Surgery & Radiation

Okay, So how many of you had surgery and still had to do Radiation....

I had both. Less than year after surgery my PSA began creeping up.

"Okay, So how many of you had surgery and still had to do Radiation...."

take a look at signatures. it's a pretty big number here. and many of those guys chose surgery because 1) I just wanted it out. 2) I just didn't want radiation 3) with surgery there's a back-up plan.

from what I have seen since being here surgery would always be my last choice. as a G9 I think your best chance now at a cure is to hit it hard with a combination treatment, and assume chosing surgery is really choosing surgery + SRT.

Given that you're a G9 that would shade me toward having radiation and--in my case trying to avoid the SEs of both treatments was exactly my reasoning as a G9er. That said, for G6 and G7 guys, most of the folks that had surgery do NOT need radiation.

What type of radiation are you having?

Ed...you're right there are definitely some G7s--with our own Pratoman as Exhibit #1 despite having a pretty favorable pathology. I'd be curious what the percentages actually are--I'd guess that it's a minority, although I could be wrong.

According to the Han nomogram, the 10-yr recurrence rates after surgery are:

Low Risk (PSA 4-10, T1c and GS6) = 5%
Fav. Int. Risk (PSA 4-10, T2a, GS 3+4) = 13%
Unfav.Int. Risk (PSA 4-10, T2a, GS 4+3) = 17%
Unfav. int. risk/high risk (PSA 10-20, T2b/c, GS 4+3) = 41% (NCCN allows recategorization to high risk if multiple intermediate risk factors)
High Risk (PSA 20+, T2b/c, GS 8-10) = 72%

As Michael said, i am scheduled to have radiation begin in about 6-8 weeks. Starting HT this week.

Here is an "Han table" site where you can fill in your numbers and see a prediction of recurrence probability. Is this from where TA gets his numbers? It seems that TA used the preoperative tables but after surgery you should use the postoperative model.
urology.jhu.edu/prostate/hanTables.php

(TA: Unfav.Int. Risk (PSA 4-10, T2a, GS 4+3) is 22% and not 17%, or have I misunderstood your table?)

I did. I had a positive margin and after two years the PSA hit the magic 0.2 ng/ml so I took the leap. Since then my PSA >.02 (undetectable).

I don't know the size, I go in tomorrow for my 1st Lupron shot, I'll ask them...

Gemlin-
I assume the OP is trying to make a decision of which primary treatment to have - so the pre-RP is most appropriate.The categories - low risk, etc. are only relevant pre-RP. He doesn't have post-RP pathology results to enter as inputs in a post RP nomogram. You are right about the 22%- thanks.

"had to do Radiation..." Well, it's my impression lots of us surgery men have salvage radiation without really having to do it, at least not so fast. It's the ultra sensitive PSA tests that makes so many of us so nervous. Some of the early SRT are over treatment. Many men within the low-risk subgroup would have an excellent outcome even without any salvage treatment (few wants to chance that he belongs to those lucky even if the odds are pretty good).