Close to Starting Treatment w/Second Thoughts

Hi Robert,

I'm with Peter, in all your research you have all the information necessary to make a decision. There really is not a lot of difference in the treatments you are considering and all should work to a high degree of probability given your stats. I would concentrate my effort of which doctor you feel has the most experience and the one that you are the most comfortable with.
JT

Time101 - your Lupron experience is pretty current. Have you had many Side effects yet? I'm at the end of my 3rd week, but have felt nothing whatsoever.

I'm planning IMRT too, but mine is G9 with some local extension.

Redwing,

I am ten months into ADT3 and I feel nothing, too. I am sooooo tired of feeling nothing. Hopefully in two years, more or less, I will feel something again. I kinda miss it.

As HT before radiation (neoadjuvant to IGRT IMRT starting about July 1), the Vanderbilt team uniformly said only Lupron was needed. The other 2 drugs add side effect risks without any study-proven advantage in this setting, or at least not enough to warrant the risk. I argued it fairly hard, but they were rather adamant.

Now, if one is dealing with recurrence after primary therapy, then everything is on the table. That's a whole different story at that point. Plus, as someone pointed out, PCa is pretty adaptive so it may be better not to expose it to any of our later weapons any sooner than necessary. However, some people here argue that you should attack it hammer and tongs, with everything available immediately upon discovery. Who knows?

The "simulation" session to plan the radiation exposure is based on a CT session so that will be coming in a couple more weeks. For staging (assessing extraprostatic extension, seminal vesicle involvement, lymph nodes, and so on) they did a 3T-MRI with a contrast agent. It was a long series (about an hour and 20 minutes in the tube). But the images are really clear, if a bit tough to interpret by a layperson. However, my cancer is quite visible on certain of the image types, with the extension being pretty evident (boo), conclusion is stage cT3a. My understanding though is MRI is only about 35% effective at finding lymph node involvement unless it's really significant.

Due to the risk I have of lymph nodes being involved anyway, but just not visible yet (G9, PNI, 100% cores, EPE-indicated, etc.), we will do a whole pelvic exposure too. That's supposed to kind of "sterilize" all of the pelvic lymph nodes. Of course, there's opposition to that too, saying if it truly has gotten that far it has almost certainly gone further, and treating just the pelvic lymph nodes doesn't confer any real benefit. The great part is that's also quite likely to wipe out chances of regaining sexual function. Awesome.

So, what? You expected maybe a clear answer? Not with this mess!!

(And Peter, you crack me up!)

Another question - for the past few mornings, and only early morning, I have had urinary hesitation and slight stop-start. This morning there was very slight burning (infection?). Makes me wonder if the cancer is growing, pressing on the urethra, or is it the Lupron. However, during the day and at night everything is normal so I doubt any infection.

Robert