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RO SRT advise to me

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Posted 3/3/2015 5:19 AM (GMT 0)
1 am 59. pretty healthy.

Had a cancerous bladder tumor removed one year before I discovered by Pca ! GU cancer strike two !
My RP 8 months ago. Has a positive margin, but psa was undetectable for ONLY 8 months. It was .07 then and .08 a month later... barely detectable.

I feel good. I am fortunate. Happy, divorced long ago, working less, in a new relationship, 2 kids at university doing well - but I am really afraid about radiation treatment. I am worried its stike three. They want to radiate the lymph nodes and prostate bed only and give a 50 % chance I will be "cured" but a 100% chance of more s/e ... sexual, urinary and colon/abdominal issues I have good doctors, a great hospital and I was told to start but there is no rush. I would love to watch it monthly and and avoid radiation.

With no radiation I was told to expect about 8 - 10 years before I may get more advanced PCa. I'll in my late 60s then. In Canada where I live doctors only stop treating your cancer if you fookin' dead, lol

I have a big decision to make soon and don't like either choice.
Posted 3/3/2015 5:28 AM (GMT 0)
That's a tough call. You could watch it a for another month or two. at that PSA level, it would be difficult to see on a scan.

The RT is a bit of an endurance test and it can cause more SEs. Guess the question really is: Is that worth a shot at 50% cure?

If you don't do RT now or soonish (you might be able to wait a bit longer), you'll end up having to do HT at some point.

Very difficult - guys with better knowledge will have better answers than me,
Andrew
Posted 3/3/2015 6:17 PM (GMT 0)
Several comments:
1) You can certainly wait out another PSA or two or three before you have to make a decision about SRT. As I understand it, .2 is regarded as the "line in the sand."
2) I just finished my SRT a week ago, 33 treatments with the Calypso system, and I have had ZERO side effects from it, nothing at all, no changes in anything. Now, I'm in good shape and continued working out during it, also was lucky enough to have a bowel movement on the morning of all 33 treatments and had no trouble with a full bladder as the facility was only 10 minutes from my home. It is probably rare to go through the entire program with no effects whatsoever, but that was my experience so 100% probability of side effects is not accurate.
3) I don't know about the 8-10 years before advanced PC shows up if you do nothing. I hope you're right, since our numbers and ages are almost identical, but that seems awfully optimistic to me.
Best of luck in your decisions and journey.
Henry
Posted 3/3/2015 8:42 PM (GMT 0)
As you can see below I had a reoccurrence 2 years after RALP. I am being treated at UCSF in San Francisco and their protocol for me was two occurrence's of PSA's above 0.2 at least two weeks apart. I complete 37 SRT treatments in November and just had my first PSA test in February. So far I am back to undetectable levels so I am happy I went through it. I had 3 gold seeds implanted in my prostate bed prior to starting the RT. That pinpoints the area more accurately for radiation guidance and less organ damagge. I had some fatigue and loose BM's for a bit but tolerated the procedures pretty well. I am no spring chicken so I would think younger guys could do quite well. It certainly was worthwhile so far in my case. It seems you are still considered in the undetectable range according to what my protocol was.
Posted 3/3/2015 11:25 PM (GMT 0)
0.08 is not barely detectable, you had positive margins, and the kinetics do not look that good so far. Treating sooner (early salvage) has better outcomes than waiting until PSA rises to 0.2. There is a test called Decipher that costs $4000 that they can do (I don't know if Canada covers it) that is pretty good at predicting future metastatic progression.

If you decide to go ahead with the radiation, you might be able to avoid hormone therapy with it. The LN radiation is controversial.

- Allen
Posted 3/3/2015 11:25 PM (GMT 0)
I waited until my Psa climbed to .2 then confirmed by .3. My SEs are noted in my signature. It's my experience is that they begin after SRT is completed. They are now pretty much over. The thing I hated most was ADT which is necessary to make SRT more effective.
Bob
Posted 3/4/2015 1:30 AM (GMT 0)

Tall Allen said...
0.08 is not barely detectable, you had positive margins, and the kinetics do not look that good so far. Treating sooner (early salvage) has better outcomes than waiting until PSA rises to 0.2. There is a test called Decipher that costs $4000 that they can do (I don't know if Canada covers it) that is pretty good at predicting future metastatic progression.

If you decide to go ahead with the radiation, you might be able to avoid hormone therapy with it. The LN radiation is controversial.

- Allen

Thanks everyone !

Well, my PSA climbed to 1.2 so I signed the consent form today and will have the SRT CT scan this Thursday am. My 33 treatments will start in 2 - 3 weeks. My RO advised me to do the lymph nodes to be thorough and also said it is controversial AND radiation with hormones is also controversial.

I just hope I get through the radiation as well as I got through the surgery. My journey continues ....
Posted 3/4/2015 1:45 AM (GMT 0)
You'll do fine. SRT is more scary in theory than in practice! Just tedious but over before you know it. Good luck.
Bob
Posted 3/4/2015 4:54 AM (GMT 0)
Being a low-intermediate risk 3+4, as are you, both my uro and RO recommended against HT in conjunction with my SRT, which I was thrilled to hear, of course. And the RO on the day of my last treatment said that if I had suffered no side effects to that point, I was unlikely to in the future. A week and a day later, that continues to be true.
Posted 3/4/2015 6:22 AM (GMT 0)
It's radiation for me. goal : undetectable PSA with minor side effets
A life after PCa .....

My hope for us all.
Posted 3/4/2015 3:02 PM (GMT 0)
Good diligence.

Good choice.

Good luck.
Posted 3/4/2015 5:15 PM (GMT 0)
Phenom and ravineman
Count yourselves fortunate that ADT has not been shown to be of any help with gl7. Since I was gl9 I was advised to have it and I did for six months which is all I could stand and my Uro felt it was adequate. I had gl7 at base where positive margin occurred so I'm hoping that the combo of ADT and SRT did the trick. I get results of third post SRT this week.
Bob
Posted 3/4/2015 11:28 PM (GMT 0)
Good to see that your doctors are treating you. My PSa rose to 1.2 in Decmeber and had my second radiation oncologist consult in January and they still declined to offer treatment. Might be because my initial PSA was so high, with a g9 and two hot spots. Go for my next PSA tomorrow. Anybody want to take a guess at what's it's going to be?
Posted 3/5/2015 12:16 AM (GMT 0)
My story is well known here. Gleason 7. Surgery failed within 9 months. Had SRT, went terribly wrong. SRT failed within 9 month as well. Left me with severe damage, resulting in needing an Urostomy. Living still 5 years later with severe chronic pain and severe chronic fatigue, PSA above 40 at this point.
Posted 3/5/2015 7:10 PM (GMT 0)
Got a CT scan and three tatoos today ... starting SRT March 17th.
Maybe a cure for my PCa ... or just more treatment side effects ...

The cancer that just keeps giving !
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