statistics and treatment choices in my signature. I was very aggressive and even added adjuvant chemotherapy to try and drive the risk down. In my situation, my doctors told me my recurrence risk was still sitting at 50% after surgery, radiation, and three years of ADT ("hormone therapy").
SC
Posted 3/6/2013 12:21 AM (GMT 0)
Cheers and blessings to you all, and a spiecal thanks to those who wrote back. I just turned 50 in nov. Gleason was4+3=7 I only had 15% involvement of the prostate, my problem was were it started. Right side was clear, left had 2 of 12 cores. Bone scan clear, lymphoid removed pathology shows no trace surgical margins around prostate show clear, I went to the city of hope, and had dr mark kawachi as my surgeon. He said most of the cancer found was in the seminal vesticles after 5:45 minute surgery. The surgeon is world class and has seen it all after 3200 robotic surgeries. I had full continance after cathader removal. Was praying he got it all, it that too Nieave to think? Is proton therapy the same as radiation therapy ? This Friday will be 3weeks post op, was having discomfort passing wind, and bowl movement . To day was better, anyone else expiriancing issues with bowl movement? Perhaps normal after this kind of surgery ? Perhaps something worse?. Thanks for your input y,all. God Bless you brave people,your friend in spirit, and the fight jim
Posted 3/6/2013 5:01 AM (GMT 0)
Hi Jim,
I've met two men who had proton therapy + IMRT for salvage after surgery and they both are doing well. I haven't seen any data to indicate that it's any better or worse than IMRT alone, either in effectiveness or side effects. It is a lot more costly. If you're in the LA area, I've met several excellent radiation oncologists including Drs. Kupelian, King & Steinberg at UCLA and Dr. Rose in Beverly Hills. You might want to talk to a couple of them about adjuvant radiation treatment.

- Allen
Posted 3/6/2013 4:44 PM (GMT 0)
Webuppp

I was T3b -- seminal vesicle invasion -- 11 years ago at the time of my open RP surgery. If you plug your numbers into a nomogram to determine probability of recurrence you may find that your long-term probability of dodging a recurrence can still be very good even with SVI.

In my case, I've done well so far. I needed salvage radiation 8 years after my surgery and am now still showing a PSA of 0 three years after the SRT.

I can't give you any treatment advice because I'm not a doctor and also because treatment standards have evolved since the time of my original surgery. These days, more doctors seem to be recommending adjuvant radiation and/or HT therapy for certain patients earlier in their treatment than when I had my surgery a decade ago. So I'd suggest you consult with your doctors, get opinions for several kinds of experienced doctors, and read the current editions of books like Dr. Patrick Walsh's "Guide to Surviving Prostate Cancer" so you will have a solid overview of treatment options and will know the kinds of things to ask your doctors about as you continue your recovery and consider next steps, if any.

Jim
Posted 3/6/2013 9:12 PM (GMT 0)
Wow Jim, thanks for your returned email, I am sure all who read your post you are an inspiration to us all. Am I to understand it was 3 years after surgery before the cancer reared it,s ugly head?. I,m thinking that may be due to the fact your Gleason started with a 3, and Thank God for that. I also had a 7 score but mine started with a 4. I have asked if proton therapy is the same as radiation therapy but as yet have not received an answer. God continue to bless you Jim, I sure hope and pray I,ll be around in 11 more year, as then I might be able to see my 16 year old daughter get married as I just turned 50. My our Lord Bless you all. Your new friend in the fight Jim
Posted 3/6/2013 9:42 PM (GMT 0)
Tall Allen, how tall my man?lol I am not in the LA area my friend, I live in North Carolina now and flew to LA as I had read so many wonderful things about dr kawachi, and the city of hope all by the way are true. Irma? Sorry,not sure what that is, I have really good insurance and as one could assume after having divinci surgery my deductibles have been met. I,m looking into the university of Pennsylvania @their proton therapy program, I hear Loma Linda s also very good, my issue is understanding the differences in the treatments like prementioned is proton therapy the same radiation therapy just delivered a different way?. I,m sure the way insurance is set up I have to have a psa score before I can start any salvage, I,m ready to get on with it boys, not sure what the healing before you do it time is, but I,m ready to go! I have love for you my friends, and I,m praying for you. All. Thanks al your a good man your new friend in life, and the fight jim
Posted 3/7/2013 1:31 AM (GMT 0)
Webuppp,

You asked " Am I to understand it was 3 years after surgery before the cancer reared it's ugly head?."

Actually it was 8 years before I needed salvage radiation. And it has now been 3 years since SRT and my PSA is zero. But actually that isn't so surprising. When I plug my numbers into any of the standard nomograms to calculate the probability of recurrence (based on the data from my original surgery) I come up with numbers in the range of 85-90 percent of being recurrence free 7 years after surgery. As it turned out I had BCR at around 7 years, so in that case I didn't beat the odds. However since my SRT I have done better than the statistical models predict.

So even though having seminal vesicle invasion increases the risk of recurrence, your risk of recurrence might still be pretty low depending on your own unique indicators -- pre-surgery PSA, Gleason score, etc. There is no reason to think you won't be at your daughter's wedding -- or for that matter at her daughter's wedding.
Posted 3/7/2013 1:37 AM (GMT 0)
LOL@Irma. No, that's IMRT - Intensity Modulated Radiation Therapy. It's a way of delivering the X-ray radiation so that it's better at hitting what they are trying to hit and not anything else. Often, it's used with an image-guidance technique (called IGRT) that further increases the accuracy of the radiation dose. Outcomes are much better if you get the radiation sooner "adjuvant" rather than later "salvage." Because they are treating a lot of the area down there and want to treat deeply into the surrounding tissues, IMRT is the treatment of choice. Sometimes they add a "boost" to the prostate bed, especially if there is some clue as to where it may have spread to. They can boost with protons or brachy, but there's no proof it's any more effective than the IMRT (X-ray) alone. They can't treat you only with protons -- that's reserved for first-line therapy. If you want to talk to a proton doctor, the center at University of Florida at Jacksonville may be closer.

Duke has an excellent radiation oncology department, and it's a lot closer.
Posted 3/7/2013 3:55 AM (GMT 0)

Just read in the UsTOO Inspire Forum where a man had the 3 Tesla endorectal coil MRI like I did but his CLEARLY showed no SVI, whereas mine showed indistinct margins. How can the same test not show the same results? He is happy he gets to avoid HT and I am confused about the differing results.

Southern Comfort,

"Seminal vesicle invasion with no detectable lymph node involvement is staged as T3bN0". 

Should I change my stage to this if my SVI isn't 100% certain? 

Peter DisAbeard,

 "If you are older it might be that hormone therapy will be all the treatment you will ever need since it takes a long time for prostate cancer to become "castrate resistant" and learn to grow without testosterone."

Are you suggesting therefore that an 'older' man should just have HT?

If so, at what age should this apply?

Phil


 

Posted 3/7/2013 5:15 AM (GMT 0)
Thanks for your kind and encouraging words bohemond, in nov of 2012 my psa was 15.08 by dec it was 23.85 I had a chance in nov 2011 as every year I have a physical . My doctor @ that time told me my psa was 3.8 and we,ll keep an eye on it I was too ignorant to understand the significance of the psa score and took his word for it as he was the trained professional. I had the early detection people pray for should they be told they have cancer, unfortunately my doctor dropped the ball, and it may indeed cost me all. On the positive side. If The Lord be for you, who can stand against you
Posted 3/7/2013 5:23 AM (GMT 0)
Phil,

It's not so much a matter of age as it is of remaining life expectancy. Doctors look at age but they also look at other conditions that might add to or subtract from the statistical norm. All that said I would think that if you are in reasonable health at 72 then your doctors' planned radiation treatments are justifiable based on your remaining life expectancy. If you were a decade older then HT might be enough.
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