Pelvic radiation as part of SRT

Goodlife,
It depends on if your pre sats indicate lymphnode PC. A high psa or a high PAP along with a G9 would be highly suspicious of lymphnode involvement. The only way to know with any degree of certainty is the Combidex MRI.
With a psa of 40 I was going to have my pelvic nodes radiated, but they came up clean on the Combidex.
With your lower psa and 0 of 23 nodes clear I think that unless you had seminal vessicle invasion your lymphnodes are probably clear. Seminal vessicle invasion follows a different path, and those nodes are not easily sampled during surgery. Also your psa has not risen in 15 months; I think if the lymphnodes were involved you would have seen a rise in 15 months.
The bottom line is that that without Combidex there is no way to be certain about lymphnode involvement and you can only make an educated guess.
JohnT

Goodlife,
The way I heard it is that it makes no difference if there is evidence of lymph node involvement detected. It is my understanding that Dr. Myers is correct in that when there is evidence of extension beyond the prostate that it can manifest in the lymph nodes and not be detected for years. Evidence shows both biochemical improvement and survival benefit for stage 3 and 4 men.

Talk to another RO. Ask if they are familiar with WPRT with a focus on pelvic lymph nodes, let them know that the radiation centers at Harvard and Stanford, and now more, have published information on their findings. Imaging scans, while unable to detect the cancerous lymph nodes, can still help mapping the pelvic lymphatic system. This is a procedure that I did back in 2007 post prostatectomy. Dr. Myers himself had a lymphenadectomy, or a surgical removal of pelvic nodes.

This was a vital part of my follow up care after surgery. Evidence that my disease was becoming systemic was blaring from the post op pathology. I removed myself from inclusion in an early chemo study because they would not allow me that opportunity to hit the nodes. At that time I only had early evidence and Dr. Myers book. To date I am doing well and the SE's are nonexistent.

Tony

goodlife, 

Dr. Myers interest in lymph nodes may be based on recent findings by Dr. Stephen Bravo.  He uses Feraheme (off label) as a substitute for combidex to help identify lymph node involvment in PCa patients.  Old school says 90% of mets are in the bones however Dr. Myers thinks that may not be the case.

My radiologist did not recommend full pelvic SRT.  He says I can come back and catch the nodes later if necessary.

Carlos

Goodlife,
Do you plan to do SRT even before you have evidence that you have BCR? My case is similar to yours (low pre-op PSA, only 2 nodes involved, Gleason 8) and have had undetectable PSA for 2 years. I'm interested inwhat you have to say.

Goodlife:  I had "full pelvic" radiation along with the prostate bed.  I looked at it as my last chance for a cure so I was willing to go wide in the prostate area.  Obviously my Rad Doc. was the one who made the decision but he did ask my opinion, I said lets go as wide as possible.

So far so good, also I had my last lupron shot yesterday.  My total amount of time on Lupron will be 24 months.

David

Nothing close to a dumb question here.

My RO said prostate bed only in my situation.

I guess I'm just going to go with what he says.

Mel

 

I had a total of 39 treatments 72y.

The first 32 were centered to my pelvis and pelvic lympnodes. The remaining were to the prostate bed.

So far so good 5 months post radiation my PSA has droped from 1.5 to .2