I finally caved and registered!!

Rivergirl,

Welcome to HealingWell. As you've already seen, it's a great place for information and support.

My numbers were remarkably similar to your husband's, as you can see below. Positive margins are always worrisome, and after reading my surgical pathology I pressed my doctor on the question of whether we should pursue adjunctive radiation therapy. He was remarkably casual about it, and said the positive margins will probably never cause a problem. Two years later my PSA is still undetectable.

Of course, that's no guarantee that it will always be undetectable, and part of me is still waiting for that other shoe to drop, but I can live with a little ambiguity in my life. You never really know for certain whether you're clear of this thing or not anyway.

In light of your concerns, my experience, and all that's been suggested here -- you and your husband might want to seek out a third opinion with a medical oncologist who specializes in PCa. The one difference between your husband's pathology and mine that jumps out at me is that his positive margins were at the posterior apex. It might be something to ask an oncologist about. I don't know if that's the basis of your doctors' opinion that radiation is necessary, but it might be worth asking about.

You'll never know for sure what the right course of action is, but that conversation might help clarify things for you. I hope he can avoid radiation and live a long and healthy life, and one more conversation with one more doc might give you some assurance. Here's hoping...

Best,

Jonathan

Rivergirl said...
I am a cold hearted facts girl...

There is no cold hard facts but this maybe why both his doctors recommended adjuvant radiation:

Radiation Therapy for Prostate Cancer After Prostatectomy: Adjuvant or Salvage?
Amit R. Patel, MD; Andrew J. Stephenson, MD Faculty and Disclosures
CME Released: 06/14/2011; Valid for credit through 06/14/2012

ABSTRACT AND INTRODUCTION
Abstract
Approximately 15-25% of men who undergo radical prostatectomy for localized prostate cancer will experience a PSA-defined biochemical recurrence (BCR) of their cancer—men with poorly differentiated cancer, non-organ-confined disease, and positive surgical margins are at the highest risk. Accumulating evidence indicates that postoperative radiation therapy to the prostate bed favorably influences the course of disease in men with pathological features of poor prognosis. Three phase III randomized trials of adjuvant radiotherapy versus observation have reported improved freedom from BCR, and one study has reported improved metastasis-free survival and overall survival. Similar evidence from randomized trials for salvage radiotherapy is lacking; however, several observational studies have reported durable responses to salvage radiotherapy and reduced cancer-specific mortality in a substantial proportion of high-risk patients, provided that it is administered at the earliest evidence of BCR. The appeal of salvage radiotherapy is that a substantial proportion of patients with non-organ-confined cancer or positive surgical margins are cured after radical prostatectomy alone, thereby limiting the adverse effects of postoperative radiotherapy—which include urinary and bowel dysfunction, sexual dysfunction and secondary pelvic malignancies—to only those whose cancer was not cured by surgery. In the absence of data from randomized trials demonstrating the superiority of adjuvant radiotherapy over a surveillance strategy (with planned salvage radiotherapy at the earliest evidence of BCR), we advocate shared decision making between physicians and patients, based on the relative advantages and disadvantages of each approach.

Thank you everyone!!!I have to say I am amazed at all the responses!

  One minute I'm for the radiation, the next I'm dead set against it.  The radioligist is in the same practice as the surgeon..It is a huge urology facility so everything you need is right there. We agreed to talk to him at the surgeon's suggestion. I thought it was a great idea to at least meet him in case hubby ever needed further treatment. To be honest I am getting angry that we have to make a decision based on pretty much specualtion.  There is no way to tell without a crystal ball whether he truly needs it or will benefit, or what side effects he will experience. And truthfully if the PSA does ever bump who's to say it's even still in the prostate bed.  Cells could have already migrated long ago and then radiation to that area wouldn't matter anyway. That's one thing that blows me away..How can some men have perfect pathology reports and low gleason grade and still end up with reccurence? How does that happen?

He has to go back in 6 weeks for a check up..the surgeon wants him to heal more before he would start if that is what his decision is.. I am hoping that hubby will put it off for way longer than that..if inevitably..it scares me to think that incontinence could become an issue again and who knows how it will effect ED...

On a brighter note we had a great weekend..great times with friends and lots of laughs!  Next weekend will be our last..a few more things to haul off and then we are done for the season. Waaahhhh!!! However I am looking forward to a bit of a break..I will have my weekends back at home and it will be nice to be able to put things off until then rather than break my neck trying to get everything doen before the weekend.

Now I have paperwork to do before I go to bed...Hubby is already snoring lol I am so jealous. I am exhausted myself.  Work hard play hard is catching up to me!!

 

Rivergirl,

Even many years from now, no one, not you, your husband, or his physicians, will be able to say your set of choices was optimum or not. Richard Feynmann wrote well about the uncertainty principle in science. That applies to this disease. I personally, being a Gleason 8, am in the throw everything at it school, notwithstanding SEs. People on this Board will differ. We deal with uncertainty every day. Best wishes to you and your best guy.

NewspaperLover