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Posted 9/25/2015 3:58 PM (GMT 0)
Hello,

After my last Onc visit 6 weeks ago, I was prepared for RT starting in Mid January. Yesterday he suggested start Lupron now and 6 courses of Chemo at 3 week intervals. This is not at all what I was expecting and had been mentally prepared for RT and now a new direction. My head is spinning.

Not sure what I should do.


Age at detection 58
PSA at detection 9
Biopsy 3/2015, 4 of 10 cores positive, Gleason: 3+4
Bone scan negative,
DaVinci 6/26/15
Pathology: 41.5 g, %involved by tumor 20%, no seminal vesicles involvement, Apical margins involved Gleason same 3+4
PSA 7 weeks post op 0.275
PSA 8 weeks post op 0.49
PSA 12 weeks post op 0.79
Posted 9/25/2015 4:19 PM (GMT 0)
While HT has been shown to increase the effectiveness of RT and doing it for a year or two is probably worthwhile, In the past, chemo was thought to be ineffective against prostate cancer...But things change...I would sit down with your Onc and ask him his reasoning on putting you through chemotherapy..Is the benefit worth the side-effect load you will suffer? At this point, you need to fight this as hard as you can, but you don't want to destroy your quality of life by submitting to a treatment with a questionable benefit....

Make your doctors justify the chemo.....
Posted 9/25/2015 4:27 PM (GMT 0)
I hope you are seeing a radiation oncologist and not a medical oncologist. The use of chemo when there are no detected mets - and several of them - has no evidence behind it, and in my opinion should not be done outside of a clinical trial. I'm not even sure that Lupron does anything when one's positive margins are GS 3+4, but that is a reasonable judgment call. I also don't understand waiting until January for SRT - you have BCR with positive margins and your PSA is rising quickly - what's the logic behind waiting so long?

- Allen
Posted 9/25/2015 4:54 PM (GMT 0)
Allen,

The MO was my main Dr. He sent me to the RO last month and we made the plan for January...6 months post op to allow healing.

Yesteday, the MO had a different idea, so I am really concerned.

Thanks
Posted 9/25/2015 7:42 PM (GMT 0)
I know that many HWers disagree, but I think it's a bad idea to bring in an MO while curative options are on the table. You run into the old problem that to a hammer everything looks like a nail. And it's simply not true that any MO knows that much about radiation and what it can do. As an empowered patient, it's not their decision, it's yours. If you decide you are going for the cure, fire your MO (you can still use him for consult on meds, but work through your RO), and take advice from the guy who can give you what you want. However, if you decide that you'd prefer to manage your disease - a legitimate choice - fire your RO. You can't follow conflicting protocols and expect good results.

- Allen
Posted 9/25/2015 7:53 PM (GMT 0)
Thanks....

I finally got my head around accepting RT and then got this news. I really respect my Dr, he is a top guy in our Cancer but this just seemed to be overly aggressive. I became so upset, I kind of lost concentration in asking more direct questions.
Posted 9/26/2015 12:31 AM (GMT 0)
Aloha CLDCR:

I disagree with the notion that you should not bring a Medical Oncologist onto your team even at this early stage. There is certainly no medical basis for this opinion. A multi disciplinary team of real experts is, in my opinion, essential as early as possible.
Posted 9/26/2015 1:07 AM (GMT 0)
Oddly, over the years, my medical oncologist has been more aggressive with the use of radiation than my radiation oncologist. He certainly knew more about what and when to use other therapies in conjunction with radiation.

Over the years I've valued my team of doctors that include a urologist, a RO, and 2 MOs.
Posted 9/27/2015 12:05 PM (GMT 0)
CLCDR,

I agree with what Allen says here, early chemo is most effective to those who have extensive mets. I am currently going thru chemo per the CHAARTED Trial and while it is tolerable, it is no picnic. I am close in age to you. I suggest you do a little research on the CHAARTED Trial, easy to find if you google it, you'll see what it says for early chemo and who benefited the most.

Learn all you can and be your own advocate.

Ed
Posted 9/27/2015 3:59 PM (GMT 0)
CLDCR,

I know that chemo sounds like a frightening option. This is certainly a very personal decision - but for whatever it's worth i'll add my 2 cents here: I did 6 rounds of Docetaxel in combination with ADT and the results in my case have fully justified the challenges of the treatment (PSA dropped from 88.5 to 0.13, mets no longer visible on scans). I would do it again in a heartbeat.

Chemo is no walk in the park but it is absolutely tolerable. Today most of the nasty side effects of chemo (e.g. nausea) can be very well controlled. It is important to take it very seriously and approach it as a project that will need time & resources and a good doctor at your side. Chemo will keep you busy at times and will affect your daily routines. But given the pretty impressive results I would absolutely do it. You can still do radiation later - and you might need less intense radiation as in many cases the total tumor burden does shrink significantly with ADT and chemo.

Let us know if you need more info. I wish you all the best!

Madagascar_63
Posted 9/27/2015 8:56 PM (GMT 0)
Thanks guys.....appreciate the help.



Age at detection 58
PSA at detection 9
Biopsy 3/2015, 4 of 10 cores positive, Gleason: 3+4
Bone scan negative,
DaVinci 6/26/15
Pathology: 41.5 g, %involved by tumor 20%, no seminal vesicles involvement, Apical margins involved Gleason same 3+4
PSA 7 weeks post op 0.275
PSA 8 weeks post op 0.49
PSA 12 weeks post op 0.79
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