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Need advice on slowly rising PSA

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Posted 8/28/2008 6:03 AM (GMT 0)
5 1/2 yrs post RP. PSA <.1 until about 18 months ago. Since then several PSA tests have been .1, .11, .13, .14, .12, .19, .18, and now latest dropped to .15.  My surgeon who is an an expert in the field of prostate Cancer recommends waiting until PSA hits .2 before starting salvage radiation treatment. My local urologist thinks this is a recurrence and I should start tratement now rather than risk spread.  Since rise seems very slow I am still hoping it may be just some benign tissue that may had grown slightly but impossible to know. I don't really want to have the radiation if I can avoid it. I have good erections now and no problems with incontinence and I don't want to risk those.  Age 50 now. Gleason 3+3.  I did have a positive margin.  If anyone has any recommendations I woudl welcome them.
Posted 8/28/2008 12:49 PM (GMT 0)
As Chas036 points out the lower the psa at time of salvage the better the results.  Your situation is very similar to mine and I know what you are going through with the worries you mentioned.  I took the radiation and it appears to have worked well, only time will tell but the side effects have been minimal and no problems with ed.  I definetly feel like I made the right decision and I would encourage you to do the same.  Recent studies have also shown that even if the radiation does not cure your disease it appears to retard the ability of the cancer to spread and to become lethal.  Make sure you get IMRT or Proton but I am not sure Proton is really an appropriate option for salvage.  In fact I don't even think M.D. Andersen offers it for salvage.  IMRT has become highly accurate and has a long and proven track record of killing cancer cells, not a dis on proton but those are the facts right now.  Bottom line, get a radiologist you trust and who has a long record of success with your type situation. Good luck!
Posted 8/28/2008 2:00 PM (GMT 0)
rdj,

I too had a positive margin. My urologist, oncologist and of course my radiologist strongly suggested that I have IMRT as soon as I healed from the RP.

As far as ED is concerned after the RP but before the IMRT I could get maybe a 40% to 50% erection and that has not changed. Whether the radiation treatments stymied any improvement I may have had I'll never know.

The same can be said about incontinence. about 4 months after my RP I was pretty much pad free but still had slight stress incontinence and to this day I still wear 1 pad a day. Most of the time I'll have a spot the size of a half dollar at the end of the day, the worst days maybe 2 bucks worth.

Ken
Posted 8/29/2008 5:45 AM (GMT 0)
I appreciate the responses. It is a tough decision to start salvage radiation when getting differing opinions from doctors. It is good to hear that side effects appear to be minimal.

Posted 8/29/2008 7:18 AM (GMT 0)
rdj,
Your PSA is going the wrong direction, but at least it's going at the right pace ~ super slow. Ask your doctor about a test called CTC ~ or Circulating Tumor Cell test. This test may help reveal if the cancer is still local. If your doctor does not know what it is, ask him to look it up. My oncologist has started using it and feels it is a useful test. If yours is zero then maybe a proactive shot at RT is a good idea.

My experience with IMRT was uneventful. I made it a practice to start the day with IMRT, then walk a few miles after it. I had some fatigue at the end but I still don't have any bad side effects. I'm doing well with an advanced stage, knock on cyber wood. Good luck to you! 

Peace!

Tony
Posted 8/29/2008 9:56 PM (GMT 0)
This is regarding proton therapy for salvage purposes - I had my proton at Loma Linda over 7yr ago and they have been doing proton for failed surgery even before then.  Because the beam can be stopped at any spot required and there is no exit radiation the chance of side effects are greatly reduced.  I am not surprised that MD Anderson doesn't do it - they also do not do any proton on Gleason 8/9 - they are very selective on who they treat.   UFPTI in Jacksonvill, FL may do it.  Best luck to you.

Dutch 

  

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