How soon is too soon for ART?

Hello All,

I had an open RP on December 19th. My surgeon recommended that I wait six months for ART. The RO, however, says that he believes I am ready to go and wants to begin ART mid-April (four months since surgery). I recovered full continence a month ago and my erectile functioning appears to be about as good as it is expected to get. I have definitely noted the "listen to the expert" advice here (RO knows RT and Uro knows surgery) but in this case there is an overlap. The surgeon thinks six months is a good healing time but the RO thinks four is fine.

Thoughts?

Thanks,
Bill

Bill-

You need to discuss with your RO, but I agree with waiting until you are all healed inside.

Bobby Mac

My brother-in-law had surgery at JH. Radiation began 3 mos. later at JH.

I couldn't tell you if this is a protocol or a case-by-case thing.

his post op path was 4+4 with 4/5 found in one node.

That was 2 years ago. He looks better than he ever has.

Here's something to consider:

/pcnrv.blogspot.com/2016/10/urinary-and-sexual-healing-improved-by.html

I started radiation nine months after surgery, I think that's the quickest appointment I could get at MD Anderson, waiting six months is prudent. Hormone therapy began about ten weeks before my first radiation session.

Schoolpsych, We are in the same boat as you - in between RP and aRT. My thoughts are there are many considerations such as pathology results and healing from RP. If path is adverse, and healing (incontinence) is not an issue (my husband's situation) the sooner the better for aRP.

Your conflicting advice seems to be common: Discord Among Radiation Oncologists and Urologists in the Postoperative Management of High-Risk Prostate Cancer (March 2017)
https://www.ncbi.nlm.nih.gov/pubmed/28301348

I'm curious if you had any genetic testing done to determine if RT will be effective for you. Article:Genomic tests to guide prostate cancer management following diagnosis
https://www.ncbi.nlm.nih.gov/pubmed/28277880

Also, has your urologist mentioned the possibility of adjuvant chemo? Article:Adjuvant radiation therapy, androgen deprivation, and docetaxel for high-risk prostate cancer postprostatectomy: Results of NRG Oncology/RTOG study 0621.
https://www.ncbi.nlm.nih.gov/pubmed/28323339

Thank you again everyone. I have decided to wait until May - five months out from surgery. Basically, splitting the difference between the Uro and RO waiting time recommendations.

Allen - Thank you, your response regarding no problems with a month lag was also confirmed by the RO. We are going to do the simulation on April 5th as planned but wait until May to start the actual RT.

Annie88 - I had some basic genomic tests done, however, it was not revealed to me if they had any bearing on my ART. I had a confirmed positive pelvic lymph node prior to surgery so the idea was all along that surgery was only a part of a three-pronged treatment plan that would include RT and ADT as well. Adjuvant chemotherapy has been a sore subject that is causing stress for me. Before surgery, I consulted with a non-local MO who is suggesting that I should add up-front chemotherapy to my RP/RT/ADT plan. However, my team at the Cleveland Clinic and at another local hospital system are very much against it. My PSA has been undetectable following surgery and their position is that they see the SEs of chemo to outweigh the possible benefits at this time. One doctor another doctor described as a "superstar" MO actually used the word "crazy" when discussing adding chemo to my current treatment plan. The adjuvant chemo for high-risk but no M1 certainly seems to be a hot potato among the medical community. If I want to get the adjuvant chemo I won't be able to get it locally because the locals refuse to do it. I'd have fly out to the non-local MO for the treatments which certainly does not seem ideal. So, it is on-hold for the time being.