2nd radiation consult

Well, I had my second RT consult this morning. It's really strange (or, as they say here in Maine, awd) - I don't feel down or scared (though, I go through cycles), just...resigned. I'm not a pessimist nor am I an optimist, but I've kind of known that my PC journey was not over. I was hoping that this was it and I could just get on with my life, but...as the saying goes, "No soup for you!".

So, the second RT doc (who was much better than the first - a real sphincter) said that with my Gleason and staging, adjuvant radiation is usually done. This means they don't wait for the PSA to rise as they do in salvage radiation, they just do the RT after at least 3 months post-op. The good news is she didn't recommend hormone therapy along with RT, as Dr. Sphincter did.

They both use IGRT, which I guess is good. The bummer is that the 2nd doc is a 40 minute drive, the 1st is 15 minutes away. Not too bad until December comes and the threat of snow and ice. Oh well, I'm a Mainah, I can deal.

So, I'm sitting here, trying to take this all in. On top of this, of course, are the two little "i" issues - incontinence and impotence. Man, isn't the disease enough to deal with - do we really need these other issues piled on? Sucks the grand wazoo, eh?

Well, nuff b*tching for now. I'm off to the store and then to see a friend, then a bar-b-cue later and a music festival this weekend. Gotta keep living despite this SOB disease!

Ted

Hi Ted,

While it is common to give adjuvant RT to folks like us (combined with 12 - 18 months of HT for the synergistic improvement in RT), it is possible to wait first to see if your PSA actually rises. I see your PSA two weeks after surgery was 1.1, but that should continue to go down, and the only PSA test that would matter is one six or more weeks after surgery when the pre-surgery PSA has all had a chance to metabolize out of your system..

If your PSA indeed becomes undetectable, you could elect to wait and use an ultra-sensitive test to monitor your PSA. Only if it actually starts to rise would you need to consider adjuvant treatment. After all, there is a chance that you won't recur. If your PSA rises, you can choose to wait as long as your are comfortable, although it is recommended to start adjuvant RT somewhere between a PSA of .05 and .1. Some studies have shown that doing RT then gives the same results as if you had done it right away, so you don't lose anything in waiting.

In my case, I was undetectable for seven months after surgery. Then in the three subsequent months, my PSA rose to .03. I chose at that time to go ahead with "adjuvant" HT/RT, even though my PSA was far from reaching the standard level to be judged recurrence. This was based on the advice of three medical oncologists, by the way.

This might be something for you to consider.

Hope all goes well for you.

Nellie

Because I was not continent until 8 months post op, I elected to do the wait until it rises routine. I waited 3 years until .06. Am currently undergoing IGRT.

It is said that radiation kind of freezes your continence status where it is now.

You have some decisions to make, that involve current quality of life and future quality of life.

If your PSA doesn't drop to 0, I would consider going ahead with the adjuvant, but that is you and your doctor's decision.

Good luck.