Radiation - to do or not to do -that is the question

Hubby has second post-RRP PSA today, had MRI of pelvis last week. We get results on both this afternoon. Please check out stats below. First 6-week post-RRP was .02 (undetectable). Surgeon advises, even with adverse path report, not to do radiation til PSA increase. Had meeting with radiation onc (for possible future needs) who requested MRI and today's PSA (which is 14 weeks after surgery). He, of course, wants to do radiation starting end of March no matter what today's results are. Here's the question to all of you that seems to be so individualistic: if PSA is up but still undetectable, and given that there was SVI, EXE, LVI and positive margin (gleason 4+3, tertiary 5), what would you do? Radiate? Wait? Why on either choice? Do you radiate knowing the positive margin needs "cleaned up"? Do you wait knowing the pos margin was a gleason 3 and might be a slow progression? Do you radiate knowing the other issues? Do you wait and see in hopes that the surgery "debulked" tumor and there might be years before PSA increase? Is even the slightest uptick in PSA (say, from .02 to .04) a signal to do something now? Or do you wait for the standard 2x up and doubling time? And at what point do we start considering this is micrometastatic and in his lymphatic system or blood stream? Is that where the higher, double digit PSA's come into play or is even the slightest increase an indication of micromets? Adjuvant vs salvage? Too little too late? Too much too soon? Our heads are spinning. Your thoughts and experiences are, as always, greatly appreciated. Not anticipating anything showing up in MRI for lymph node involvement but you never know and that, I think, puts us in a whole new ball game.

Age 58
Sep 2013 PSA 3.7, clinical stage T1c, 3+4
RRP (Patel in Celebration) 10/31/2013, path stage pT3bN0Mx
SVI bilaterally, LVI, pos margin at apex (3+3), EXE at base
4+3 w/ tertiary 5 (65% 4, 35% 3, 5% 5)
6 week post-op PSA 0.02 (undetectable)

Post Edited (mbock) : 2/17/2014 6:20:22 AM (GMT-7)

Radiate.

I will go for radiation and short term ADT both if the second psa is also the same or increased. Path report not very encouraging. Hit fast hit hard. All the best.

I would go back to Patel and ask him how patients of his who had the same postoperative pathology have fared. Given that Patel has done over 6,000 surgeries, he should have quite a lot of experience with people in your situation.

Mbock,
Sorry that you are here and also that you have decisions to make. I like Tall Allen's analysis and tend to subscribe tp Jerry l and PeterDA's beliefs. You have a "bad" pathology report but the "good" aspect is that you are currently undetectable. Some may recommend that you hold off until "you see the whites of their eyes" and others like myself believe in "overwhelming firepower". If you elect to "hold off" there is the chance that it will be too late and the beasties will have had a chance to regroup and spread.
"Horns of a dilemma". Personally, I am a wuus and terrible gambler; I would go the hormone and radiation route! I wish you the best.
Bill

This is why I find it so difficult to read this forum at times. While my Uro is concerned by my recent .2 PSA one year out from surgery and doubling since last PSA six months ago, he told me not to worry yet and to see what happens three months from now. If the number climbs past .2 then he said we may need to start radiation. However, reading some of your comments, many of you make it sound like I should be running, not walking, to a radiation specialist yesterday. Like many of you, I am concerned with recurrence and want to zap it the moment I know it has happened. At the same time I don't want to put myself through radiation treatment if there is no evidence of recurrence. It is so difficult to decide what to do.

tdnjam,

Second opinions are always in order. Talking to a RO doesn't commit you to seek treatment. I just gives you more info. On my way home from the gym yesterday I stopped at the Cadillac dealer and talked to the salesman about their 560hp monster. I'm never going to have one of those. At 14 mpg I could never afford to feed it. But I told the salesman he might see me on his used lot in a couple of years looking at its little 460hp kid brother.

Lupron and Peter thanks for the info. It never occurred to me that insurance might not cover radiation unless it meets a certain threshold. Guess the insurance companies know better than anyone else, he said sarcastically. I will give serious thought to searching out a medical oncologist.

Dr. Patel did my surgery also and he has done more than anyone, over 6,000. He told me to wait until or if it rises. It is best to get some of the side effects of the surgery behind you, as he said, before jumping into radiation.
I have been undetectable for 18 months and my last PSA just went from undetectable to 0.1. I was told to wait until it gets past 0.3 before I need to consider radiation, so that is what I am doing.

Bill from Florida

I would wait and do all I could to help via natural therapies.

On Sydney radio, they run an ad for Hyperbaric Oxygen Therapy, and they talk about treating the damage done by radiation treatment... that is the really serious point ..
DAMAGE is what radiation is intended to do to both the bad and the good..

An interesting fact of life...
A good friend was Dx'ed with G6 cancer.. he knew of the effects of surgery and thus sought alternatives.. He pureed asparagus stalks and consumed a TS. Morn and night.. when the Onc. finally screamed at him to do something, a new Bx was the response... the new Bx showed "no evidence of cancer"
No one will recognise that just perhaps, other things work...

So, back to my first thought... Alternatives NOW, and wait for advice from the specialist...

PS.... I have farewelled a few friends who have died of Radiation Cancer. A cancer that arose after 10 to 15 years post radiation...
Hence the need to balance fear of the current unknown V's the likely damage done, treating the unknown
..
.

I would tell you not to be in a hurry to radiate. Been there. I know radiation has changed, but it is still
a fireball. My husband is looking at major surgery to irradicate (interesting term), rectal cancer that came from the initial radiation..twelve years ago. Also a fistula..actually a cancer fistula connected to the bladder..is what the doctors called it…My husband is going to have pelvic exenteration March 7. They take the bladder, colon, rectum, and anus. Yes., and there are going to be two permanent colostomies. A rare, but real side effect that can come from radiation, and then salvage surgery.
No one, but no one, knows what the future will be with whatever choice you make. Just do your homework, look at your age, the scores, the doctors, what you can and want to deal with..and I can tell you that even something difficult, like diapers, fistulas,AUS, (artificial urinary device) for those who don't know, can become almost normal. My husband, Pete, is so brave, and is going ahead with this surgery, because he chooses LIFE! That is the goal. Di

Sorry.. did not see the question...

TS - TABLE Spoon...

@DIVO.... my (our) prayers for Pete, and courage for you both

Thanks for sharing... Long ago I said this was a dark place that people visit in desparation and then disappear into the human condition..

I know of TOO MANY men who have suffered terribly from radiation treatment.
I know that they say it's better today, but it is STILL radiation, and little different to that encountered at Chernoble and ***ushima... at least as far as the end effects..
(And that goes the same for Xrays and CT scans etc. Etc. It's. All cumulative)

Burn-Docs sell their treatment because that is their money making speciality..
Avoiding Removal because you want. to boogy, is in my mind, foolish, if like Pete, your preference is life itself..
100% of men that I know, lost their ability for "normal" intimacy after an RP..
I do wonder about the figures quoted by doctors..
I UNDERSTAND that radiation gives the same results after perhaps two years, but leaves behind the lingering fear of radiation damage...

Now, if Burning is a last chance salvage for life, then that raises a real dilemma..., but 10 more years, is a definite plus, if the alternative is months...

If radiation has been used then I am a GREAT believer in AntiOxidants etc. To help negate some of the cellular level damage...
I believe it works, but cannot prove that it does, despite the massive number of technical papers suggesting that it does..

Tell you Peter that we are praying for you both..
..
.

Good Lord.. What you have been through..

So - were you offered the option of a Radical, way back when first Dx'ed..

That history brings to mind a comment "..and the cure was worse than the disease.."

..
.