Decision time - adjuvant radiation vs wait and see - indecision seems insurmountable obstacle for me

David:

Thank you.

As painful as it may be for you to frequently have to recount your story, it's very useful for guys like me to know the possibilities.

Lord knows my oncologists aren't telling me.

I think one of them promised me candy and a new Tesla if I did treatment now.... ok, maybe joking, but the hard sell can seem to be extreme sometimes.

Aachen,
Prior to responding to Nick's thread (Appleseed) I reviewed your stats also--2 different scenarios. As a "newbee" I must bow to the comments and evidence that the experts have provided. Your positive margin has been verified as a G6 which is not know to metastasize outside the prostate..Based on that I can see no reason for you to get Zapped at this time..Keep an eye on your psa, enjoy life, and go in peace. In Nick's case, with G9's and G8's verified after surgery and a "positive" lymph node my opinion is completely different..
I wish you the best!
Bill

James Joyce,
At least we agreed on something..I feel for guys like Aachen who are given varying answers by different experts (doctors); the same goes for Nick..In many cases, ultimately, the patient has to make a decision based on his personality and mindset. After many years and studies, there is still no consensus on what the best treatment is or when to initiate it. A very few, like John T, resolved to become experts and fight the disease on his "high ground"..I wish that there were easier answers..The more I learn the more confused I become..I thank Tall Allen for his many contributions.. Sorry for this "rant" on Aachen's thread, but there are many times I get disgusted when the patient is left in limbo or to his own devices.
bill

Men:

I appreciate all your input.

I went to see Dr. Anthony D'Amico at Dana Farber in Boston.

He's done a ton of studies on the need for radiation after surgery.

Turns out he strongly suggested I wait.

His studies show that Gleason 6 and 7 have only a 18 percent chance of ever needing radiation, even with a large positive surgical margin.

And if radiation is needed it has a 99 percent 'cure' rate.

And waiting until PSA rise has NO EFFECT on success rate as long as you catch it early (ideally around .5).

Also, Gleason 6 and 7 doubles so slowly that unless you go a long time between PSA tests it's very hard to not catch it early.

It's this study http://www.ncbi.nlm.nih.gov/pubmed/20553253 . Sorry, but I havent found a full text version online.

If anybody wants it just email me and I will email it to you.

So I'm going to take his advice.

Sortof amazing to me that none of my local oncologists mentioned this study or these stats at all.

Again, though, this is specific to Gleason 6 and 7. D'Amico recommends adjuvant for higher Gleasons and other high risk factors.

Sounds like a good plan. Now go celebrate, monitor your PSA periodically, and try to put the cancer side of this behind you.

What happens when ultra low psa's are thrown into the "studies " on earlier treatments being better, is that people who will never have a recurrence are thrown into the mix thus skewing the results toward it being better to treat earlier, thus stetting up a vicious cycle of over treatment itself "proving" the "need" for over treatment. The statement makes sense if you think about it and not parse words too thinly. The extreme paradox here is that we are told to "take our time: with initial treatment, and then with the same gleason score are told to rush into treatment on " recurrence" { possible apples and oranges… still}The paradigm is more and more like the the SFO air crash, the media{ktvu} and the ntsb name release. Everyone pretending to be doing the right thing, with disastrous results. Human decision making in all things is depending on that which is out side rather than that which is inside and at the core of our being.

Google and read Plato's "Allegory of the Cave" sometime"

Hi Aachen,

Watchful waiting might be in your best interest, but it's definitely worth looking into other treatment ideas... you never know what might turn up. If your prostate cancer is still localized, it might also be possible to receive HIFU treatment. I've been doing a lot of research for a friend in the past few months or so, and HIFU is something that seems to be ideal for men who have low-intermediate risk prostate cancer that hasn't spread elsewhere in the body. My friend's is still only in the prostate luckily, so I'm learning a ton about this solution.

It isn't approved by the FDA yet, but there have been countless clinical procedures done right outside the U.S. in places like the Bahamas, Mexico and Canada. HIFU basically hones in on the cancerous prostate tissue and then uses intense ultrasound waves to dissolve it. But, the devices only dissolve cancerous tissue; the healthy tissue is left untouched and many men have had a full recovery. Maybe look into it more if you don't want to "wait and watch."

Jake, after one of your previous posts one of the moderators asked you for a little more info so that he was convinced ou were not a rep for a HIFU manufacturer. We are still hoping you will provide that but in the meantime I have removed the link you included. Please email me and we can discuss...Tudpock18

Post Edited By Moderator (Tudpock18) : 7/26/2013 1:01:35 PM (GMT-6)

Hi Aachen,

I just noticed this thread regarding ART versus active surveillance for positive margins with a G 3+3 = 6 at the margin. I also noticed that you consulted Dr. D'Amico in Boston, and that he recommended that you you do not do ART.

I encountered a similar situation as you, where my surgeon suggested active surveillance, but a radiation oncologist from the same institution suggested ART for a 3mm bladder neck margin with G 3+3 = 6 at the margin. I have Dr. D'Amico in my short list of doctors for further consultation. I noticed that you posted a link to the abstract for one of his research papers. Do you know of other papers from his group covering the same topic?

All the best,

Joe.

Asking for advice on whether I should start 5 weeks SRT soon? I am 10 months post RP and received PSA results of 0.12 this week up from 0.03 in June. I am planning on taking another PSA test in 3 weeks to have results when I meet with the SRT doctor just to verify reading was not an anomaly. My surgeon and I are both puzzled at a 4x increase in just 4 months considering that the RP went well and things looked OK. Post-biopsy reported 1mm focal margin but surgeon considered to be insignificant. No seminal vesicle invasion or protrusion beyond capsule. Should I wait another 3 months and retest PSA or start SRT ASAP?

Hello Rust. Welcome to the forum. I've started a new thread for you so more folks will see your question. It is here: www.healingwell.com/community/default.aspx?f=35&m=2876347