PSA rise after RRP

Hey Mag,

So sorry about your PSA turnaround. But you are on top of the situation and that's the important thing to do. Action is essential because cancer is very sneaky. Oncs are strange birds so be sure to take your list of questions with you. I say that because their experience is with all kinds of cancer and IMHO they assume way to much knowledge on our part. So be specific and insist on answers. Just my unsolicited advice from experience.

Best of luck to you and we WILL get well together...

Jim

Yeah Magaboo,

+s and -s as far as outcomes are concerned so you can weigh the possibilities vs side effects. I think they tend to underplay the side effects because they, for the most part, have never experienced them. I don't know anything about radiation but chemo can produce devastation and we need to be prepared. No more surprises please. HT can produce problems too so make him be specific (as much as he will be) about the effects of low testosterone, especially depression.

My cancer clinic uses physician's assistants to monitor the day to day treatment and I found that she is more open to getting me answers than the onc. (Don't know how they do it in Canada) I think that TC-LasVegas probably has researched ongoing PCa treatments more than anyone here so he is an excellent resource too.

There will be dark days, bad news, frustration and fear. That's when we have to take a gut check and FIGHT!!!

Jim

Hey Magaboo.  Have you had a further consult with your dr?  I have mine in early 2009 and will let you know.  In the meantime, I hope that my increase (and yours) was, as you say, just a blip.  Dr seems puzzled, as he is convinced that Ca was limited to the prostate with no path evidence of any Ca at the margins or in the seminal vesicles.  He told me he thinks another type of non-cancerous inflammation could be involved.  Has your dr commented on that possibility?  I'm pulling for you.  We need to keep our spirits up!

Hi Magaboo,
I seem to be having about the same luck as you. I saw my radiation Oncologist today for my first consult. He set me up with a MRI in a couple of weeks and then back to him for a ct scan to lay out my treatment. He said he would do IGRT for 7 weeks with a total of 68 Greys to the prostate bed. This isn't what I had been looking for but it is what it is! Good luck with your appointment. Hi Tony hope all is well with you and yours. Later.........David

Just quick update for those that are interested.

Well, I had my meeting with the Oncologist today and we have decided to go ahead with the RT only. I'll get a definite date for the MRI within 10 days and the RT should start by the end of October 08. I'm scheduled for 33 days of RT to the prostate bed  (6.5 weeks). I wish the Onc hadn't  told me about all the possible short and long term side effects.......scary!

Wishing the best for all of you.

Magaboo

Hi Jim,

Thanks for your pad on the back. Feels good to hear from friends after a stressful, scary day at the Onc's office. I will try not to dwell on the scary parts (at least I'll try ).

Wishing for sunny days ahead for you.

 

Paul

Hi Paul,
You and I will be on this journey together! I think I will ask my radiation guy about the whole pelvic region as Tony spoke of also, that may be what he is planning. I understand the scary side like you do. My appointment was a week ago today and I have settled down pretty good. I am planning on a week at the beach for some fishing before all this begins which I think will help.....lol. Good luck and be of good cheer.


David

I don't always understand how these doctors think. We have had a few guys with rising PSA's get WPRT. The problem with EBRT is that they hit everything in the area, like rectum, bladder, etc. A shot with IMRT using WPRT on the lymph system is able to hit the bed and the surrounding tissue while reducing the destructive hits in those important places and has proven results. But they know more than I do. In any case, our prayers and best wishes alike to you and to David!!!

Tony

Hi Tony,

 

Thanks for this heads up on my forthcoming radiation (simulation is on 14 Oct., 08). I'm a little anvious of David in that he has all the latest equipment available to him. One consideration is that here in Canada (West Coast - Vancouver) the available equipment is not what it is like in the USA. i.e.. We have no IGRT available in this part of the woods. Also, the Onc stated that with salvage RT, the accuracy of IMRT is less important since we don't know exactly where the cancer cells are located. With all these considerations, I'll just have to go along with the Onc's decision since my choices are somewhat limited.

All the best to you.

 

Paul

Hi artu 7,

 

Sorry to hear about the increase in your PSA, but without more information about your specifics, it is difficult for anyone to make an intelligend comment. Proton seams to be the latest in RT treatment, but with a fairly short track record. EBRT used to be the 'gold standard' for many years and is still used in many facilities. IMRT is somewhere in between and is apparently doing less harm to the tissues surrounding the prostate. Each seams to have it's place and a lot seams to depend on your condition, preference and perhaps even the area that you live in.

Wishing you all the best.

 

Magaboo

Hi Bill,

 

Thanks for your comment. I've read the same thing, hence my decision to go ahead and do the radiation. The simulation is scheduled for the 14th Oct. I haven't got a date for the RT yet, but it'll probably start towards the end of Oct.

All the best to you Bill.

Magaboo

Hi Puget,
Great to see you, and I hope all is well.

IMRT stands for Intensity Modulated Radiation Therapy. Layman terms: Basically they use lead pellets and air to shape the beam during treatment. This is done in a matter of seconds by computer. Mine was done in seven angles and each angle was hit with about five shapes each. In fifteem minutes they hit my prostate bed and surrounding areas with 35 shapes a day. As the treatments progressed, the shapes were altered to intensify the beam at prostate bed and lymph nodes I still had, while being shaped in a way to not hit other organs like my rectum and bladder.

there are other methods to deliver IMRT. IGRT (Image Guided RT) uses a CT scan to guide the beam and reshape it before each dose. This is more precise than my seven angle version and takes into account the daily changes in our body.

Another method is Tomotherapy. Also image guided by CT Scan, Tomotherapy uses IMRT from 53 angles simultaneously by a rotating gun.

Which one is best? It really depends on each case and how accurate the beam needs to be. For me with the 4 positive margins, IMRT with seven angles was not as accurate, but would likely hit stray cancer cells better.

Boy I babble on too much sometimes...

Tony

Thanks for the information, TC.  I'm waiting to see if I am also going to need radiation.  Hopefully not, but since I won't know until January, I might as well learn as much as I can now.  I don't want to be a deer in the headlights like I was for the first month or so after my initial Dx.

Thanks again.