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Posted 2/11/2010 8:15 PM (GMT 0)
Surgeon recommends radiation and hormone therapy.  Meeting with medical oncologist February 15th and Radiation Oncologist February 26th.

Pre Surgery psa 4.6.  Biopsy gleason 4+3=7

Divinchi January 4th.

Pathology from surgery

Gleason 4+3=7

Present in right and left lobes and involving approximately 40% of prostate tissue.

Tumor involves inked margin at base.

Extraprostatic extension  none identified

Seminal vesicles  Involved

Perineural invasion  Yes

Lymphatic/vascular invaision Yes

Lymph nodes  Negative

Tumor t3b

Some sites say it is t3c with seminal invasion.

First psa 0 after surgery January 27th. 

With seminal invasion what are the chances of it staying local and being able to cure it with radiation?

My husband is glad I'm looking into things but does not want to know to much especially if it is not possitive news.  I think that is fine, what ever keeps him with a possitive attitude.  I would like to know what are the chances of recurrence?  What % of cases metastatis and and how long until it spreads and how long does the person survive if it does spread.  

The surgeon said not to let the oncologist talk us out of radiation.  It appears that the treatment opinions differ from doctor to doctor. 

I would appreciate any help and information that anyone has.

 

Posted 2/11/2010 9:02 PM (GMT 0)
Hubby,
i just found an excellent ref for u at cancer.org. Its free to join and has a profiler to give u a report on viable options and educate u more on prostrate cancer. Make sure u ask the doctors specific questions on your husband status. Best of Luck and god bless,PS: U will find Healing well to be an excellent support site! You'll find me on the chatline on Weds around 9pm est.

-----------
pc diagnosed 10/08, age 58, psa 7.5, G 8, biopsy positive in 3/12 areas; imrt Jan-Mar 08,treatment at 6500 rad, lupron Ht- Dec/08 ongoing for over a year;current psa trends .20; T1c
Posted 2/11/2010 9:10 PM (GMT 0)
Welcome to HW, sorry you had to come. There's more guys who have a much better grasp on your question, so I'll just welcome you and let them answer...
Posted 2/11/2010 9:21 PM (GMT 0)
According to your post, your husband was suppose to have had his first PSA reading post surgery. Did that test happen yet, and what were the results. Based on my conversations with several radiation oncologists, even they didn't reccomend radiation until there was proof of recurrance taking place. In the normal manner, it means 3 consecutive rises above a PSA of .10. There is some variation there among doctors on the subejct. It strikes me a bit odd that the surgeon doesn't want the oncologist to talk you out of radiation, most surgeons would discourage radiation this soon after surgery unless there was some hard evidence to support it.

While his current pathology has some negative implications, its does not mean that recurrance is guarranteed, or even how far out it may occur, if it occurs.

He is pretty close to having just had surgery, another reason not to rush to radiation is dealing with incontinence, the better he is there before starting radiation, the better the chances he will have after radiation with incontinence issues.

There's a lot at stake here, don't be bullied into anything. Find out what the attitude is like with the medical oncologist. He should be seeing a radiation oncologist as well, in my opinion.

Good luck, and keep posting.

David in SC
Posted 2/11/2010 9:52 PM (GMT 0)
Thank you so much for your responses.  His post sugery psa was 0.Yeah!!!  The surgen said he wouldn't start the radiation for 3-4 months after sugery.  We are seeing a radiation oncologist February 26th.  With his pathology is there a good chance that the radiation can cure this?
Posted 2/11/2010 10:04 PM (GMT 0)
Hello Hubby's Advocate,

As the others have said welcome. Sorry you have to be here, but here is where you can get some good insight. You didn't list your husband's age, but if he is about to turn 68, he could be me. Please read my signature, and you'll understand.

My first post-op psa test was at 4 weeks post surgery, and also came back at zero. (The zero is very significant.) I met with a radiation oncologist and a medical oncologist/hematologist. The consensus was that I should begin Hormone Therapy right away, with Radiation Therapy to follow 2 months later. Part of the workup is to do a CT Scan and an MRI. Both of those came back clean, so in my case there is good likelyhood that the spread is localized. So, I started HT in October, and RT in January. I am 2/3 way through the RT, and have high confidence that this proactive approach will take care of my disease. I am feeling fine, with minimal SEs from the HT, and nothing to date from the RT.

Prostate Cancer does not follow one particular course. It is fickle, and what happens to one person does not necessarily happen to the next.

But, i wanted to let you know how a guy who sounds a lot like your hubby is doing.

All the best.

Roger

Posted 2/12/2010 7:44 AM (GMT 0)
Hi Hubby's Advocate,
Welcome to HW

As you will see from my signature I have seminal Vesicle invasion, so I
am interested in what your husband's situation is and in what the guys
on the forum are saying.

As I understand it SVI puts you in a group with slightly worse chances of a
good outcome, but those are just statistics

I think that the problem is that therte have just not been enough (long term)
studies yet.

One of the studies I found was at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1476128/

The conclusion in this report that worried me most was:
"External beam radiotherapy, used postprostatectomy at the time of
prostate-specific antigen signalling cancer recurrence,
may not benefit patients with a history of SVI."

My first post-op PSA was 0.1, but my surgeon says they will wait for an increase
in PSA before recommending radiation. But even before we get there the problem
for me is that the radiation will have "quality of life" side effects: specifically
incontinence and ED and diarrhea for up to 36 months.

I don't want to get all those extra problems if I am going to live just as long if I don't
have any additional treatment. And that may be what your surgeon is thinking too.

I have an example of the dilemma close to home:
My brother-in-law, who is a very young 75, has PCa (and his father died of it aged 65)
By the time they detected his cancer about six years ago it had spread
outside the prostate so he had radiation not surgery.
His PSA remained what I would call high (and is now nearly 6)
but ever since the treatment he has had 100% ED, he is not 100% continent
and had terrible bowel trouble for a very long time. And has suffered from clinical
depression for about 50% of the time.
To put it in a cliché: He is now not the man my sister married.

I have my next PSA test in March so you can imagine that I am hoping that it
stays 0.1, but in case it does not I am already preparing the questions.

Alfred
Posted 2/18/2012 7:40 PM (GMT 0)

Hi group, any help with trying to understand this report and see what the future holds for me would be very welcomed. 50 years old and in good shape pre surgery PSA 5.6 Gleason 3+4 = 7 TC1 3 cores of 12 positive for cancer prostate inlarged. Robatic nerve sparring Surgery Jan 23rd 2012. Nerves sparred. Post surgery pathology report Left pelvic Lymph 5/5 regional nodes negative for metastatic tumor. Right pelvic Lymph 1 regional node negative for metastatic tumor. Prostate gland and bilatereal seminal vesicles: Adenocarcinoma, gleason 3+4. Seminal vesicle identified. Microscopic Description: Sections show adenocarcinoma involving 28% of the prostate. The margins are not involved. Capsular invasion is not seen. However tumar extending up towards the base of the prostate with involvement of the root of the seminal vesicles with tumar tracking up into right siminal vesicle. Pathologic staging now pT3b Seminal vesicle invasion. pNO: No Regional lymph nodes metastasis. My doctor tells me in Canada we do not start any further treatment following this info. We will wait 1 month and do a PSA and meet to discuss. His feeling is that PSA will come back not detected. Scared and confused only 3.5 weeks post surgery and dealing with healing and such right now and this was quite a blow to get Thursday. Thinking about how long i may live and quality of life remaining. Thanks in advance for any support.

Posted 2/18/2012 7:57 PM (GMT 0)
I to was diagnosed with seminal vessel invasion, 6 months post op with psa tests every two months I am still at undectable levels, my urologist has not even discussed any further treatment until after psa increases, I am a little suprised that your urologist is all-ready discussing radiation and other treatments, myself I am perfectly happy just waiting to see if the psa levels increase, no reason to put the cart before with horse 
Posted 2/18/2012 8:00 PM (GMT 0)

jerryo said...
I to was diagnosed with seminal vessel invasion, 6 months post op with psa tests every two months I am still at undectable levels, my urologist has not even discussed any further treatment until after psa increases, I am a little suprised that your urologist is all-ready discussing radiation and other treatments, myself I am perfectly happy just waiting to see if the psa levels increase, no reason to put the cart before with horse

Hi Jerry - Did you take any second opinion? It does not hurt to ask another good doctor.
Posted 2/18/2012 8:40 PM (GMT 0)
Hi Jerry your path report looks quite simular to mine. I would agree with your comfort level on any firther treatment before seeing a increase in PSA. Im glad to see your PSA 6 months post is undectable I can only hope and pray mine will be the same. Best of luck to you.
Posted 2/19/2012 6:17 PM (GMT 0)
Hey PatMac,

I'm also in Canada (ontario) and I have the same pathology as you T3b(sem Ves invasion). T'd love to chat with you via email and maybe compare notes re. treatment etc. I'm 12 mos post surgery and my PSA is just starting to creep up. Decision time is looming and I'm pretty up tight. If you're interested my email 

(email removed - please use the email entry in your profile to avoid access by those who are not members of the board - 142) 

Regards

Post Edited By Moderator (142) : 2/19/2012 7:42:01 PM (GMT-7)

Posted 2/19/2012 8:20 PM (GMT 0)
There were extensive studies carried out in Germany and Holland re seminal vessicle invasion. With seminal vessicle invasion there is a much higher probability of lymphatic invasion, but not to the lymphnodes that are commonly sampled in surgery, but lymphnodes in a different pathway fed by the seminal vessicles. 50% were found to have lymphnode involvement in the nodes not commonly sampled.
Without a Combidex or USPIO scan to identify individual infected nodes the most common treatment is to radiate the upper and lower lymphatic system combined with a course of HT for at least a year. Since you already have confirmed lymphatic involvement and positive margins, I see no reason to wait for a psa rise before beginning treatment. Be sure to question your doctor if the radiation plan is just to the lower pelvic region instead of both upper and lower.

Another option is to have a consult with Dr Myers in Earlysville Va as he is the foremost expert in lymphnode involvenment or Dr Jelle Barantsz in Eindhoven Holland who has done the most research on lymphnode detection caused by seminal vessicle invasion.
JohnT
Posted 2/19/2012 10:02 PM (GMT 0)
Rocky01,
It is not wise to put your email address in the forum where it is liable to be either spammed or hijacked by outsiders. Better to put it in your profile and direct members there.
Bill
Posted 2/20/2012 12:45 AM (GMT 0)
I am in similar situation too, i guess thee are a lot of us, I am on Lupron now, one shot so far
it makes me feel weird, but i am better off to actively be fighting this t than doing nothing.
i will take another shot next month and take blood at that time to see PSA and Testosterone.
then probably in six months i will undergo radiation, and spin the wheel of fortune one more time
and see if i can get lucky and obtain a cure, wow wouldn't that be nice.

i try to take good care of myself, exercise , diet, prayer, faith, religion, church.etcc
i am in Gods hands and what else can i do but go on with Gods plan for me,

i wish you all well, this is a good group.
Posted 2/20/2012 12:51 AM (GMT 0)
PatMac,
Last Thursday I celebrated my sixth year post surgery, RT, and HT. i had bilateral seminal vesicle invasion post surgery. Like your husband my PSA went to zero. but I wasn't happy just waiting around and I did extensive research on what else could be done. I started HT 3 months after surgery and stayed on that regimen for 2 and a half years. 4 months after surgery I have radiation therapy with focus on the iliac region lymph node. The results? I have never had an increase in PSA and I am five years out in full remission and I am free of all therapy at this time.

Feel free to contact me or read my blog page for my history.

Tony
Posted 2/20/2012 1:36 AM (GMT 0)

jaxum said...


i try to take good care of myself, exercise , diet, prayer, faith, religion, church.etcc
i am in Gods hands and what else can i do but go on with Gods plan for me,

.

Six religious references in the one post ------ wow! ------ That has got to be approaching a record. I think the previous best was five.devil
Bill
Posted 2/20/2012 1:49 AM (GMT 0)
I go along with John T & TC Vegas...The pathology report reveals that the surgery failed...Waiting for the PSA to verify that might not be wise...When choosing an RO, find one who has done many salvage jobs for prostate and has access to newer equipment...

In the past, salvage radiation would produce a cure about 50% of the time...Today, using advanced equipment (like a Varian RapidArc) and combining the radiation with a 2 year (+-) course of HT, the results have improved by 30%...

In my case, I got "Full Pelvic" with the last 8 sessions focused on the prostate bed in a technique my RO called "Boost"...72 Gray total dose..

As you have discovered, surgeons, urologists, medical oncologists and radiation oncologists don't always see eye to eye when it comes to treatment choices..
Posted 2/20/2012 8:40 AM (GMT 0)
@JohnT,
This is a well intended question of your data. You state that Snuffy Myers is "the foremost in lymph node involvement" can you please post the proof. I can't be and I'm not so sure. I know his excellent resume but I don't see him doing either independent randomized trials that can verify he is truly the foremost expert on lymph node invasion. There are nodes that can be invaded beyond the surgical zone when a patient is diagnosed as pT3. But there are seldom any when the local Iliac nodes are supplemented with radiation.

Where ever prostate cancer is beyond the peripheral local therapies of prostate cancer is always an anomaly but it doesn't quite often mean that a local therapy failed. Local therapies still kill a lot of cancer.

This is where the ball lies with Hubbies Advocate. There are some really good options available...

Tony
Posted 2/20/2012 12:49 PM (GMT 0)
Hubby's Advocate,
there is an intresting study available for pT3B-N0-M0 patients. A multicenter study randomized 199 of these pts. to one of the following therapies:

A: adjuvant RT
B: androgen deprivation therapy (ADT)
C: ajuvant RT +  ADT
D: control group (salvage therapies if necessary)

The 7 year freedom from biochemical recurrence (BCR) are as follows:

A: 28.6%
B: 32.3%
C: 62.1% !
D: 25.9%

This multicenter randomized trial (Level of Evidence 2b) clearly shows us, that a pts. benefit exists for adjuvant-RT+ADT only!
http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2011.10332.x/abstract

The problem with any RT is, that you must do it right the first time! Salvage therapies after RT failure are difficult. Additional RT sensitizing with COX-2 blockers (Celebrex®) and/or Statins might be beneficial.

All the best,
LR

Posted 2/20/2012 4:37 PM (GMT 0)
LowRoad,
Thanks for that post. Well done. It is consistent with data from Stanford that I saw back in 2007. Interestingly they state that it's the first comprehensive study on SVI positive patients. I personally have seen about 4 such studies that all consistently say the same thing. pT3b (AJCC2007) or pT3c (if using the AJCC1994 staging manual), patients should all at least consider adjuvant therapies post prostatectomy. The evidence is mounting...and compelling.

It's probably worth mentioning that there is even better benefit if the nodes are radiated.

Tony
Posted 2/20/2012 5:50 PM (GMT 0)
Tony,
Should have stated "one of" and not "the". My evidence is that he is the only one to write a book that deals primarily with lymphnode involvement and has has treated himself for this condition for well over a decade with success. He probably has the most patients with this condition as they fly from all over for his consultations. He was one of the first to send his patients for the Combidex scan and currently is only one of two doctors that are in trials with the USPIO scan for lymphnode detection. He has identified that oligimastastic cancers (less than 5 involvements) are still curable given that you can identify their location.
He follows the exact same protocol that you used and is agressive in treating lymphnode involvement with both removal, radiation and HT. The only difference is that he concentrates on targeting only the infected nodes rather than a broad radiation swath if applical. He concentrates on treating patients rather than research and his treatments are more based on his vast and individual experience than pure research. I know of no other doctor that has as much knowledge and experience dealing with lymphnode involvement than he has, with the exception of Dr Barantsz, but Barantsz is purely research and doesn't treat patients.
I think this is evidence that he is "one of" if not "the" primary expert in treating lymphnode involvement.
Posted 2/20/2012 6:06 PM (GMT 0)
Tony,
When it was indicated that I had a high probability of lymphnode involvement due to my high psa the most agresssive treatment option recommended was full upper and lower radiation combined with at least 1 or 2 years of HT in addition to the combo seeds/IMRT to the prostate. Radiation to the pelvic nodes only was the secondary recommendation and was left up to me. In either case agressive adjuvant treatment was in the cards. It was only after a clear Combidex scan that Scholz felt comfortable with a much less agressive treatment. I spent about 1 1/2 hours talking to Dr Barantsz about some of his published and unpublished research and I fully agree that aggressive adjuvant treatment with either removal or radiation of the nodes gives the best probability of success.
Posted 2/20/2012 7:05 PM (GMT 0)
John,
My feelings that we ever had a good imaging scan for LNI is well known here. Combidex is no longer available and I have seen no data to suggest that we have ever had anything that can effectively be used for steering treatment protocol. Still where you are is working and at the end of the day that's what's important.

Thank you for clarifying the Myers bit. There are many great oncologists out there and I would hate to diss any of them based on anecdotal accounts of the quality of physicians. Myers has never released any data or study showing that he is truly the best at anything. I love his web stuff but he sometimes is off on a tangent in his videos. I consider him an opinion worth listening to, but certainly not the end all stop for the best information available. Additionally there are studies, such as the one posted above by LowRoad and also the SELECT trial, that contradict some of the writings and videos he has posted.

I think zufus says it bast to question everything. No matter whom you receive the data from...

Tony

Post Edited (TC-LasVegas) : 2/20/2012 12:13:05 PM (GMT-7)

Posted 2/20/2012 7:12 PM (GMT 0)
Hubby's Advocate, PatMac,
This link is to a great write up on the effectiveness of RP in high risk cases such as your husbands and for that matter my own case. This is data that matches many other papers that RP in these cases has a great track record of disease control when measured against other treatment options. But the key is what to do after the initial therapy and I think that the paper posted by LowRoad shows some excellent data on what might be a great next step.

prostatecancerinfolink.net/2011/10/10/is-surgery-appropriate-for-men-with-high-risk-prostate-cancer/

Tony

Post Edited (TC-LasVegas) : 2/20/2012 1:45:03 PM (GMT-7)

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