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Posted 4/23/2013 7:12 PM (GMT 0)
In another thread, and in response to Compilers good news today,

PSA 60 said:
"Nearly same situation here: Last PSA 60, MRI guided biopsy G4+3, possible extension to nodes. Lupron 4/1/12 with IMRT scheduled for 6/1/12. Urologist wants to take another PSA test before IMRT; says if still high (>20) IMRT would be a waste of time. Does this make sense?"
Posted 4/23/2013 7:15 PM (GMT 0)
Welcome aboard. Sorry you're here.

A PSA of 60 is a high number and the likelihood of a spread outside the target area of IMRT is real. But that does not mean you can't benefit from IMRT that includes a hit to the area nodes. I think it's very important to get below 4 on the PSA but I think you will with hormonal therapy. At that time, the decision to move ahead with IMRT, while controversial, is reasonable. Good luck with the next tests.

Tony
Posted 4/23/2013 7:19 PM (GMT 0)
Welcome.
I'm thinking a radiation oncologist would be the person to advise about the radiation, not a urologist. Maybe radiating the nodes would help you.
Some dates show 2012, should they be 2013?
Anyway, good luck to you.
Posted 4/23/2013 7:32 PM (GMT 0)
Hi PSA 60,

I'm sorry to hear about your Dx. The only sense I can make of what your urologist told you is that your high PSA puts you in the "high risk of recurrence" category rather than "intermediate risk." Still, Lupron plus IMRT, sometimes along with a brachy or SBRT boost to the prostate as well, is a common option. This may be something that your radiation oncologist rather than your urologist may be more familiar with.

I'm concerned about your comment that there is a "possible extension to nodes." I don't know if the source of that was based on the probabilities from a nomogram or the MRI. If the MRI detected that your nodes are enlarged, your radiation oncologist may want to prescribe an SBRT boost to the affected nodes as well. In either case, there may also be a role for advanced imaging like a C11 Choline or C11 Acetate PET/CT scan to help detect exactly which nodes are involved.
Posted 4/23/2013 10:22 PM (GMT 0)
PSA60:

Welcome to our club ... but sorry you need to be here.

Regarding a blanket no IMRT with PSA > 20: I'm going to go out on a limb and call bs on any doctor who says that without extensive experience in lymph node IMRT and a detailed look at either CAT or MRI or PET scan.  That pisses me off.  See, I was told something similar, that since the cancer had spread to my lymph nodes within a large region of my torso, i wasn't a candidate for IMRT. 

I didn't take that well; I ended up talking to the radiation oncologist who wrote the NCCN standards; he looked at me and said it was a 'no brainer' -- of course we would treat this with IMRT.  He specializes in treating lymph nodes in these cases.  Now, there isn't loads of clinical studies proving it works -- because there just aren't that many of us and it's tough to control forother factors.  But

I'd encourage you to talk with a top radiation oncologist yourself.  And i'd personally be skeptical of that doctor ...

Regards,

Ray

My personal plan:

Starve it, radiate it, poison it, then use pliers and a blow torch if needed.  And pray like it matters.

Posted 4/23/2013 10:42 PM (GMT 0)
Welcome to the best PC forum on the net PC60. I never play oneUp man ship, this is just to let you know that a high PSA is no death sentence. My first PSA was a 511, that was six years ago. Now it's 4.5 and all is well. The best of luck and the least of pain . . . Q
Posted 4/23/2013 10:42 PM (GMT 0)
Welcome to the best PC forum on the net PC60. I never play oneUp man ship, this is just to let you know that a high PSA is no death sentence. My first PSA was a 511, that was six years ago. Now it's 4.5 and all is well. The best of luck and the least of pain . . . Q
Posted 4/23/2013 11:42 PM (GMT 0)
Thanks for the welcomes!

Brief history (all with Kaiser HMO): 10 years of rising PSA (3 yr dbl time) WITH 5 negative biopsies before G3+4 TURP biopsy in January 2013. Got an MRI/Coil biopsy and 2nd opinion from UCSF, changing to G4+3 anterior tumor with possible extension to surrounding stroma and suspicious pelvic nodes due to size and location.

This seemed to take surgery off the table, as well as brachy or CK due to TURP defect, so I am scheduled for 5 weeks 3D-MRT + 3 weeks IMRT starting in June. Starting my 3rd week after Lupron injection with no side effects so far. If my PSA fails to drop substantially before RT, should I postpone or eliminate it as a treatment option?

P.S. I was prescribed finisteride for two years (2010-11) to see if it would correct my PSA level. It did drop by 1/2 initially, but started rising again and jumped back higher than ever after I stopped taking it. Was this accepted medical procedure, and may it have aggravated my PC?
Posted 4/24/2013 12:50 AM (GMT 0)
This website gives me optimism during a supremely hard time right now. You guys are the best.

Susan
Posted 4/24/2013 12:56 AM (GMT 0)
Hi PSA 60 - welcome and good luck to you!
Posted 4/24/2013 2:18 AM (GMT 0)
PSA60,
Those anterior tumors are sneaky devils!

PSA60 said...
If my PSA fails to drop substantially before RT, should I postpone or eliminate it as a treatment option?

The ADT helps make the cancer more radiosensitive. I think that many ROs prefer that it bring down your PSA to very low levels before beginning. I've seen studies that say 2 months is good enough, others think 6 months may be optimal -- no consensus on this. I would not forgo the RT, since it is your chance at a cure.



PSA60 said...
P.S. I was prescribed finisteride for two years (2010-11) to see if it would correct my PSA level. It did drop by 1/2 initially, but started rising again and jumped back higher than ever after I stopped taking it. Was this accepted medical procedure, and may it have aggravated my PC?

I wish more doctors used it that way. The finasteride is good at eliminating the PSA due to BPH, which is why it dropped by half. It's not so good at eliminating the PSA from PC, which is why it started to rise. IMHO, it's a great detection tool when used that way to unmask the cancer and can eliminate many unnecessary biopsies. Studies on its long-term use have found an increase in detected G8-10 PC, but most attribute that to detection bias -- it's easier to find that needle in the finasteride-shrunken haystack.

I don't know if you can go outside Kaiser for second opinions, but I know some doctors down here who do brachy and SBRT after TURP. Are you allowed to get a second opinion on brachy or SBRT boost? If you're in Northern California, one of the foremost brachy experts, Dr. Al Taira is in Mountain View. And I know Dr. Alexander Gottschalk does CK at UCSF. Since you're not scheduled to start RT until June anyway, it can't hurt to get more opinions.
Posted 4/24/2013 2:47 AM (GMT 0)
Thanks Allen,

Actually, my 2nd opinion was Dr. Gottschalk, who recommended against brachy. I am not thrilled with Kaiser's limited therapy options, but they seem to do a lot of RT in Roseville.

John B.
Posted 4/24/2013 3:37 AM (GMT 0)
John B.,

I used to live in Sacto, but I don't know any ROs there. I've never heard of a 3D-CRT boost with IMRT, but I'm sure they've had success with this in cases like yours if they're recommending it. I hope they are planning to use an IGRT technique with it to help spare your urinary tract and bowels. That can be done with gold fiducials or the placement of radio transponders (Calypso). There's also a device called Tomotherapy that has built-in prostate tracking.
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