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Posted 1/22/2020 8:57 PM (GMT 0)
Had a blood draw this morning.. just received results. PSA 2.57, up from 2.21, 6 days ago.
meet with RO in the morning. hopefully start hormone therapy. additional imaging.
Posted 1/22/2020 9:10 PM (GMT 0)
John, I think your conversation will be about developing your adjuvant therapy plan, especially centered on when to begin RT, given the specific adverse features in your path report. (My hunch is that your PSA levels may lead to shortening the typical number of months to healing before RT, but I'm not a doc.)

You havn't answered the question as to how many (negative) nodes were removed at your RP. This may come into the decision regarding fossa-only vs. whole-pelvis radiation. You can also discuss ADT, genomic testing, and advanced imaging tomorrow. I suggest bringing written questions; if you trust your memory, you will probably forget something -- you get into the details of one issue with your doc and loose track of your questions.

Keep us posted, please,

Djin
Posted 1/22/2020 9:15 PM (GMT 0)
"hopefully start hormone therapy" I try to avoid ADT as long as I can. Some doctors recommend to start with ADT not before the mets hurt or become visible. If you start now you will become non-metatastic castration resistent.

Make yourself familiar with all the side effects of ADT and what you can do against them:
https://www.pcf.org/wp-content/uploads/2016/10/maintaininghealthadt_monograph_2017.pdf
Posted 1/22/2020 10:50 PM (GMT 0)
I don’t see how John can avoid ADT with 2 month PSA stabilizing around 2.57 and then going with ART/SRT as soon as he is physically up for it. My understanding is ADT can be avoided when the post-op PSA is really low but not at these levels where the treatment benefit is better established.

I went through ART last April at 5 months post-op and was substantially healed up and ready to go for it. I could have done it a month earlier but had some other conflicts that pushed it back. My PSA was < 0.10 so there was no pressure to do anything on any given day but I felt I had to do something when I was ready. Your situation is bit more pressing so getting everything lined up and ready to go is what you will hopefully accomplish tomorrow.

Djin’s comments are good.
Posted 1/22/2020 11:18 PM (GMT 0)
It’s a number.

The cancer is assumed to be localized at this point. The number will fluctuate (as has happened already).

Try not to let these variations slap you around John. (Easier said than done). It’s in your crotch. You’ve got a plan (or will have tomorrow) to kill it.
Posted 1/22/2020 11:48 PM (GMT 0)
Sorry to read about that number John. Yes, looks like you're headed for more treatment.

If more scans are the plan you might have to hold off on the ADT until that is done.

Do keep us updated on what the doc says.
Andrew
Posted 1/22/2020 11:50 PM (GMT 0)
PCA and anxiety go hand in hand....
God bless..
Posted 1/23/2020 1:12 AM (GMT 0)
John,

If you can get to a gym to lift some weights, walk on a treadmill and otherwise exercise....it feels good and brightens your day.

You feel like you are doing something for yourself to win.

It will help with the potential ADT side effects I am told (I had my first shot a week ago).

Hang in there. Its amazing how fast you will adapt.
Posted 1/23/2020 1:58 AM (GMT 0)
Nix on the rad...MO needed...they say ADT is baaad...whose got the most skin...rappin in the wind...make the call...just dont crawl
Posted 1/23/2020 2:38 AM (GMT 0)
Kill it now or fight it forever. Get good docs and put your trust and life with them.
Posted 1/23/2020 5:21 AM (GMT 0)

DjinTonic said...
John, I think your conversation will be about developing your adjuvant therapy plan, especially centered on when to begin RT, given the specific adverse features in your path report. (My hunch is that your PSA levels may lead to shortening the typical number of months to healing before RT, but I'm not a doc.)

You havn't answered the question as to how many (negative) nodes were removed at your RP. This may come into the decision regarding fossa-only vs. whole-pelvis radiation. You can also discuss ADT, genomic testing, and advanced imaging tomorrow. I suggest bringing written questions; if you trust your memory, you will probably forget something -- you get into the details of one issue with your doc and loose track of your questions.

Keep us posted, please,

Djin

At his PSA values the treatment is not adjuvant.
Posted 1/23/2020 10:52 AM (GMT 0)

Duck2 said...

At his PSA values the treatment is not adjuvant.

You are correct--my error stems from distraction, thinking that adjuvant therapy would likely be advised even with an undetectable PSA, in light of the OP's G7 (4+3), bladder neck invasion, positive margins, and seminal vesicle invasion. But yes, the treatment would be directed at disease known to be present after RP (salvage) and not added (adjuvant) after RP to help prevent a recurrence (BCR) from occurring.

Djin

Post Edited (DjinTonic) : 1/23/2020 5:41:07 AM (GMT-7)

Posted 1/23/2020 4:49 PM (GMT 0)
The grey area between ART and SRT relative to post-op time and PSA is subject to some debate but certainly a 2 month post-op PSA in the whole digits (1,2,3) is too high and the concept of "early" anything never presented itself. Hopefully, John's 3 month PSA looks better but I think getting a special PET scan scheduled between now and then would be recommended. As Logo noted, seeing a MO might be a good idea at this time also and the MO would probably concur with the scan before ADT or RT.

Post Edited (Mumbo) : 1/23/2020 10:40:23 AM (GMT-7)

Posted 1/23/2020 5:45 PM (GMT 0)

Mumbo said...
The grey area between ART and SRT relative to post-op time and PSA is subject to some debate but certainly a 2 month post-op PSA in the whole digits (1,2,3) is too high and the concept of "early" anything never presented itself. Hopefully, John's 3 month PSA looks better but I think getting a special PET scan scheduled between now and then would be recommended. As Logo noted, seeing a MO might be a good idea at this time also and the MO would probably concur with the scan before ADT or RT.

Yes, the "early" in this case would refer to the waiting time before having SRT. The degree of urinary and potency recovery would IMO need to be balanced with the number of extent of the adverse findings in the post-op path report, imaging results, and, perhaps, a genomics score.

Djin
Posted 1/23/2020 5:57 PM (GMT 0)
Agreed, he should just proceed in a manner that he is comfortable with based on his recovery and recommendations from his doctors. While keeping after it, he also needs to take his time and get ready for the next steps. I had my surgery in November like John and was not ready at 2 months for anything serious other than getting back in shape.
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