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Post surgery PSA and What's next

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Posted 10/27/2017 11:10 PM (GMT 0)
Hi all;

Just had my follow-up with my urologist. Post surgery PSA was 0.13 - which he noted was a gigantic improvement from 34.2 in May. I was hoping for undetectable, but realistically this isn't a surprise with my pathology (below). Follow-up with urologist 2/2/18 with a PSA just before, so we will know a little more.

I'm healing well, mostly continent (a few night time issues), and ED is slowly resolving itself - so good news on both fronts.

He is suggesting HT with ART starting in about three months - January / February or so. He indicated it would be IMRT (I'm assuming IGRT / IMRT, but I'm not sure).

I meet with the RO in a few weeks, what should I be asking about?

He also mentioned a journal article that came out yesterday comparing the various treatment regimens for node positive, stage 3 patients - has anyone seen that, or heard which journal it might be in?

Thanks all

Rob
Posted 10/28/2017 11:30 PM (GMT 0)
Hi Rob -

Hormone treatment 2-3 months before radiation seems to be the way to go. The HT radio sensitizes the cancer cells to allow the RT to work better.

You should be fully continent before RT because if incontinent before you probably will still be incontinent after radiation.


Questions for a Salvage Radiation Interview (from Tall Allen)

1. What is the probability that I need salvage treatment? Do you calculate that from a nomogram?
2. Do you think I should get a Decipher test to find my probability of metastasis in the next 5 years? Do you know if my insurance covers it?
3. How large a dose do you propose for the prostate bed? (should be near 70 Gy)
4. Do I need concurrent or adjuvant ADT?
a. Why?
b. What's the evidence that it's useful?
5. How do you decide whether to treat the pelvic lymph nodes?
a. If so, at what dose? (50 Gy)
b. How do you plan to prevent bowel toxicity?
c. How will you account for the separate movement of that area and the prostate bed?
6. What do you think of doing this in fewer treatments (hypofractionation)?
7. What kind of machine do you use? (e.g., RapidArc, Tomotherapy, Vero, etc.) Why do you prefer that one?
8. What is the actual treatment time for each treatment? (faster is better)
9. What kind of image guidance do you propose? fiducials in the prostate bed? Using the fixed bones only?
10. How will inter- and intra-fractional motion be compensated for?
11. What measures do you propose to spare the bladder and rectum?
12. What side effects can I reasonably expect?
13. What probability of a cure can I reasonably expect, given my stats? Is there a nomogram you use to come up with that?
14. How will we monitor my progress afterwards, both oncological and quality of life?
15. What's the best way for us to communicate if I have a question or issue?

Bobby Mac
Q
Posted 10/29/2017 6:17 AM (GMT 0)
You might want to have another PSA test in a month or so just to see what it's doing..If it goes up appreciably, I would start ADT NOW just to stop any spread of the cancer while you finish healing prior to radiation treatment...
Posted 10/30/2017 2:41 PM (GMT 0)
Since I was node positive, I automatically moved to the "triple play" category at MD Anderson. Lupron and then radiation when my pelvic bed was healed.
Posted 10/30/2017 4:04 PM (GMT 0)
Sounds like your doc has a great plan there.

For studies, you want to email Tall Allen, he can point you to those.

Andrew
Posted 10/30/2017 10:21 PM (GMT 0)
Thanks Guys;

I hope I'm not in that camp yet Andrew!

Cheers!

Rob
Posted 10/31/2017 2:01 AM (GMT 0)
@Fairwind, what is considered and "appreciably increase" in persistent PSA?

My husband had a 0.41 (7 weeks post RP) and just got a 0.50 (12 weeks post RP).
Posted 10/31/2017 2:15 AM (GMT 0)
scar - you might want to start a new thread on that. That's something that would be good to get more of the folks here talking to you about. That kind of change post RP isn't good.

Andrew
Posted 10/31/2017 2:52 PM (GMT 0)
Scar....do a search on my name. I've been posting about my persistent PSA, which is now .42 and as Andrew says, is isn't good. A complex and challenging issue from all I've read. No experts on it either that I can find.

Your husband need a really good RO, and an MO to offer other options. An Aximun PET scan would be a very good idea to see if the PCa has spread. Don't delay!

Good luck!
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