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What's next after robotic?

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Posted 9/27/2010 2:36 PM (GMT 0)

Had robotic on 9-8-10.  Gleason 9, PSa 21.00. Invasion to 2 of 9 nodes, invasion seminal vesicles, and vas deferens all of which were excised. Stage was pT3b, pN1,pMX.

My question is: When I meet with Oncologist on 9-29-10 what is he likely to reccommend as follow up?

 I feel certain with all those scores they will want some sort of follow up treatment.  At this point I have not had a post PSa done. 

Calling on the vast knowledge that is available on this website is there anything in particular I should know about each treatment?

 I do have Walsh's book.  However, I feel there is a great deal to be learned from the experience of others who have been there and done that.

I have a tendency to second guess myself, usually after the fact.  Now I am wondering if I should have gone with Proton.

Here is an excellent read detailing the journey of another.  The author is an excellent writer.

http://protonpals.net/wp-content/uploads/2010/03/a-patients-odyssey.pdf

Posted 9/27/2010 2:52 PM (GMT 0)
Hi there. I have the same staging as you. I also had robotic RRP. My surgeon, my medical oncologist and my radiation oncologist all want me to have radiation and hormone therapy now. The rad oncologist even says i should do chemo after that. The only disagreement is when it should start. Since post op PSA is only 0.54, surgeon wants to start HT now and wait for RT until ED and urinary recovery has maximized. The oncologists want to start after 3 or 4 months post-RRP. My surgeon has agreed to call the oncologists next week. Of course I'll go with the oncologists recommendation if there is still disagreement.

It will be important to get your PSA before deciding on the next step. But my oncologists, who recommended surgery in the first place, also recommended followup RT and HT even before the surgery's poor results.
Posted 9/27/2010 3:07 PM (GMT 0)
Walsh's book, pages 377-384 pretty much spells it out...I'm G-9, positive margin, positive vesicle and my docs recommend the same path as Julio..Hit it as hard as you can NOW and hope for the best...
Posted 9/27/2010 3:51 PM (GMT 0)
Mr Bill,
A gleason 9 with a psa of 21 is an extremely high risk cancer. Since a gleason 9 tumor generates a small amount of psa for it's size there was a very high probability that the pc is growing outside the gland. Many doctors would have refused to do surgery on you. Was surgery done as a debulking procedure? Proton or any other mono therapy would not have been appropriate with your stats.
The next step should have been the first step, go on hormone therapy. Salvage radiation will have a very small chance of curing you and will only cause more side affects. Radiation to the entire lymph system is an option along with HT, and I would talk your oncologist about it. Seminal Vessicle invasion usually means it has spread to the nodes and this was confirmed. The issue is that the nodes that were sampled are a different path than the nodes fed by the seminal vessicles. This and your psa would indicate more extensive lymphnode involvement.
I would read "Beating Prostate Cancer Hormone Therapy and Diet" or Prostate Cancer Basics" by Dr Stephen Strum. Books or recommendation by surgeons will not help you now as you are now in a stage that is above their training and skill level. Get a good medical oncologist that specializes in PC.
Good luck to you and it would have been better for you and other patients to have this type of information before you chose a treatment and not after.
JohnT
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