Sonny met with the Rad Oncologist Today

As you guys may recall, my first one month post surgery PSA test was 0.40. We discussed the fact that it could be blip because of PSA still in the bloodstream and that I should wait until the January surgery follow-up before I do anything.

In the interest of being prepared and learning I had an appt with the Rad Onco. at my Uro's office today. As one might imagine, he is all for my beginning the treatment now and not waiting until January.

Additionally, I kind of knew they would recommend treatment now and this is further documentation for my submission to the VA for the PCa and Agent Orange 100% disability claim.

He is proposing IGRT fro 37 treatment at 66.6gy.

However he pulled out an interesting study that was just published March 2009 that showed the advantage of T3's being treated within 18 weeks of surgery.

"Adjuvant Radiotherapy for Pathological T3N0M0 Prostate Cancer Significantly Reduces Risk of Metastases and Improves Survival: Long-Term Followup of a Randomized Clinical Trial"

This link is the published study;

http://www.jurology.com/article/S0022-5347%2808%2903059-0/fulltext

I would appreciate any and all feedback. I am not planning any long walks off of short piers because of my PSA test, I just want to know my options and have a plan.

Let me know what you think of the article and the premise.

Sonny

Sonny,
I read the same article, and it reinforced my decision to start HT right away, then begin IMRT after 8 weeks on HT. We are both T3, and I have additional seminal vesicle involvement, (which takes me to T3b) that you don't have. I took my first Lupron injection on 10/21/09, which will have me starting RT just before Christmas.

Even though my 2d psa test came back at <0.01, I am confident that the conclusion that my team came to (consisting of the Uro, Hemo/Onco, and Rad Onco) to recommend adjuvant therapy was the right one. I am moving ahead with confidence and determination to kill this SOB ASAP.

That's my choice. You've got all your nerves, only focally positive margins and perineural invasion. I would take your outcome if I could, and might not do the HT part. But, it's your call to make.

All the best.
Roger

Sonny, sounds like a plan in the making. If you are convinced you have re-occurance, than sooner is better than later, espec. since you are a Stage 3 to begin. Little surprised that they aren't want to put more radiation in you. Mine, is 72 gys at 39 treatments, and my psa was lower than yours and I am a Stage II. But different doctors see it different ways.

Keep me posted. Waiting to see your psa rise even more makes no sense as far as trying to kill off the rest of the PC that might be lingering in your, that was the one point my uro/surgeon and radiation oncologist agreed about with my case.

My best to you brother.

David in SC

Sonny, how soon before you can re-test your psa, if that .40 is/was real, then you are already getting close to the .5 line in the sand that my doctor's preach. If really is already .4, waiting till January could put your over that mark. Just concerned for you.

And Sonny, there are many men here that can be poster boys for SRT working well and being uneventful, I can guarantee you that I am in a very small group of probematic SRT folks.

David

Thanks guys.

David, had my blood drawn for the last PSA on October. I guess that means I could do it again on Monday the 23rd. Is one more at 1 month okay at this point post surgery, or do you think it is too soon for realistic results?

Got a couple more reasons for not waiting too. Could get this done by the end of the year and include it in this years out of pockets for healthcare.

The other is that I am already getting my assignments for the upcoming College umpiring schedule. Already have about 30 top notch games on the books and some of the conferences I work haven't started assigning yet.

If I wait until January to start it would pretty much wipe out 2010 for me. Man I love umpiring. It ain't so much about the pay as it is working with the youth and doing something that I am really good at.

It's almost like when I was going through the decision process on the surgery. The PCa is almost secondary, it's the not letting it affect or change my life and that of my wife that is more paramount to me.

I'll get it figured out.

Sonny

Opa, yep another PSA test is in order. The question is should I wait for 30 days, or do it now? My last one was done in house at the Uro Center where my doc and the RO both reside. I was lead to believe the last one was done as a post surgery sensitive test, but I will verify. Maybe I would be better off getting an order from my GP and going to an independent lab for the test.

Sonny

Sonny, who was doing your PSA before dx and surgery? Your GP, like me? If so, I would schedule your next one through him/her, so that there is some consistency with the results. Just my take.

David in SC

Sonny, that has been my personal approach. I volunteered for the surgery, had to be talked into the radiation without HT, and it the radiation fells, then will have to be talked into HT. Of the three Radiation Oncologists I "interviewed", only one suggested HT with SRT, and he was the one when pushed, said that he couldn't tell me if it would work, and couldnt tell me if I needed it. The other 2 rad oncol. said I didnt need it nor would they recommend adding the HT at this time. I went with my gut and the majority view this time.

Thanks Jeff,

Really appreciate it,

Sonny

Sonny,
Nothing new to say advice wise but I want to tell you good luck with everything. My surgery was the same day as yours so I really pay attention to your post. My first post op psa test is scheduled for Dec. 11th. I guess my surgeon wanted to wait that long for all of the reasons we read about on here, but it sure does not make it easier to not think about it.In my case there is a 50/50 chance that I am cured according to my surgeon when he was explaining the path report. I will be thinking of this for another month. Take care, Wes

Larry, Wes, GL,

Thanks guys for the good wishes.

I have no idea what I am going to do in the future, but right now I am going to wait it out until a month has passed since the last PSA and then test again. I don't think I will wait until my January trip to Detroit for post surgery follow up though.

Actually, I had the 1 month 10/21; I can do a 2 month 11/23 and another right before Christmas. Then the 4th month will coincide with my schedule for Detroit.

Of course if the numbers are climbing or hanging in at 0.4, I may have to make a move.

So thanks everybody, we now have a plan of attack to gather more information. Then I can make an informed decision.

Here's hoping that I just had a little stubborn PSA that decided to hang around for a while after I took their house away. Must be the weather. Every year about this time in Orlando we begin to see a big rise in the transient and homeless population. Maybe my little homeless PSA guys are afraid to hit the road after their home was ripped out from under them. LLOOLL.


Bless all of you folks at HW for your support,

Sonny

Good Morning all you happy campers at HW,

Okay, I have decided to take the Bull by the Horns on this. I personally need some reassurance on the accuracy of the PSA testing done (In House) by my Uro.

I have called my GP and they are writing orders for me for a PSA test. They will write them for "Post Surgery - Ultra-Sensitive" testing. I have called the lab they use, Lab-Corp., an independent lab, and they have confirmed that they can run the US testing.

I am going directly to the lab today at 1pm, they will draw the blood for the tests and will have the results to me on Monday.

At least I can approach the weekend knowing that I am doing my part as a pro-active PCa brother and with some level of confidence in the findings.

If the results come back the same (.4) I can deal with it from a confidence standpoint in the testing. If they come back as undetectable, WELL, that may be a different story in my confidence with my Uro and their testing procedures.

We always talk about going with our gut on some things. And my gut just can't fully resolve my conflicts about the URO, their da Vinci surgeon, and the Rad Oncologist, all being under the same roof, the same practice and the same revenue stream.

Either way I can enjoy the weekend and put it out of my mind for a few days. I really thought I would be in that Non-Worry state of mind at least until my January follow-up.

Jeez, but this PCa thing can be a real p*sser, can't it.

Sonny

Hi Sonny, I had RRP surgery 9-15-08 and began adjuvant radiation 12-08-08. When the Doctor said, "You will never have as little prostate cancer in your system as right now!" it was a no-brainer to get on with the adjuvant IMRT rather than waiting for a recurrance. That was my decisin, and I do not regret it. So far, so good. Best to you, Bill in San Diego