Radiation after RP -- right away or after PSA starts to rise?

Melanie, although SE can be minimal, I would not want to do SRT without a reason to. However effective they are at avoiding damage to surrounding tissue, it is present. My proctologist tells me that my colon tissue is definitely radiation-affected. The other thing to consider after surgery is that the level of continence recovery may not progress further from the time that radiation is given. If your husband is now fully continent, then this point may be moot - but if he is still improving in that regard it may be helpful to wait.

The other point that may be relevant is that he is only a G7, rather than an 8-10, so there may be lower risk and reason for not pulling the SRT trigger quickly.

If it were me, I would get the regular PSA tests, and until a detectable rise, try not to worry (I know this is easier said than done).

All my best!
Jeff

The lower the Gleason score the more comfortable I am with the idea of waiting for recurrence. In your husband's case it's right in the middle and I have no particular opinion one way or the other. For the most part that is a decent pathology report, negative seminal vesicles and lymph nodes. The positive margins are described as "focal" which generally means small, and with low-Gleason disease focal positive margins are often not that significant

I agree with advice to wait for if/when a recurrence manifests. There was some research done on the difference outcome between immediate radiation and fast salvage radiation at the first evidence of a recurrence, and the research shows that there is little if any benefit of immediate vs. salvage radiation in a case like your husbands. But there is definitely more morbidity in the case of immediate radiation.

I understand the dilema. It's scary to think of waiting if there are Ca cells floating around in the pelvic bed. Much better to catch them before they run free in more remote parts of the body.

But as others have said, the SE's are not to be ignored. Any degree of incontinence will be greatly exacerbated by RT. That is what happened to me. I also developed strictures which have been attributed to the RT, but I'm not convinced of that. May have occurred as part of the trauma when a catheter became loose.

With an undetectable PSA, I'd be tempted to wait, but would jump on it quickly if things change.

Good luck.

Chas

Hi all,

Thanks for all the responses. And sorry for the delay in posting again. (Last time I had checked my thread, no one had responded so I thought my post had trailed off the board.)

It's refreshing to see that there's concensus! Makes me feel much better about it all. The five focally positive areas is a new piece of news we received when we saw DH's local urologist last week. (Up until then, we thought DH had negative margins or, at most, one or two focally positive spots.) DH's surgeon has been less than straightforward so I'm afraid that more info is being withheld.

We have emailed the surgeon to ask about the size of the margins and kinds of cells. Maybe not that important as long as the PSA remains undetectable. (For the record, only one lymph node was removed--and it was from the "wrong" side, if there can be a wrong side when the cancer is in both lobes.)

Thanks for all your help!

Call em late in the swing or mid shift, no suits, they bored, usually very willing to help. I did that to clarify some points of conflicts in my mind. Sounds like your doctor punches the clock. Doesn't make him a bad doc or surgeon. It is nice to find one once in a while from the " old school ", tho.

I have learned never to question a woman's wisdom.

Melaine, its hard to believe you are even going through this, that the operating surgeon can't be pinned to the wall and forced to give you the facts. Geez , seems pretty outrageous in this day and age

Hi Pratoman,

Yes it is pretty outrageous--and frustrating. We're working on getting the answers with the hope that, even if there are focally positive areas, that they're not clinically significant. The majority (above) agreed that there's no need to do RT unless and until the PSA becomes detectable. But I'd like to make sure that the positive areas are truly small. And unfortunately I can't help shaking the feeling that this surgeon is either hiding something deliberately (which I doubt) or can't remember one patient from another when he's giving them info. (which is possible but not acceptable).

Rigby: Are you on the west coast? Is that where your well-known surgeon was? Would you mind explaining how your PCa was staged T3a? I've been reading a lot about Myers and wish you all the best. I'm looking forward to hearing about your graduation!

Thanks all!

Melanie,
Nope, I'm in Chicago area. T3a means cancer was outside the capsule but within the surgical margin, I think. But since my psa started up again it either wasn't within the surgical margin or some was elsewhere or some benign tissue was left behind. At least that's how I understand it. I figure the "but within .1mm..." is what went wrong, either in that spot or another that they didn't find in the pathology. So far the docs aren't saying do radiation in that location, or what's left of that location.

Thanks for the graduation wish!

Let me take shot it getting this figured out. It could been that there were 5, and remember the wording as best you can. Was the word foci ever used in the description. because there could be 5 foci of cancer found near the boundaries{pseudo} of the capsule wall and flesh beyond that wall. Not thru{-epe} the wall but right there. So now the surgeon has cut a wide margin beyond those points into the flesh beyond the same points. Voila, you now have negative margins, not of the prostate necessarily, but of the prostatic specimen. Key word here… specimen. This is the blob of meat that the post op pathologists slice and dice. If the margins of the whole intact blob are negative… thats gold. It is your surgeons view{pure edumacated speculation here} that there is no problem because hey this pathology reports negative margins. When these folks are writing up there report, they use language to communicate to each other , not the patient. Some times they will use a term in one context and use the exact same term in another and the meaning of the term changes by its context. To some surgeons, theyfeel that it is not their job to educate you. I see their point . Medicos today, and who can blame them at some point make decisions of protocol and will not depart from them, no matter how much their heart tugs. They will turn off the heart, so as to have some sense of a life part from they work. I mean right here on the forum the so called "wiring" runs the gamut from there is no end to the worry and questions unknowledgable people will submit to the "other". then there are others who never ask questions about their needs at any point. Which one would you rather have as a patient? Anyway I think your doc for is on it, I think he knows that their is/was a communication issue. He is comfortable with the report and so as to have some control over his life, he is the "boss" and if the patient don't like it, do what you gotta do.. I kinda think thats the way I would be, now that I think about it . I mean where does it end. Well enjoy the holiday, there is an answer and it will come in due time. There, in my view, is nothing shady happening here, no hidden agenda's. Just simple miscommunication? Some times we all just think too much, create a scenario, which is totally real to us, but without any basis in facts. Any way I am certainly going to enjoy my "Thanksgiving Feast", as I suspect you and your surgeon will. I will, will my thoughts away from the inherent irony that remains in the "specimen"

Thanks very much, Logo. I'm going to read your posts a couple more times because I'm sure the answer is there. And I have read Walsh's book but I'll read those chapters again.

Hoping you have a wonderful holiday!