1 yr check-up after IMRT

I finished IMRT Labor day.
I'm 78 yr old. Was on AS since my first Bx 03-05-09, until last year.
Initial PSA was 4.1, Bx GS 3+3
I had a total of 4 Bx with 12-13 cores. The 2nd and 3rd show no ca but suspicious pathology.
The 4th went to GS 4+3 in 1 core (20%), and 3+4, 1 core, 3+3 (5%). This bx was April 2013. Regarding PSA's, these went up in the subsequent 4 years to 5.0, 5.7, and 8.0. The last just before the IMRT was 11.7
I received 77 Gys over a 2 mos period. I'm doing well. Only side effect right now is difficullty peeing. No fatigue, no ED. Initially I had rectal problems with bloody and painful BM's.
I've had now three PSA's this year: January '14: 2.25, July '14: 1.5, 10-14-14: 1.31.
Recently I went to a PCRI symposium in L.A. which I found to be outstanding. I learned a lot and was amazed at the great number of people there and their knowledge of this darn illness...!
I was somewhat overwhelmed and filled with auto-recriminations re: how little I knew and still know about Pr ca.
The speakers were outstanding.
Armed with new knowledge, I want to ask several questions to my Radioncologist (who's retiring this month).
I'd appreciate if you guys tell me what you thing about them and suggest further questions for me to ask, etc.
1) Please tell me exactly what my Pr ca's stage was just b4 the RT (My guess was a T2c, because bx involved both lobes. MRI with rectal coil showed no lymph node involvement or metastasis)
I just want this question answered as I didn't get much definite opinion from doctors last year.
2) Can we trust the "CT Abdomen/Pelvis with IV contrast"done June '13 (just B4 RT) which showed: "prominent prostate, 5.4 x 3.8 cm, and "no enlarged lymph nodes by CT size criteria and no metastasis"? (I realize I should've asked this questions at that time, not now. Like I said, I was a passive, trusting pt B4, but now I'm more knowledgeable or more "neurotic"?
At the PCRI meeting I learned about better ways to detect local or distant metastasis, like C14 choline, C14 acetate scans.
3) It seems that the PSA nadir after RT may be at 2-3 yr post Rx. First of all: what should be my PSA level to consider me "cured"? How is "failure of RT" defined in terms of PSA levels?
Of course, although not relevant now in my situation, I'd like to know about PSA-DT, PSA velocity, etc in case of biochemical recurrence.
4) What to do if my PSA never goes down to the expected nadir?
5) It doesn't seem logical for people on RT to wait 2-3 yr for a nadir to occur without being pro-active. I'd like to discuss with the ROncologist about doing one of the scans I mention above. (Even if I have to pay OOP myself)
I'd appreciate very much help on this matter from you members of HealingWell.
Thanx for your consideration,
Locolindo

Hi Locolindo, I'll take a stab at your questions.

1) Please tell me exactly what my Pr ca's stage was just b4 the RT (My guess was a T2c, because bx involved both lobes. MRI with rectal coil showed no lymph node involvement or metastasis)
I just want this question answered as I didn't get much definite opinion from doctors last year.

You can't guess about clinical stage and it's not based on the Bx results. It's based on what your doctor felt with the DRE and any other info from MRI or US. If he felt nothing and saw nothing, you are stage T1c.

2) Can we trust the "CT Abdomen/Pelvis with IV contrast"done June '13 (just B4 RT) which showed: "prominent prostate, 5.4 x 3.8 cm, and "no enlarged lymph nodes by CT size criteria and no metastasis"? (I realize I should've asked this questions at that time, not now. Like I said, I was a passive, trusting pt B4, but now I'm more knowledgeable or more "neurotic"?

You can trust it to show if any lymph nodes were enlarged. If there weren't, and with your relatively low Gleason score and PSA, there is small chance of LN invasion.

At the PCRI meeting I learned about better ways to detect local or distant metastasis, like C14 choline, C14 acetate scans.

Little chance of this with your numbers. Those scans are used for men who have failed primary treatment, never for guys in your situation.

3) It seems that the PSA nadir after RT may be at 2-3 yr post Rx. First of all: what should be my PSA level to consider me "cured"? How is "failure of RT" defined in terms of PSA levels?
Of course, although not relevant now in my situation, I'd like to know about PSA-DT, PSA velocity, etc in case of biochemical recurrence.

Try to keep your head in the here and now, and not with what may or may not happen in some mythical future, and probably won't. Any nadir ≤.5 is considered highly prognostic for success. Biochemical failure (different from clinical failure) is defined as confirmed nadir+2.

4) What to do if my PSA never goes down to the expected nadir?

Some guys reach higher nadirs and do fine, some guys reach lower nadirs and don't. Take it as it comes.

5) It doesn't seem logical for people on RT to wait 2-3 yr for a nadir to occur without being pro-active. I'd like to discuss with the ROncologist about doing one of the scans I mention above. (Even if I have to pay OOP myself)

That would be grossly inappropriate and misleading. No one knows what a prostate that has been recently irradiated is supposed to look like on those scans. Because it takes several years for the cancer to give up the ghost completely, what would it mean if you detect cancer there? Those scans were never meant to be used on an intact prostate, and no one knows what the results would mean.

The "logical" course is to let the radiation continue to do its work, while monitoring that with PSA, and not over-reacting to expected bounces.

- Allen

quotes didn't work - replaced with italics

Post Edited (Tall Allen) : 10/22/2014 11:57:33 AM (GMT-6)