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Found My First Pothole in My Pca Journey

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Prostate Cancer
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Posted 7/17/2014 4:25 PM (GMT 0)
Got my pathology report and my first PSA test after surgery on 5/30.

Prior to this, In anticipation of any issues had formed a team for me: Added a Medical Oncologist and a Radiation Oconologist along with my Urologist/oncologist

Pathology report showed positive margins and small area of extraprostatic (sp?) extension. Tumor size was 23% of prostate. Prostate was 23g

focal extraprostatic extension was .5mm in diameter located on left posterior

Gleason: 4 about 80/90% 3 about 10/15% scored Gleason 4+3

PSA was 1.76

Urologist says no adjuvant radiation, go on ADT immediately, reassess later

Oncologist says go on ADT immediately for 6 months, adjuvant radiation 6/8 weeks after starting ADT, says all indications from pathology report show high probability of no spread beyond prostate bed. Disagrees strongly with Urologist approach

Radiation oncologist agrees with Oncologist, also disagrees with Urologist. Says high probability of cure with ADT/adjuvant radiation. Radiation would be 40 treatments, not sure of dose.

Both oncologist and radiation oncologist agreed that surgery did not hurt my situation but was a positive factor in treatment.

I am going to follow their recommendation and proceed with ADT for 6 months with radiation 6/8 weeks after starting ADT.

Still trying to figure out how to handle Urologist. Was disappointed with his approach and surprised by how strongly the other 2 disagreed with his approach.

There was no indication of PNI or seminal vesical involveme.nt and lymph nodes were clear

Not what I was hoping for but I always understood that adjuvant radiation and ADT were a real possibility.

Semper Fi
Walt
Posted 7/17/2014 4:56 PM (GMT 0)
A buddy of mine hunts kodiac bear. I like his style and think it should be applied to Pca. Keep shootin till it stops movin. Empty the magazine and have a back-up weapon at ready. . Just sayin.
Posted 7/17/2014 4:57 PM (GMT 0)
Sorry to hear it. I've been there. It sucks.

But you'll get through it.

For what it is worth, I tend to agree with your MO and RO. Feel free to tell you urologist that some random guy on the internet thinks he should reconsider.

That'll help.
Posted 7/17/2014 6:49 PM (GMT 0)
Walt,
Will you want the urologist to do the ADT part? You would be doing what urologist wants plus more. If you get ADT soon, he should not be too unhappy. Good luck.
Posted 7/17/2014 7:23 PM (GMT 0)
Walt, just for what its worth.

My medical team consisted of a Uro, Surgeon, Onco and Rad Onco. My Uro found the lump, did the biopsy and shared the results with me.

If I have trouble peeing, bladder infection of something along his line of expertise, I will go see him. In all matters of Pca, I rely on the team that make it their specialty. I had surgery, Radiation and am now on HT. I get my shots through my Onco's office.

Haven't had the need to see my Uro in 4 years. Do what you have to, rely on the experts and don't worry about hurting anybodies feelings.

Best to you,

Sonny
Posted 7/17/2014 8:37 PM (GMT 0)

robertC said...
Walt,
Will you want the urologist to do the ADT part? You would be doing what urologist wants plus more. If you get ADT soon, he should not be too unhappy. Good luck.

Thanks, I actually stated the casodex today. I doing the ADT under supervision of the Oncologist.
Posted 7/17/2014 8:40 PM (GMT 0)

Sonny3 said...
Walt, just for what its worth.

My medical team consisted of a Uro, Surgeon, Onco and Rad Onco. My Uro found the lump, did the biopsy and shared the results with me.

If I have trouble peeing, bladder infection of something along his line of expertise, I will go see him. In all matters of Pca, I rely on the team that make it their specialty. I had surgery, Radiation and am now on HT. I get my shots through my Onco's office.

Haven't had the need to see my Uro in 4 years. Do what you have to, rely on the experts and don't worry about hurting anybodies feelings.

Best to you,

Sonny

Thanks Sonny. My Uro and surgeon are one and the same. Kinda complicates things a little since I am still incontinent and recovering from surgery. Not concerned about his feelings but may still need his services.
Posted 7/18/2014 2:43 AM (GMT 0)
Sorry to hear about the outcome, but I think it's very likely you'll get past this okay. You've already been given some good advice and encouragement in this regard. And although I'm not a medical professional, I also tend to feel your oncologist and RO are also on the right track. I know your urologist says to assess later, but it seems to that the ADT will make that more difficult since it will likely suppress your PSA. I seem to recall their is also research that the sooner you start SRT the better--I'm sure someone can weigh in on if that's actually the case or not.

At the end of the day, if your urologist is a pro he'll realize that you've made your decision and that it has been based on opinions by other medical professionals. It should not affect in the slightest any additional urological-related treatments you'll have, although I can certainly understand the concern on your part.

Most of all, I wish you the best on your hormone therapy and SRT.
Posted 7/18/2014 8:15 PM (GMT 0)
did the urologist recommend surgery in the first place?

ed
Posted 7/18/2014 8:29 PM (GMT 0)
ADT + SRT in the manner that has been recommended to you has the potential to be curative but the odds go down as PSA goes up. You can use the memorial sloan kettering nomogram to figure out your odds.

ADT without SRT has little possibility of being curative. But ADT directed by someone really good can keep the cancer at bay for quite a long time.

So why give up your remaining shot at curative treatment? The only case I can see for going with ADT alone is if you had significant comorbiditities, were not planning on living long, and didn't want the potential side effects of radiation. Or if your calculated odds of it being curative, on the nomogram were on the low side, and you didn't think it was worth piling on the extra toxicity for something with a low likelihood of cure.

I don't know that you need to worry about needing the surgeon's services in the future. What else could a surgeon do for you? If you have complications of radiation that require a urologist you can probably find another good one.

Post Edited (proscapt) : 7/19/2014 12:34:58 AM (GMT-6)

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