Adjuvant or Salvage RT

It's generally accepted that RT should be delayed until continence returns. RT puts stress on the bladder. Good luck. Hopefully you won't need it.
Bob

Jimo48,

What is your PSA reading after your surgery? If it is undetectable I would wait until you see to start increasing above 0.2.

Wait till your psa becomes detectable. the svi is inconsequential from a art or srt point of view. The seminal vesicles were removed{ this is how they determined there was cancer there}. So since they were removed the cancer was removed or it had escaped from them prior to removal. If they had escaped, the cancer would be systemic and out radiation's field of vision. the t3b certainly increases the risk of having pca in the pelvic area, so I suppose you could radiate that rid yourself of that concern, only to have the side effects and the real possibility of it being systemic via the seminal vessels. Both of the possible sites of cancer are susceptible to standard HT tx, also with S/E's. Why not wait till you are sure, via a continuous psa rise. That would be my advice and rational for such. In my view all the studies of early, quick post op radiation as being helpful are skewed, as you never will know if there was ever any cancer there post op to begin with. Radiation is splayed all over, damaging healthy cells and then when the psa never rises, viola, the radiation is given credit for destroying something that was never there. If you don't mind the S/E's go for it. I would prefer to see a real sign of cancer,via symptoms/substantial and continuous psa rise before I started throwing everything at " it " Bottom line most post op radiation tx's are not successful and when they " are " it can never be really known unless there was a substantial and continuous rise and that rise stops and retreats.

There have been some trials looking at the specific question of whether adjuvant radiation is noticeably better from a cancer control standpoint than SRT. I don't remember the specific studies but you can search for them or ask your doc. The essence, though, is that fast SRT, that is to say SRT at the first sign of a recurrence, seems to be just as good or nearly as good as adjuvant, with less side effects. You should probably test use the ultrasensitive assay rather than the one that doesn't register below 0.1. You might consider working out a threshold for pulling the trigger that is somewhat lower than the usual standard of 0.2 for example 0.1 if there is strong evidence of a steadily rising trend in the range leading up to .1. Once it is obvious that a recurrence is underway in a case like yours why wait for it to take another lap around the track.

My post-RP PSA at 3+ months came in at undetectable or somewhere around .0004. I am nervous about all the studies saying do ART in 4 or 5 months post-RP or side effects can occur. I am t3b post RP GL8 with epe and svi , no nodal involvement evident.I am going out of the country for 3 weeks and want to do the ART at 5+ months. My Doc said no problem, just do the Cagle training and wait until dry but before 6 months. This is my first day on this awesome forum and I will post all my stats tomorrow. My concern is is continence the driver here or is zapping any possible pc cells ASAP the driver?

Thanks, guys, for all history shared. The Doc's are so busy that they can't share all they know when I see them. So great to hear from those that have done the RT, hormones,etc. The studies I have read mostly all favor ART(when PSA at lowest) over SRT for control of the PC, but seems to be no consensus on the survival value of ART or even SRT. Side effects are a concern. I appreciate any help or comments.

jimo

2/2014 PSA 4.6(had been 1 to 2 forever)
3/2014 Biopsy Right prostate 3/6 cores have pc. GL 4 +3
Left side clear
7/2014 Lap Surgery removes prostate, and some LN's(negative), SVI, PNI, positive margins, 20% of prostate cancerous. GL 4 +4, t3b
ART recommended after continence but before 6 months post-RP
10/25/14 PSA undetectable, ART still advised, still incontinent, hormones not advised for .
now since no PSA
11/6/14 ART postponed until dry, possibly Dec 2014(5 months post-RP, or even Jan 2015(6 months)

All studies are wrong, by definition. Its the truth ask anyone involved in them. They are all inherently flawed. Only trials are right. Don't want to rain on any parade, but its true. I gave you a good one on art and srt, of which the logic is irrefutable, even to the greatest doubter. Use your own mind to see the truth of what I said. I want to see the flaw in my logic I really do. Doesn't mean you shouldn't use them as a guide, a hope. Nothing wrong with hope, which is the better part of studies. I only say this so you know what a study is and what it is not. Epidemiologists do all kind of studies in their work and the first sentence in this post is a mantra of their profession. My rational on the early art and srt is solid. life is choices, I don't care what way you choose, be cause you will be fine in the long run either way imo, just want to save you from so S/E's. Not muddying the water, just trying to crystalize your thoughts. Please take it with the intent offered.

I totally agree that the american cancer society definition is a good one for a recurrence. Whether to treat or not to treat or when to treat is personal , individual decision, ideally made with as much factual knowledge the individual can muster. There can be a bandwagon effect based simply on what is in vogue at any particular time on any particular pca forum, when a new and frightened newbie checks in. One of them is the value of studies in making that decision. I want to share a different perspective on studies. It
is true that anything shown by one study can reputably be contradicted by another. Studies, as is all science, a different form of the dialectic method, where a little bit of a puzzle is posited with or against another bit of the puzzle so as to gain knowledge. It is a study… not a learnt. I, myself am heartened by studies of various sorts. But I am not led by them. To clarify studies do have a place in making an informed decision. Medico's opinions are obviously as valuable as the medico. The best thing anyone has, so as to to make good decisions, actually two, lie in the skull and the left part of the chest. Oh and a tiny seed of faith, for grins and giggles.

Good luck...seriously...we hated the decision making. My husband was going through RT a yr go. He did well only side effect was half way through...serious exhaustion. He never really took it easy didnt take any time off from work. His psa has been good ever since...i think we made a good choice.
Good luck, Alison

My husband is PT3B post-RRLP, all PSA's to date (since 11/2013) have come back undetectable (pre-biopsy PSA was 3.7, biopsy gleason was 3+4=7 but path gleason flipped to 4+3=7). However, path report (surgery was 10/2013) indicated several adverse findings: SVI, EXE, positive margin, PNI. We spoke with numerous medical specialists to get recommendations as well as did extensive research on what to do next. Surgeon advised to wait til PSA rise; medical oncologists were talking HT alone, limited HT with RT, extensive HT post-RT; radiation oncologists were leaning toward both ART or SRT as possibilities as long as PSA was constantly checked to manage any rise. Husband came out of surgery with ED and minimal incontinence (mainly stress leakage). We came to realize any decision on future treatment had to come from us and the knowledge we acquired from research and communication. We decided on ART and had it begin when husband felt he was fully continent (ED was a work in progress, but progressing nonetheless). This was July 2014 (8 months after surgery) for 40 sessions for a total of 72 gy. His side effects from RT were very minimal. No bladder/bowel issues. Fatigue was last three weeks but was also limited (he would take his 15-minute "power nap" every afternoon). He was able to be on the radiation table at 6:30 am, to the gym by 7:30 am, and at his home office desk by 9 am. He truly felt that the side effects were kept under control by exercising regularly, watching his diet, and constantly doing his kegel exercises (which he started even before surgery). His first PSA reading post-RT is in a couple of weeks (Nov 26) and we are expecting (with a good dose of hopes and prayers) that it is undetectable. What we have learned throughout all of this is that this is a very individualistic disease. What works for one doesn't necessarily work for another. When researching, verify dates of information you come across because methods/success are constantly changing. And when you make a decision to do any further treatment, don't waste time second guessing yourself. Best of luck to you.

My husband was 58 at surgery, turned 59 in January. The radiation oncologist we started talking to two months after his surgery was advising ART to begin by the 4th to 5th month out from surgery as long as continence was good. We felt that with monthly PSA tests we could keep a watch out for any rise but still take as much time as necessary for continence. The radiation oncologist was OK with this plan and RT was started 8 months from surgery. My husband probably could have gone another month or two but if RT was a certain and continence was good (completely dry with a few minimal leaks when doing certain weights but nothing that required a pad) he decided to start when he did, get it over with and on with our lives. RT was 40 sessions at 1.8 gy per with total of 72 gy using IGRT/IMRT with fiducial markers. This was done at Moffitt Cancer Center in Tampa. So far, so good. ED is improving without assistance of Cialis or devices. Stress leaks have all but gone away. If you do decide to wait, keep an eye on the PSA. Keep up with the kegels. Here's hoping for great outcomes all around!