Need Some advice on whether to pursue radiation

Pelahatchie:

Radiaiton will, of course, have to be YOUR decision, but with all of the new radiation treatments available the side effects are quite tolerable - both the proton and the photon.  I have never heard much about any incontinence from radiation and most of the products like Viagra work good if and when ED becomes a problem. 

Good luck on YOUR decision.

Dutch

Although not specific to my case (yet - still waiting to do the first post-surgery PSA) one urologist told me that statistically it was not worth pursuing adjuvant therapy if/until a PSA level of 0.4 (not 0.04). Some on this board have heard otherwise. Radiation is apparently only recommended if cancer spread is localized to the area of the prostate. The idea behind waiting for a clear rise in PSA is that if cancer has metastasized to other parts of the body, waiting to do radiation will not make a difference even if done early. However, if the spread is local to the prostate bed, some waiting can be beneficial to hopefully avoid unnecessary adjuvant therapy, assuming that the cancer does not spread beyond the prostate bed while waiting. Again, you will also hear different cogent opinions on this board.

Interesting I too have had my last PSA tests in the detectable range (.1 /.2) My Surgeon has recommended radiation and I have been trying to get a second opinion at the Loma Linda facility but the earliest Appointment is in March my radiologist has strong opinions about waiting beyond thanksgiving and I am making a decision as we Type !

Partin and Walsh have indicated that they do not recognize post surgical reoccurence until you have two or more psa readings of more than ( .2) .

I just had my nine month psa come up at a .02 .  My urologist suggests that we do nothing until my psa has at least two readings over .1 . 

Like you I start asking the question of when to seek follow up treatment.  I can be an alarmist, so my wife is essential in keeping me calm.

I read an article last night from Phoenix 5. Titled "What happens if PSA comes back after surgery?"

 http:// www.phoenix5.org/Basics/psaPostSurgery.html

Interesting reading and answered many of my questions.

Hi Pelahatchie,
You would be receiving adjuvant, and not salvage therapy, but it doesn't really matter, you can use Proton or IMRT treatment for both. I did may post operative IMRT about 4 months after the surgery. I have heard others use the 0.4 number as the marker for when to delve into adjuvant therapies, but with my pathology me and my team decided to go on the attack and even without a PSA climb I am on hormone deprevation and completed IMRT in August. I feel fine. My RT was a breeze. The adjuvant use of RT is about 22% less exposure of the dose than as a primary treatment so either Protons or Photons will usually suffice. But if you are worried about side effects, perhaps review Protons or Tomo Therapy. But I have heard that you can wait a while, but my logic is..Why? If you have three readings that indicate a climb in PSA then why wait for a forth? Get another test and see if is climbing then make the call? Good luck in your decision.

Tony

Hi Dutch,
Glad to. Adjuvant treatment is done in conjunction with another primary treatment(s) in search for a cure. Slavage therapy is done to improve the quality of life when a cure is improbable.

For example, All of my treatments after surgery have been done because I chose to add them in hopes I would beat the statistics and not ever have the disease relapse. They have been done as adjuvant treatments.

In the case of an individual with advanced prostate cancer in a great deal of pain, say in the hips or legs, they can elect to have radiation performed where an accumulation is identifiable in hopes that the pain will reside or that the treatment will add time to ones life. That is salvage treatment. At any time during an incurable disease can be made less painful or more manageable, the treatment would be considered salvage treatment.

In Pelahatchie's case, he is surely hoping by adding radiation he can stop any progression from leaving the local area and return to remission, which by the way he may still be in. I would also suggest that he consider talking to his medical oncologist about a brief stint on hormone deprivation to shrink the target before hitting it with RT. This logic is common when considering adjuvant RT.

From the Journals:

Salvage therapy: A final treatment for people who are nonresponsive to or cannot tolerate other available therapies for a particular condition and whose prognosis is often poor.

Adjuvant therapy: Treatment that is given in addition to the primary (initial) treatment.

Adjuvant treatment is an addition designed to help reach the ultimate goal. Adjuvant therapy for cancer usually refers to surgery followed by chemo- or radiotherapy to help decrease the risk of the cancer recurring (coming back).

In Latin "adjuvans" means to help and, particularly, to help reach a goal.

Tony

Here's another two cents worth....

A lot of Docs consider <.1 as undetectable because the older PSA tests (and some still use them) only go that low.   THe newer tests go lower.

I had IMRT, and the line in the sand I drew was .2 on post-RP PSA (it hit .24)....I didn't wait around for another rise at that point.  THe best I've read was that you want to get the treatment as long as you are south of .5.

My doc seemed to think the bouncing around under .1 was was just testing noise.   With a YOUR moderate Gleason, and good pathology---this could well be thye case.

I got on well with HT and RT combined, but I DO have lingering side effects --- some stress incontinence and some rectal problems.  I already had ED, so I can't tell you anthing there, except that radiation sure won't HELP you in that area.

You might want to set up a consultation with a good radiologist/oncologist and get their take on at what point they would want to treat you ---can't hurt!   GOOD LUCK.......

Good luck on the hunt. It's great excersize, and it keeps my mind on track. I will be heading North near Idaho in about two weeks. I don't have the tag but I will be a spotter for my buddies. Funny though, they are mostly cops and I have to be the designated driver...Talk about the fox watching the hen house...

Tony