HealingWell
Search Close Search
☰

Round 2

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 1/15/2015 10:59 PM (GMT 0)
Just received my third post-op uPSA results, and have now gone .04, .05, .07 respectively (surgery 5/14, first uPSA 7/14.) Far from large numbers, I know, but certainly not a trend that I was looking for, and highly suggestive that there is something going on that we'd prefer was not.

So, round 2 of research (well, really freshening up on the research done initially) is now well underway. Uro recommends radiation now. Talked to RO this afternoon, and have an appointment to follow up with him as well as the MO next week. RO recommends looking at four options:

1. Continue to monitor actively, strongly recommends taking action (based on age, pathology) at .1
2. RT to prostate bed
3. RT to prostate bed and lymph nodes
4. Option 2 or 3 with the addition of HT (likely Lupron for six months)

He stressed, and I knew, that a decision did not need to be made immediately, but that we should meet, and I should research my options to determine what I want to do next (even if it is continue to actively monitor.)

Though I don't post much, I'm here frequently reading up on everyone's journey. I owe my current state of knowledge greatly to the information (and references) that are posted here on a daily basis, and I am very grateful to this community for that. I had hoped (and still do) that I wouldn't have any additional experience to share.....

Onward I go.

Rich
Posted 1/15/2015 11:17 PM (GMT 0)
Good luck, Rich, go for the .4 and "trust MSK who have factored in all the noise meaning dis says dis and da udder says dat, the EPE means squat with negative margins. the grades are concerning. If its out its systemic, beyond the scope of radiation, all arguable! MSK is not stupid!
Posted 1/15/2015 11:27 PM (GMT 0)
Rich,

See:
prostatecancerinfolink.net/2015/01/04/when-should-the-patient-and-doctor-consider-salvage-radiation-therapy/

You are certainly above the .03 threshold they found, and sooner treatment gives better results than waiting.

Your pre-op PSA was low, but your post-op Gleason score was on the high side, so I think you are on the edge for the probability of LN involvement. What does the nomogram tell you? And at what probability would you feel comfortable?

Six months of ADT is good insurance, and probably won't cause major or lasting symptoms, but it may impede your erectile function recovery.

Lots to consider.

- Allen
Posted 1/16/2015 2:00 AM (GMT 0)
@Allen - I read your article, as well as the "Low Detectable" one and found both useful. I've done a few monograms along the way. I which are you referring?? ...and, of course, you are right. The decision to wait or act comes down to comfort over with the knowledge and statistics.

Fun stuff!

Rich
Posted 1/16/2015 3:31 AM (GMT 0)
I just noticed that you were N(0) - so they already did check your lymph nodes. Why did your RO raise that as an issue then?
Posted 1/16/2015 4:18 AM (GMT 0)
@Allen - My RO laid out prostate bed+lymph node RT as a more aggressive approach (than just prostate bed alone) given that we are already talking about taking a stab in the dark about where any "stray" prostate cells are likely to be. While less likely to be in lymph nodes than prostate bed, perhaps more likely to be there at this point than anywhere else. It seems to me that it's a bit of a crap shoot either way, but without a reliable scanning technology at this point, it comes down to statistics, and one's outlook on balancing efficacy vs. side effects/quality of life. That's probably over simplifying the process, but also where it boils down to for me. I'm not yet sure what I think of that possibility (RT of prostate bed + lymph nodes), but I'm very much ok with my RO throwing that in the mix. We will thoroughly discuss the ramifications and potential side effects of all potential avenues (including doing nothing yet), but I like that he's bringing all he can think of as reasonable options to the forefront. I'm very interested, of course, in what the MO has to say as well.

Like I said, fun stuff. :)

Rich
✚ New Topic ✚ Reply