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Is it Time for SRT ???

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Posted 2/22/2017 12:04 AM (GMT 0)
HI ALL,
My first post, and let me first start off by thanking each and everyone of you. You all are totally amazing people. You have made my emotional journey much more bearable. The understanding, compassion, knowledge and conviction shared by each one of you is incredible beyond words. I've been lurking and educating myself since the PSA when up in Sept 2015.

As you can see by my signature, I'm in the elite G-9 club. With such an aggressive type, should I be heading to the RO for some SRT with a PSA of 0.08 a year+ out of surgery??? My next PSA and appt with the surgeon is in May. Should I chill and not freak out and see what May may bring?

I've already contacted the docs office and we'll know how that sometimes goes. The office staff doesn't get it, wants me to come in see the surgeon rather than an appt straight with the RO. My thoughts are aggressive cancer aggressive treatment but, on the same token don't want to over treat til it's needed. At least an appt with the RO I'd be ready if things change.

All Opinions Welcome...especially the Tall One!

Jeff
Posted 2/22/2017 12:19 AM (GMT 0)
Welcome to HW, sorry you need to be here.

Yes, that's a worrying pattern. Get thee to the RO. If you have to go through the surgeon, that would be annoying but wouldn't hurt.

Current thinking is that SRT sooner rather than later is better.

Others will be along soon to contradict me. smile
Andrew
Posted 2/22/2017 12:31 AM (GMT 0)
First off, I am no expert, but what would it hurt to speak with a RO and be a step ahead if your May test comes back unfavorably? With a G9 and a PSA trending upward--all be it slightly at this point--I would get my foot in the door with an RO just in case. If nothing else you could hopefully get in quicker if need be in the future.
Just my opinion.

Good luck,
Tom
Posted 2/22/2017 12:46 AM (GMT 0)
Hi bigwillietex-

Do you have to go through your urologist to see an RO? Your positive margin and GS9 and increasing uPSA are all worrisome. Meeting with an RO to discuss this doesn't necessarily mean you will have SRT right away. Perhaps you need more time to heal from surgery. Perhaps he'll want you to start on ADT first. Perhaps he'll went a CT to check your lymph nodes. It makes sense to talk to the right kind of doctor ASAP.

Here's a good explanation about why it makes sense for guys in your situation:

/pcnrv.blogspot.com/2016/08/how-soon-after-surgery-should-salvage.html

I notice that the following study was done at UT Southwestern. Are you able to use them? Neil Desai may be a good place to start.

/pcnrv.blogspot.com/2016/09/very-early-salvage-radiation-has-up-to.html
Posted 2/22/2017 1:05 AM (GMT 0)
Jeff
You have some very favorable factors. Positive margin at APEx is better than bladder neck, no SVI and your PSA doubling time is slow. So cheer up!

IMHO the only reason to speak to your surgeon is to ask him the precise reason for the positive margin. Why did it happen? That will give you an idea of how much PCa was left behind.

You probably don't need to rush into SRT but as a gl9 HT and SRT will most probably be necessary.

Good luck! You're one of the fortunate G9s!
Bob
Posted 2/22/2017 1:34 PM (GMT 0)
Welcome, sorry you find yourself here.

I agree. Talk to the RO now and review a game plan. IF you get another rise like I did from .07 to .09 put the game plan into action immediately with the HT shot. This gives you time to setup the planning for SRT and schedule the actual treatments. Talking to the RO set my mind at ease, it felt like I was doing something other than just clicking my mouse on the last PSA result.

If you don't get another rise all the better, just keep testing every 3 months.
Posted 2/22/2017 4:28 PM (GMT 0)
current thinking for when to start SRT and/or HT is all over the map...throw a dart...your mortality from pca wont change much imo...of course...how would anyone ever know that??...other than questions dis- guised as evidence...dis-guised as answers...

Do your thing and don't look back...its all personal... a reflection of selection....
Posted 3/2/2017 6:04 PM (GMT 0)
Thanks all for the great information. Its very reassuring to hear what your gut knows is the best way to proceed for your situation. Especially since everyone is different and there is no magical cure.

I've been able to sure appointments with two different RO's, Dr. Desai @ UT Southwestern in Dallas and Dr. LaNasa @ USMD in Arlington. I think I've read enough here to have a fairly intelligent conversation with them about my treatment options.

My question for clarification has to do with the amount of Gy's vs the number of sessions. Isn't there new research showing that higher amounts of Gy's with low number of session are showing better results long term along with the HT? And if so, what is a general idea of the number of Gy's vs sessions with this thinking verses the older method of lower Gy's and more sessions? Hope I'm making sense.

Fighting forward
Jeff
Posted 3/2/2017 7:08 PM (GMT 0)
Yes reducing the number sessions and increasing the dose per session has shown the same or better outcomes with the same or lower toxicity.

There was a study done at UW Madison that showed favorable results.

/www.ncbi.nlm.nih.gov/pmc/articles/PMC3064951/


My RO is one of the authors of the study. He is treating me with (25) 2.5gy = 62.5gy total which is bioequivalent to the conventional (39) 1.8 = 70.2gy I'm one treatment away from completing the 25 sessions. So far only mild urinary and rectal side effects.

I'm also doing Lupron for 6 months. You might want to discuss that with your RO too.
Posted 3/5/2017 5:18 PM (GMT 0)
Thanks Greytech,

A good read. I don't always understand some of the technical parts sometime but get the point.

Jeff
Posted 3/5/2017 5:48 PM (GMT 0)
According to another post by TA you can read, .03 is the proven trigger point for RT after RP so you're already there.
Bob
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