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Posted 10/27/2010 11:21 AM (GMT 0)

 my uro surgeon at 3 weeks post and just the other day, October 25, at six weeks post. My PSA's where .06 and less than .03 respectively. Surgeon sent me over to see radiation oncologist (seems like a very bright and upcoming Dr) in the event I did need radiation I would know what my options were. Rad. onco explained that of the 200.000 cases diagnosed only 5% were as agressive/serious as mine. That was one that was hard to get my mind around.  He recommended a shot of hormone a couple of weeks before I start radiation (36 - 39 sessions) and one just at the end. His theory was that he would rather attack any cells while they are "sleeping" rather than while they are "awake." The hromones, obviously, putting them to sleep.  He felt comfortable waiting for awhile. And also indicated he could start without PSA on upswing or wait until it moves up a tick, say to .04.

With my signature and positive margins I am not going to think will it go up? But it is just a matter of when it will go up.

Questions are:

  1. Is the hormone therapy as described going to benefit me such as side effects vs. value?
  2. What do you think about jumping in to radiation so quickly?

I know it is still early post op, but still getting a little rammy about the future.

 

Thanks,

Mr. Bill

Posted 10/27/2010 1:30 PM (GMT 0)
Bill:

That's exactly a question I have.

I will be asking that question when I see an expert oncologist on Monday

Mel

Posted 10/27/2010 1:47 PM (GMT 0)
Bill,
My understanding is that they don't start RT until you completely heal from your surgery. Normally that is at least several months.
Posted 10/27/2010 4:20 PM (GMT 0)
Bill,
I depends on how much risk you are willing to accept. You already have confirmed lymphnode involvement so you know you have systemic disease coupled with a very high gleason. It is highly unlikely that either surgery or radiation alone will cure you. The earlier HT is started the better the chance of going on long term remission. If your objective is to live a long life then hitting it hard with everything you have gives you the best chance of accomplishing that. If your objective is to have a few quality years then defer treatments. These decisions are highly personal and results can only be discussed as probabilities and not individual certainties. For very high risk cases, such as yours, the most common recommendation is a combination therapy as soon as possible.
Good luck
JT
Posted 10/27/2010 4:45 PM (GMT 0)
I am with John here and believe that with the positive nodes and high Gleason that it is probably better to strike early. We still really lack long term data on combined therapies but for relapse free disease adjuvant is performing well and if the PSA does not indicate a remission then there is no question that you need to address it as soon as the surgery heals.

But don't be too despaired. I have seen many cases of node positive disease do very well. Pelvic nodes are examined to determine the probability of metastatic spread but it can still be locally spread. This would indicate why many men do well with followup radiation. I would ask your RO about the positive nodes and whether he is in tune with techniques to hit local nodes in the pelvic area.

On the HT part, in virtually every study I have seen, the use of HT ahead of salvage or adjuvant radiation has a positive profound affect on biochemical failure rates. There is very little data on the mortality in long term studies, but it stands to reason that early neo-adjuvant HT before radiation is a very reasonable approach.

You are a stage 4 case and I decided to move forward at stage 3B. While I have tests coming next week, I expect good results and should do well. I do not know what the long term SE's will be from radiation but the short term have been non-existent.

Tony
Posted 10/27/2010 4:53 PM (GMT 0)
Bill,

You are asking the $64,000 dollar question which will evoke a lot of 2 cent answers because we don't know.

All of us G 9's have to wrestle with these issues. I too had surgery at Cleveland. My surgeon was inquisitive why I would start radiation until I had a rise in PSA. He said that he current thinking was to wait for a rise in PSA. I also went to Umich where they were advising adjuvant within 3 months.

John T's response is right on the money in terms of how we need to approach our personal answer. Not sure where he saw lymph node involvement in your sig, but as i understand it, you did have seminal vessicle and vas deferens involvement.

That being said, based on your low 3 week PSA, I would say that it would appear that radiation may be successful if cleaning up any residual cells which may be in close proximity to the prostate bed.

I would make sure that your incontinence is cleared up, and if you are seeing good things in the ED recovery, give that some more time. The next PSA which may be at the 6 week checkup may be key factors.

I have adopted the wait and see. After 18 months, I am delighted, but I am realistic. I am ready to jump when I see a trend in my PSA. I am not waiting until .2 or .5, whatever the current numberis out there.

Best of luck.
Posted 10/27/2010 10:50 PM (GMT 0)
Being in the same boat, I have been around the block with this question several times..ALL of the doctors that have been treating me, including an outside medical oncologist, surgeon, u-doc, 2 R-docs, all of them recommended HT and RT as soon as possible after surgery for ALL their G-8, 9, 10 patients..They all agree mortality rates are significantly reduced (in the high-risk group that has the highest mortality rate) if Ht and RT are used as the standard treatment regardless of what the post-surgery PSA might be...There are a few exceptions when Gleason 9 patients catch it very early and have a clean post-surgery pathology report..But they watch that PSA very closely for several years....
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