dazed and confused

Question

I went for my post op visit to the oncologist and of course when I got the less than good news, my head was spinning and I was not prepared with the right questions. I was expecting good news.

He said the Radiation and Hormone therapy would start soon, I am about 7 weeks post op now (BTW the surgery was not bad at all, I was expecting much worse)

He did not specify what kind of Radiation therapy, I see here there are several types, and the hormone therapy scares me because I am pretty active in the gym and like to play golf....wondering about loss of muscle mass, fatigue, and so forth.

What I am wondering is will I have energy to work, be active. Not sure what side effects to expect.

Any advice is welcome.


Age at detection 58
PSA at detection 9
Biopsy 3/2015, 4 of 10 cores positive, Gleason: 3+4
Bone scan negative,
DaVinci 6/26/15
Pathology: 41.5 g, %involved by tumor 20%, no seminal vesicles involvement, Apical margins involved Gleason same 3+4
PSA 7 weeks post op 0.275

Radiation did not have any effect on my work schedule. I would suggest that you find the best radiation oncologist in your part of the world- he may not be associated with your surgeon. Travel if you have to- this is your next best shot left for a possible cure- It is more important than playing golf or work schedule in the long run- your RO, and his ability, will have lasting effects on your outcome. You are young for this junk- take the time to get this right- go play golf when you get old!

Thanks Guys.....

He said about 6 months on HT

How soon after surgery can the radiation treatment start?

OK....Hold on everyone...I understand CLDCR has positive margins, but....he is also 3+4 not 4+3 or higher.... 7 weeks is too early to for a PSA test after surgery.....It should be 3 months. I am not saying that you don't need SRT, but there is a small possibility that your surgery killed the cancer left behind. Read about positive margins by Dr. Walsh.... I am not trying to get your hopes up about not needing SRT or HT.

But, I would think your Dr. would wait until 3 months to do a PSA and then see where you are at before starting therapy that you may not need yet.....There are a lot of guys on here with positive margins that were 0 for a long time.

I'm just saying...I would not jump the gun yet.....I would make for sure your PSA is still detectable at 3 months.....and then if so proceed....

They usually wait about 3 months for healing. They typically begin HT two months before they start the adjuvant RT. I think it bodes well that they can identify a positive margin - at least there's a good chance that it's only there and not in some distant place.

- Allen

You could also request a second opinion on your post-op slides. Send to Bostwick or Johns Hopkins. Some people also request a Gleason score reading of the positive margin. If it is 3+3 then it seems less of a worry to some.

I would still wait until 3 months and get a PSA test. I would not start HT before then as it will obviously affect your test.

I am just saying, if you don't want to start HT until you actually need it wait for 3 months and get a PSA and see where you are at. This is the standard protocol for PCa treatment.

Don't worry. PC is a very slow growing cancer. Waiting that long is normal. A 3+4 puts you in an indeterminate risk group. But don't delay too long though.

and you should have your PSA checked again at three months to confirm that you still need SRT and HT. There is always a possibility that you might see a further drop.

It's kind of a waiting game right now - wait for a bit of healing, recheck the PSA and if needed when you can get scheduled for everything else. Sometimes you have to wait a couple of weeks for a schedule opening on the RT machine.

Andrew

I think it is prudent to plan for adjuvant radiation now and keep open the option for a reprieve if your PSA goes undetectable at three months. They generally give a man at least that long to heal after surgery before they start the radiation anyway.

PSA has a half-life in the body, as I recall, of three to four days. If your PSA immediately after surgery was, say, 10 then, based on the half-life, after 3 1/2 days you would expect it to be 5. After a week, 2.5. After two weeks, 0.625. Three weeks 0.156. Four, 0.039. Five, 0.00977. Six, 0.00244. And, after seven weeks 0.00061, which I think most machines would read as "undetectable".

But, of course, nothing is ever that simple. As ChrisR mentioned, sometimes prostate tissue is, technically, "left behind" in surgery with positive margins but is cut off from its blood supply and quickly dies. While this is going on the dying tissue can generate a bit of new PSA in the blood and screw up the math I showed above. So, yes, seven weeks is a bit early to make a set-in-stone decision.

But, on the third hand, 0.275 is really high at seven weeks. I'd go ahead and plan for the radiation and see what your PSA does while you wait for it to start.

There's that chance. Wait a few weeks for another test. It won't hurt.

Andrew

at 7 weeks you were .275 and at 7.5 weeks you are .45

It is rising....Are your numbers correct?  Were you .275 on your 7 weeks test and now at "7 1/2" weeks you are .45?

BTW, here is a new article on Positive Margins.  It is along the lines of what I was talking about earlier.

http://prostatecancerinfolink.net/2015/08/19/if-you-have-positive-surgical-margins-post-surgery-you-need-to/