Latest PSA and headed into HT and RT

My 6-week post-RRP PSA came in at 1.7. Now, 2 months later, it's at 2.2.

I'm on track for starting HT and then radiation. At first I was holding out hope that I could somehow hold out for the soon-to-open proton beam center here in town, but there are 2 issues with that. First, my doc says he isn't aware of proton beam therapy being used for post-RRP patients (for some reason I hadn't even thought about that factor), plus it will probably be awhile before the proton beam center is open for business. That leaves me with IMRT. More about that in a second.

The first RO I saw prefered Firmagon for HT and from what I've read, it seems like the best available option. However, for IMRT on post-op patients he does not use calypso beacons. The other RO I've seen uses the beacons, but he has never used Firmagon. I decided to go with the second doc since it seems like he can do a more accurate job with the IMRT with the beacons. When I met with him this week he said he wouldn't mind using Firmagon, but I got a call from his nurse today and their hospital's pharmacy doesn't carry it. She is willing to give me a prescription to get it elsewhere, but after a round of calls today I found a couple of places that can order it, but can't promise a reliable supply each month. Because of that, I'm thinking the wisest course is probably to just go with either Lupron or Zoladex. 

I guess my question at this point is whether anyone has anything to offer on choosing between these two drugs? I've done a little searching online, but I would value some input from the folks here.

Hello Pog..Yikes, 1.7 then 2.2 right after surgery, that can't be good news...I'm in exactly the same boat, my six week test came back 0.9 so no zero club for us. I'm Gleason 9, how about you??

I also looked at the Firmagon, it's new on the market and I suspect it's VERY expensive if you can find it..Insurance companies are bound to squawk...Also, you need a shot every 30 days, no 60-90 day option like with Lupron...

Here in Denver, all the big hospitals are upgrading their equipment and I found one with a brand new Varian Trilogy Rapid Arc machine that can do very precise RT without any markers. It uses a built-in CAT scanner to aim the beams before every zap... But like everything else, it's the skill of the radiation oncologist that really counts..The machines just do as they are told to do..

St. Anthony Hospital in Denver recently decided to get into Radiation Oncology in a BIG way. The built a free-standing building, filled it with the latest equipment and hired the best people they could find. Since this facility is approved by my insurance, no "out of network" problems, I'm going to visit with the Director of Radiation Oncology Tuesday and get the ball rolling...

I have talked with this man once before, right after I was diagnosed last June. I was trying to decide between Surgery and Radiation..He told me then, after studying my biopsy pathology report, 'Surgery is not going to cure you, you might as well skip those side effects and start RT immediately because you are going to have to have RT anyway"...

The man was certainly correct then and I hope he can still work his magic now...

Fairwind,

I got the same "RT will take care of it" story, but when pushed, "70% success rate for advanced cases like yours". That was why I did DaVinci first, then immediately followed with IGRT. Now, 4 months from IGRT, I have a detectable PSA. Not much, but it is there now after having been undetectable. So neither one has proven to "cure" me, and even the two together can't claim that.

Can't say that I expected better, but it would have been nice to be undetectable for a few years -

By the way, be sure that all of the doctors involved are "in-network". I ran into that with my CT scans. The facility was "in". The technican and physician were not. Because I had the stroke of luck to insist in writing before-hand that all the staff involved be "in", they had to adjust and re-bill at the "in" rates. But it was quite a fight, and it took months to get my money back. All in the midst of trying to recover from surgery.

The big advantage of the latest equipment is its ability to target its beams with pinpoint accuracy using a low-power instant CAT scan before every beam is triggered..It can compensate for breathing and other organ movements without any tattoos or other markers..It can also direct its beams from a 360 degree arc around the treatment table..

Whether or not this will make any difference in the outcome in a SRT treatment protocol over an older IGRT machine is open for debate, but since it is available to me and I need all the help I can get, I figured why not??

All of this is being delayed by the complications from my surgery when an abscess formed where several lymph nodes were removed for biopsy..That is still draining and until it dries up or the docs dry it up, any further PC treatment is on hold..I suppose I could start the HT now...I'll know more Tuesday...

having the latest IMRT hardware and a host of "experienced" operators didnt prevent my SRT from going south. The table I was on was aligned by GPS and they constantly used to "snap" x-ray machines overhead and I had 6-7 tattoos, and a cast from the hips down to keep me aligned. despite all of that, they had nearly daily problems aligning me, and we know the rest of the story. the supposed highly focused beam still burned me and produced a lot of "scattering", ultimating frying my bladder and bladder neck, thus causing me to now have a urostomy for the rest of my life.

some folks get too hung up on the novelty of the hardware side of RT, like its some new electronic toy to explore. theres a lot more involved than that to safely deliver radiation, and each body, reacts differently to the dose and delivery for sure

david in sc

Just a word of caution for patients having HT with radiation. There is a lot more to HT and monitoring it than radiologists and surgeons think there is. My radiation doctor was one of the best, but his recommendation for the HT type was based on older , conventional information. My oncologist recommended a much different protocol and monitoring that resulted in about 20% of the side affects of conventional HT with better effectiveness.
Monitoring HT is much more than just getting a Lupron shot and a psa test ever 3 or 6 months. Administering it is a skill and an art that radiologists and surgeons just don't have.
A good oncologist specializing in PC can monitor with tests to see if the HT is working and has much more experience in reducing the side affects with dose adjustments and meds. I would never even consider having a urologist or radiologist give me HT for any reason for the same reason that I would never have my oncologist operate on me. They are completely different specialities with completely different skill sets.
Dr Strum's rule #3 is "get the very best artist for the treatment you choose." Radiation and HT are two completely different art forms.
JohnT

John, I think you may be making HT far more complex than it is...The goal of all HT is to lower testosterone to the lowest levels possible or to block the effect of any remaining testosterone. LHRH analogs, LHRH antagonists, Estrogens, all are trying to achieve the same goal. Lower testosterone to castrate levels...Hormone therapy for prostate cancer patients has not changed significantly for 20 years....