Two different hospitals - two different opinions. Great! Now what?

So dealing with reoccurrence. Met with doctors and University of Chicago. They recommend IMRT, hormone therapy ( Lupron and Casodex for 4 months), and radiating the nodes.

Northwestern recommends just IMRT.

Can anybody share what they did with similar statistics to mine. Hopefully they show up in the signature.

Diagnosed G6 PSA 4.7 (2 oppinions)
RP 7/14/2015 G7 3+4, Negative nodes, negative seminal vesicles, 1 positive focal margin at apex
Reoccurence 7/2017

Post Edited (Skylark72) : 8/11/2017 9:45:04 AM (GMT-6)

I tried to get IMRT with hormones but I was not considered "High Risk".... felt like saying to Doc, stand in my shoes and tell me if you feel the risk is high or low. Possibility the most important thing is the amount of Gy's. The older standard is 66.6 Gy, today its up around 70Gy. Your one focal margin is most likely the thing that pushes Doc's at U-of-C to go with hormones and zap the lymph nodes, which of course then carries more risk... but possibly a better chance of cure..... but...... but..

One other thought, in my readings of new drugs trials, some of these seem to want men who have not had other hormone treatments. Since I did not have hormones I have not focused on that possible exclusion. Others here may have a better handle on trials and exclusion criteria for previous hormone drug use... if any.

The risk / reward is more cloudy for us who are in the Gleason 7 gray area.
Good Luck and keep us posted.
-Ken

When I was told my various options, at North Shore, NW and UC, I was told that that the hormones would bring my testosterone down to zero, making it easier to kill the cancer cells, which feed on testosterone. I was told in laymen's terms that there are dumb, medium and smart cancer cells. They can kill the first two, but the smart ones have a way of escaping and mutating everything they can throw at it.

So...why not throw the kitchen sink at it? UC has the most clinical trials than any other Chicago area hospital? The doctors are professors for God's sake.

Good luck,

Nick

P.S. Go with the doctor who has done the most operations! My first two choices both did over 4000. However, one had no bedside manner, plus the other doc was known as a "Doctor's Doctor". He was the guy doctors who have PC go to for their operation. Find out which one is a Doctor's Doctor. Not too old, not too young. Best if at a teaching hospital.

Nick

Up front my docs all said this stuff is usually more serious than it first appears so they took the aggressive approach. After seven years on this forum the stories of many have confirmed my docs assumptions. If I were you I would add the ADT. Better safe than sorry and the side effects are not really that bad from my experience. I think it is better to get ahead of the disease rather than reacting to continual recurrences. Do the ADT.

I am 52 maybe? My PSA hit .2 this month. Tumor volume was 15 % . I don't know what to do.

Skylark. You asked if anyone in similar situation, so see my signature. I was slow to get the salvage radiation, PSA kept coming, I got the nano-MRI at Nijmegan in the Netherlands, then radiated those nodes along with 4 mths of ADT. After the ADT wore off the PSA came back strong so I am now on long-term ADT. Did the scan and resulting treatment help?--not much I would guess. I did the node radiation outside Northshore (Dr. Hollister, worked with Zelefsky at MSK), but with the support of my Northshore Oncologist (Dr. Shevrin).

Cigafred,
I haven't had any scans yet. They want to do a 3t MRI.
When you had your RP did your PSA go to zero initially?

Skylark,
Interestingly both institutions have very good prostate cancer programs. U of C is home to the only Nobel prize in medicine related to prostate cancer, and Northwestern has one of the research physicians I most highly respect (Maha Hussain).

One of the philosophies behind the combining of HT to IMRT is that there are many papers out there that indicate improved results by shrinking the tumor. And of course there are papers that indicate that this also reduces quality of life and it should not be a standard of care for everyone adding HT in the hope of improving results.

As I stated in your other thread as to going to Mayo or JHU, I don't think either of those institutions have better programs than the other or either of these two institutions.

Skylark72 , you are not in the best situation , we all are mentally preparing for a BCR and with your stats it's come lot sooner than
one would expect. Stay strong and and all I can say is don't delay too much.
And please keep us posted.

Skylark72. Yes, PSA went to zero for 2+ years.

Skylark, what lifeguyd says about conflicting opinion is certainly true. Different doctors approach nearly every disease differently. In your case you don't know where the recurrence is but it is likely local (at the site of the positive margin). Hopefully they will do a scan that can determine that. I had persistent disease post surgery in a pelvic lymph node. In my case, both my local RT doctor and the consult doctor at Mayo advised adding Lupron to radiation even though my only known persistent disease was a pelvic lymph node. They believed that the Lupron treatment would sensitize the tumor and make it more likely curable with the radiation. There is evidence to support this theory. Also, Lupron may actually kill some prostate cancer cells by itself so if I or you have small amounts of tumor metastatic elsewhere perhaps Lupron could eliminate it. Perhaps. Anyway, I chose to go the most aggressive route from the beginning in hopes of cure or at least best possible result. I wanted to have no regrets that I didn't do what I could have. Not an easy decision given the unpleasant side effects of Lupron which I am still not over four months after finishing but I am glad I chose that route.