rt with incontinence

I feel the oncologist will recommend radiation therapy at tomorrows appointment. As I am only three weeks out from robotic and still not continent I am concerned that any progress will be halted. However, On the other hand I am concerned about PC spreading.  I still do not have post surgery PSA which I will get tomorrow. I was told, after surgery, with gleason 9 and presurgery psa 21 that this was agressive, and they did find invasion to seminal vesicles and 2 of 9 nodes. however, bone scan and CAT negative that they could see. I did receive feedback from JB71. Does anyone else have idea how fast this spreads? Does it hurt to wait till continence improves?

Thank you

Bill. Sorry you have to deal with this at all.

I am a 4+3, they all suggested radiation aftyer when I had pos margins.

My post op was 0.1. I told my rad onc that I would prefer to wait until I heal better before committing to rariation poisening.

He actually agreed with me, understood completely the WHY I would make that choice.

The fact that I was 0.1 (lowest the initial test could measure, I will have Ultra psa if I go radiotherapy).. Was important of course in him agreeing with me that I should wait 3 months, AND/OR until the psa rises. So by waiting, even after that 1st 3 mo period, we're really talking about salvage radiation if I decide to get it now. I'm hoping Naturally, #1 My psa never rises again, #2 if it does, they've at least become more advanced in how they deliver the radiation.

So, other than my 7 and your 9, the initial psa result was all I needed to convince my radiation oncologist to hold off for now.. he said "not to worry, you're not hurting yourself by waiting" (I think he meant for another 3 months..). I did ask, and he did say, that that IF the PSA went up and if the PCA returned, it would likely 1st return and be found in the prostate bed. For whatever that's worth.

Best of luck to you.

JohnT makes a valid point...But RT STILL might be worth a try..You could start HT NOW, instantly suppressing and shrinking any possible cancer while you finish the healing process from the surgery...90 days of HT prior to radiation is a very common treatment protocol and it should prevent any spread while you fully recover from the surgery. Talk to your Docs about it...

Bill,

My IGRT did not involve HT. However, when all the treatments were discussed, the HT was a potential factor in IGRT. When used that way, they told me that they would start on the HT immediately.

For me, the rush to RT was a G 4+5, multiple EPE on all sides, and positive margins. The objective was to not allow it to even start to grow.

Bill,

Yes - I was still at 1-2 pads per day at the start, and it has worsened to 2-3 per day at about half way through. I am just at 3 months after the last IGRT session.

I'm not sure that I can expect it to improve now, but I keep doing Kegels.

You will be doing Kegels for a long time to keep the muscles in tone. I slacked off a little due to some low back pain, and saw things get worse in the days following. Just get them into your daily routine.

My "major" improvement was about three months out - I got down to 4-5 pads per day. By 6 months out I was at 1 pad most days, rarely 2. Then came the radiation.

There was not a gradual, progressive improvement day-to-day for me. I dropped from free-flow to 7-8 per day, then had days with 4 and days with 10 for a couple of weeks, then settled off at 4-5, and so on. Real bumpy ride.

For my husband's case, he has surgery on 5Jul and he started RT on 4Sep. The RO said that he will not do RT to until his patient is 8 weeks out of surgery. When my husband started RT, he is more or less continent and he is completely continent at week 10 after surgery (i.e. 1 week after started RT).

His RO told him that with his high Gleason score, the current protocol is to start RT asap regardless of after RP's PSA or whether there is pos margin. The effectiveness will be 30% higher than doing SRT later on.

He also told us that when doing the pathology report after RP, it is not a complete analysis of the prostate gland, it is only by sampling. Therefore, if all the samples they took from the margin are negative, then one is labelled as negative margin. However, since it is not a complete analysis of every cell in the margin, it might be the case that the patient is actually having pos margin but somehow the sampling did not catch those cells. This explains why the PSA for those patients with negative margin will have a PSA rise later on. Only those patients without PSA rise after around 2 years can be truly termed as having negative margin.