After surgery.

I've often asked a similar question, especially for cases where the post-op pathology suggested there might be problems ahead (positive margins, EPE, etc.).

I think the answer with prescribing an immediate treatment of radiation is that it would hinder the recovery process for someone who just went through surgery.  The chances of recovering any continence or sexual function would be pretty much eliminated.

However, rather than radiation, why not include a short treatment of ADT for these 'suspect' cases?  Couldn't hormone therapy do some 'cleanup' of cancer cells along a focal margin?

John,

For some high-risk men who choose surgery it is not uncommon to put them on ADT for a while to reduce the chances of recurrence. It's not generally done for low risk cancer because the benefit, if any, is small for them and it would not be worth the side effects of the hormones.

I became high risk when my post-op pathology came back and was immediately scheduled for radiation and ADT with no thought for my PSA. We waited a while to start the radiation in hopes that I would become (more) continent but went ahead anyway to keep the radiation within the six-month envelope for adjuvant RT.

Slow growing is a plausible reason.
Regarding undue stress/treatment after surgery, wouldn't a woman having gone through surgery, and then rad or chemo therapy be added stress to an already existing stress from surgery?

I don't know, it just seems that they (the docs) throw the sink and the kitchen and the baby and whatever else they can think of at women's cancer treatments.
I think some of it is over-treatment yes?

iSpark, the word you are looking for is adjuvant therapy , whereby a treatment is given in addition to the primary, or main, or initial treatment.   There are PC cases where adjuvant treatments are prescribed; not all cases are the same, and studies of the effectiveness of adjuvant treatments have been mixed.   The trade-off discussion is often whether the treatment is worse than the disease.   There are also cases of neoadjuvant treatments , or treatment before the main treatment, may be appropriate.   For example, sometimes androgen deprivation therapy is prescribed to shrink the prostate before surgery or radiation.

From a woman's perspective it may be a bit simpler- - - we don't have a simple blood test (like PSA) for breast cancer.  There is almost no way (that I know of) to detect Breast cancer other than a mammogram and/or a physical breast exam. Same for most other 'women's' cancers.  And, once you've had surgery, it's mostly a matter of waiting for symptoms of mets.  Even after surgery, you guys can 'monitor' yours rather easily!  And as others have commented, most breast cancer is faster growing, while many (not all) prostate cancers are slower growing. 

iSpark said... Not sure what they are measuring, but her and her doctor are really happy! Perhaps CA-125 blood test. CA-125 is a protein released into the bloodstream by many, but not all, uterine and ovarian cancers.   In someone with uterine cancer, a very high blood CA-125 level suggests that the cancer has probably spread beyond the uterus.   If CA-125 levels are high before surgery, some doctors use follow-up measurements to find out how well the treatment is working (levels will drop after surgery if treatment is effective) and to see if the cancer has come back after initially successful treatment.    

Both my uro and med oncologist wanted me in an early-chemo scheme (with or before HT), but the insurance company refused to approve it as it was not FDA approved, and I don't have the mega-bucks to pay out of pocket.

Ricky,

I understand that the friend was happy that all tissue was benign, but if we had that same discussion here (I got my prostate removed because there were all sorts of warning signs, but there wasn't any cancer) there would be screams of overtreatment and malpractice.

I read this whole thread to be comparing things that although apparently similar, are not at all easy to compare with the "state of the art" (or lack of) that we have today.

The ladies have a better program working on their cancer issues, no doubt.

Not that I want those treatments, just curious as to why it's surgery, and then a wait-and-see-if-it-comes-back-deal for PCa.

my doctor did not believe in the incremental approach (wait and see) to ridding me of cancer.  he ran the numbers and said I had a 60% chance of the cancer being out of the capsule so therefore would not recommend surgery even though he and his partner are both surgeons.  his partner does robotic and he does open.

so I guess it just depends on who treats you.

ed

 

worriedabouthubby said...
From a woman's perspective it may be a bit simpler- - - we don't have a simple blood test (like PSA) for breast cancer. There is almost no way (that I know of) to detect Breast cancer other than a mammogram and/or a physical breast exam. Same for most other 'women's' cancers. And, once you've had surgery, it's mostly a matter of waiting for symptoms of mets. Even after surgery, you guys can 'monitor' yours rather easily! And as others have commented, most breast cancer is faster growing, while many (not all) prostate cancers are slower growing.

Worriedabouthubby and Montee bring up good points. A woman's breasts are not internal, self-contained glands as with a prostate. Thus, if prostate cancer is confined to the organ, itself, removing the organ automatically removes the cancer along with it.

In addition, PC patients have the PSA test to keep monitoring the situation, whereas breast cancer patients seem, in many cases, to have to wait for new symptoms to arise.

I truly wish there was some sort of simple test to check for breast cancer recurrence as we have a PSA test for PC patients.

Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1. PSA tests now annual.
Semi-firm erections now happening 14 months post-op & VERY slowly getting a bit stronger.

Aimzee - Yes, I have heard this as well (PAP smears).  GYN actually told me that because of my husbands PCa and our lack of intimacy I wouldn't need another one for 2 years unless I was having "issues".  They have even changed the guidelines for younger women.  My 21 year old daughter was told she wouldn't need another PAP for 3 years, but she still has to go back to the GYN yearly to get BC prescription.  Go figure.

Hi Aimzee,

I've heard about how painful it can be when the breast is squeezed, pinched, etc. I'm very happy to hear that more modern machines are able to avoid this. Certainly, those are the clinics to visit for these tests.

Yeah, I guess going without a PAP smear is taking a chance that this new line of thought will not prove to be wrong in the future. Is it painful to take this test? If not, it should probably be continued until medical science knows, without a doubt, that it is okay to stop at a certain age.

Take care!
Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1. PSA tests now annual.
Semi-firm erections now happening 14 months post-op & VERY slowly getting a bit stronger.