Post RP - some good news, some not so good news

Congratulations on the 0.0 ! Are you staying at the Rotary House? MDA is a nice place, if you must go to a medical center.

Hello John,

Based on the 0.0 you are on your way to being cured. ART is a 15 minute daily nap for 8 weeks, really.

Most of us experience loose bowl in weeks 5-6 out of a 8 week cycle. No sun-burn, hair loss, burning sensation, or any of the other 15 possible side effects. I kept up the daily walks and never had any fatigue which a few others have reported.

I believe a 6 month cycle of Lupron is the norm with ART or SRT but some doctors skip it. Due to the short cycle the only side effect are hot flashes after the first 30 days for most guys.

HMS

John,

I finished SRT at MDA six weeks ago. 35 sessions. No problems.
Outstanding service from everyone that helped me. Weekly doctor's visit. I will get my first follow up visit mid-August. Of course I am expecting good news - my RO felt like I would have better than 80% chance of good report.
Good luck in you journey.
Blessings
David

If Dr. Davis is your surgeon and not a prostate oncologist, I would get more opinions. You have time. Your PCa may come back, but with diet and supplements, double at over one year rate, meaning that it may never be threatening enough to kill you.

--------------------------------------------

Age 63 in 2015
12/02 PSA 2.9 age 51
9/03 BX/DX, Gleason 6, 4 of 12 cores
9/03 Brachytherapy
5/08 PSA nadir 1.1
12/08 PSA 1.8
2/09 BX/DX, Gleason 8, 1 of 12 cores
6/09 Hyperthermic Radiation, Hormone (short term), IMRT (10 fractions) spring 2009
10/09 PSA nadir < 0.1 10/09 through 01/12
4/12 PSA 0.2
3/14 PSA 2.9
5/14 C11 Acetate PT/CT, found 2.0 cm lymph node
5/14 Lupron/Casodex (9 months)
8/14 nadir <0.01
2/15 SBRT to node
3/15 PSA 0.02,T=0
6/15 PSA<0.015,T=105 (yippee!)

John we are also at MD Anderson. Just wondering if you had to ask to have the decipher genome test done or if they just ordered it on your follow-up visit? Is it a blood test? Wishing you all the best. Thank you .

celia01 said...
John we are also at MD Anderson. Just wondering if you had to ask to have the decipher genome test done or if they just ordered it on your follow-up visit? Is it a blood test? Wishing you all the best. Thank you .

Dr. Davis suggested the Decipher test at my first post-op meeting end of March with him based on my pathology report. I think the 'trigger' for the Decipher suggestion was a positive node but it also could have been the overall situation with my path report and what he found during surgery.

It is not a blood test. Tissue samples of the excised prostrate are sent off to the Decipher facility for analysis.

WeGotThis said...
Thanks so much for sharing your story John. My husband is facing a somewhat similar dx. This is the first I've heard about the Decipher Test too. I looked it up. Is this a routine test for your doc or did you request it? (And do you happen to know the cost or if it's covered, I couldn't find this...just wondering.)

Hi Gina,

So many of us here [sigh], sorry your hubby is going through this as well. I think some of your questions I answered above. It is not a routine test and I never heard of it either before Dr. Davis mentioned it. The Doc wasn't sure if it was covered, I've only been on Medicare for a year or so and don't have a feel for what's covered or not (and don't have a clue if my previous health care insurance would pay or not.) I think the Doc said the test was about $4k if you have to pay out of pocket. Hopefully we won't have to pay the entire expense but even if we do, I think it's money well spent. I would rather get intervention now than after my PSA started to climb.

By the way, my tissue sample(s) was sent off probably end of March or the first of April and the results were faxed to the Doc end of May. (Doc said it would take several weeks.)

Gina,

It is covered by Medicare (plus co-pays) in certain circumstances, although it may not be with all Advantage plans - check first.

It is useless in your husband's case, however. What it tells you is the probability that there will be a metastasis found outside of the prostate within the next 5 years. Since you already know that with his N1 diagnosis, it would tell you nothing. It is for men with low PSAs and/or aggressive pathology after surgery and no clear indicators of progression.

The real decision for you is based on whether you have reason to believe that the cancer has already progressed beyond the lymph nodes. The kinds of tests that would help determine that are not Decipher, but are imaging studies. At minimum, a bone scan, or possibly a PET scan. If there is evidence the cancer has progressed beyond the lymph nodes, then salvage radiation is probably not going to work, and only hormone therapy is used.

Even so, salvage radiation treatment with positive lymph nodes remains controversial. We don't yet have the results of a randomized clinical trial, and the studies we do have show conflicting findings. These two studies argue that it's a good idea:

Impact of Adjuvant Radiotherapy on Survival of Patients With Node-Positive Prostate Cancer

The Impact of Definitive Local Therapy for Lymph Node-Positive Prostate Cancer: A Population-Based Study

While this study found no benefit to it:

Patterns of care and outcomes of radiotherapy for lymph node positivity after radical prostatectomy

- Allen