 |
 | Home | Contact Us | FAQ | Search & Site Map | Link to Us |
 | Sign In | Join | Other 45 Sites in Network |
Medical Forum / Diseases and Disorders / Prostate Cancer / December 2005Advice/Info needed - Adjuvant vs salvage radiation
I am hoping that some of you pseudo experts can give me your opinions, or at least point me in the right direction. My info is as follows: DX: Aug 2005, age 41, Gleason 3+3, PSA 5.5 RLRP: Oct 2005, Gleason 4+3, pos right anterior margin, no lymph/other involvement, both sides of prostate involved, 30% total PSA: Nov 2005 - <0.1 The pathology classified me as T2c as they did not have any evidence of "capsular penetration". My surgeon said that based on the aggressive cancer (that damn gleason 4 stuff) and the positive margin, he recommended that I consult with a radiation oncologist. I met with the radiation doctor a couple weeks ago. He "highly encouraged me to consider adjuvant radiation treatment". I asked about "salvation" treatment down the line if needed, as opposed to adjuvant treatment now. He quoted some recent studies that had positive results for adjuvant treatment in T3 patients. He then said that I am technically a T2, but that the high gleason and positive margin means I could be a T3. There just wasn't enough evidence for the pathologist to call it. He said that if he were in my situation, he would definitely have the treatment now. He said that right now we have a very strong probability that if there is any cancer, it is almost certainly in the prostate bed. If I wait until it comes back, the liklihood of it being confined to that area reduces as time goes on. I have seen a few opinions scattered about that touch on the "adjuvant" versus "salvage" argument. I have not seen much substance to the remarks though. I would like to hear whatever info any of you might have been told by your doctors or what you may have read. If you have links to any stories or studies, I would greatly appreciate those. I am certainly concerned about the long term side effects of the treatment. At two months post surgery I have pretty well conquered incontinence. Not nearly as much luck in the other arena though. I'm leaning toward going through with the treatment based on the worst case scenario outcome of the two decisions: metastatic cancer vs. no sex life. Obviously the best case scenario is no radiation and no recurrence. I don't know if that's a risk I want to take at 41, especially with three kids. I appreciate your input. DX: Aug 2005, age 41, Gleason 3+3, PSA 5.5 RLRP: Oct 2005, Gleason 4+3, pos right anterior margin, no lymph/other involvement, both sides of prostate involved, 30% total PSA: Nov 2005 - <0.1 The pathology classified me as T2c as they did not have any evidence of "capsular penetration". ====== hi steve - i guess my question is....... why??? why the radiation so quickly? sure, i've seen the reports about where they do the RP followed up by radiation and the results. but here's some points to ponder. pretty well..... everyone who gets an RP will have a path report come back T2c. on the bad side. positive anterior margin. both sides of prostate involved, 30% total. on the good side. low psa - 5.5. before surgery.no lymph/other involvement, they did not have any evidence of "capsular penetration". and the best news..... PSA: Nov 2005 - <0.1 now, the low psa number is common right after surgery. but, personally, it is my opinion...... to wait. you have a whole new set of rules after the prostate is removed from the body. if your psa starts to climb at all, then it's time to consider options. but in the meantime, you could be freed of the prostate cancer, so why burn the second trump card? the psa rest will measure ANY psa that is being generated in the body. at the age of 41, if you have radiation, you've done everything you can to stop the cancer. if your psa where to climb after this,, then hormone therapy is left. if you go to the partin tables, you will see what your chances are for success. and these tables are used before surgery. there are some other paths that one could take and it would take a lot more band space, so i will stop here. then make your decision. if you want more info, just let me know. ~ curtis knowledge is power - growing old is mandatory - growing wise is optional "Many more men die with prostate cancer than of it. Growing old is invariably fatal. Prostate cancer is only sometimes so." http://community.webtv.net/PALMER_ENT/doc Curtis, Thank you for your response. I too initially wanted to keep that trump card (radiation) until later. There's something psychologically comforting knowing that you always have something to fall back on. Lately, however, I've been wondering if it is wiser to play the trump card when it is much more likely to be effective (now), rather than later when it might not be as effective. More to think about. hi steve - you have to remember that you are playing with a whole new deck of cards and rules after the prostate is gone. technically, you should stay in the undetectable range, because there is no more prostate cells in your body to generate a psa reading. but, if there is a chance for a biochemical failure, it usually happens before 18 months post op. so, if you want to keep things in focus, that may be your reference point. for some reason, that is when things start to become noticed as far as a rise on psa. now, the key to survival AFTER the prostate is gone is how fast you respond to any changes. yes, you can burn that back up card, but what happens if 5 years down the road, if you were to need that card? here's the odds as a rule on surgery. you have an 50% chance in three years, after post op that if you are going to have a recurrence, it will happen then. you have an 80% chance in 5 years, after post op, that if you are going to have a recurrence, it will happen then. you have a 99% chance in 10 years, after post op, that if you are going to have a recurrence, it will happen then. notice, i said IF IT IS GOING TO HAVE A RECURRENCE. i want to make sure you don't think that you have high odds of having a recurrence. this is why they say that if it has been 10 years since your surgery, that you only have a 1% chance of a recurrence which is the next best thing to being cured. it is something to give some thought about on how soon you want to burn the radiation card. also, radiation does cause side effects. just ask some of the members who have had it. nothing is without risk. ~ curtis knowledge is power - growing old is mandatory - growing wise is optional "Many more men die with prostate cancer than of it. Growing old is invariably fatal. Prostate cancer is only sometimes so." http://community.webtv.net/PALMER_ENT/doc "c palmer" <wrote> > but, if there is a chance for a biochemical failure, it usually happens > before 18 months post op. My oncs and many in this group disagree, saying the odds are spread very generally evenly over the next decade. > here's the odds as a rule on surgery. > [quoted text clipped - 6 lines] > you have a 99% chance in 10 years, after post op, that if you are going > to have a recurrence, it will happen then. Please clarify. You lost me. Do you mean "by then" rather than "then", which would make more sense? I.P. From: fuhgheddaboutit@noway.nohow (I. P. Freely) " c palmer" <wrote> but, if there is a chance for a biochemical failure, it usually happens before 18 months post op. My oncs and many in this group disagree, saying the odds are spread very generally evenly over the next decade. ======== i understand that there is a different school of thought on the 18 month rule. just as there seems to be an 18 month rule on the "bump" on the psa rise on anyone who has radiation treatment too. why? just seems to happen and it doesn't happen in every case, so i guess as an end result - someone could say it is a matter of opinion. ------ here's the odds as a rule on surgery. you have an 50% chance in three years, after post op that if you are going to have a recurrence, it will happen then. you have an 80% chance in 5 years, after post op, that if you are going to have a recurrence, it will happen then. you have a 99% chance in 10 years, after post op, that if you are going to have a recurrence, it will happen then. Please clarify. You lost me. Do you mean "by then" rather than "then", which would make more sense? I.P. ============== what's interesting is that i went back and reread this section three times and something didn't seem quite right but i couldn't quite put my finger on it. i was tired too and that didn't help. i didn't want someone to think after reading this that they had a 99% of having pca after treatment. i agree that the word "by" definitely clarifies it. thanks.. ~ curtis knowledge is power - growing old is mandatory - growing wise is optional "Many more men die with prostate cancer than of it. Growing old is invariably fatal. Prostate cancer is only sometimes so." http://community.webtv.net/PALMER_ENT/doc > i went back and reread this section three times and something didn't seem quite right but i couldn't quite put my finger on it. > i agree that the word "by" definitely clarifies it. Just about every time something doesn't "feel right" but I hit SEND anyway, the light bulb over my head seems to come on as though I had hit the light switch instead of the SEND button. That, or somebody else nails my boo boo to my forehead later. I.P. c palmer wrote...snip... > here's the odds as a rule on surgery. > [quoted text clipped - 6 lines] > you have a 99% chance in 10 years, after post op, that if you are going > to have a recurrence, it will happen then. Swanson has studied failure rates for RP and RT over long periods of time (20 plus years) post treatment. He finds relatively linear rates of recurrence over time, e.g. about the same percentage of men fail after 10 years as before 10 years. Of course this study started quite some time ago and methods have improved over time. Absolute recurrence rates have certainly dropped, but I suspect the linearity in recurrence rates remains. The RP data in the Hopkins' 0-10 year nomograms provides another chance to test Swanson's conclusion, and indeed, here to, the recurrence rates are basically linear over time. Although, when data for the higher-risk men is plotted, a flattening of the curve does seem to appear over time...Best wishes and good health, Ron Steve, your numbers are very much like mine including the positive margin although I was 60 when diagnosed. First off, I opted for no radiation since there was no evidence at the time (2003) that there was any difference in long-term survival between adjuvant radiation and early salvage radiation. I could see no advantage to undergoing additional treatment and adding to my side effects if there were good odds I would never need it. Secondly, the presence of a positive margin may or may not be significant. Mine was "a well-focused, 2 mm tumor located at the margin with no evidence of prostatic extension" which to me is a whole lot different than having a positive margin where it's obvious the surgeon sliced right through the tumor leaving a chunk behind. Also, as was earlier pointed out, if there is any small amount of cancer left behind it is often starved of nutrients by scar tissue. So far I am 2.5 years out with PSA's <0.1 (my last one at the two-year mark). Best of good luck to you no matter your choice. Dave Perry Steve, Go for the Rad/Onc consult to learn more. Weigh what your Doc that performed the RP says since he did the operation and has a good feel as to what might happen down the road. I was in the same situation as you but my psa rose to .3 - 5 months after surgery. I had salvage and am still <0.01 2.5 years since beginning the radiaiton. I went to the best Rad/Onc at Sloan Kettering in NYC for an adjuvant consultation due to my psa being <0.1 - 3 months after RP sinceI had a positive margin, my Doc wanted me to get adjuvant due to the margin - the same circumstances and recommendation as your Doc has given you. The Doc at Sloan along with others there stated that I shouldn't get adjuvant until there was a rise in psa. If there were a rise than do salvage. They reported that it may never rise and I would of received radiation for no reason. I listened to them and was going to continue just getting my psa test every 3 months but my psa rose 1 month later. If I had to do it all over again I would still wait for it to rise. The Doc at Sloan stated that some guys never rise with positive margins due to the cancer dying during surgery from the knife/cut and not being able to survive due to not receiving blood supply. It comes down to you making the best decision for yourself - making sure you have all the info you need. Good Luck. DP >I am hoping that some of you pseudo experts can give me your opinions, or > at least point me in the right direction. My info is as follows: [quoted text clipped - 46 lines] > > I appreciate your input. Dave, It sure sounds like we were in the same boat. Thanks for your insight. I agree that if my PSA becomes detectable, it's a no brainer. My original post may not have been too clear. I did go to the rad/onc. He's the one the "highly encouraged me to consider adjuvant". Your remarks about the cancer left behind from a positive margin might not survive certainly coincides with what I remember from Walsh's book. Thanks for that reminder. I'm glad to hear you are doing well 2.5 years later. > Steve, > [quoted text clipped - 81 lines] >> >> I appreciate your input. Steve, Adjuvant Radiation is insurance. If there is any remaining PCa the Adjuvant will take care of it. The treatment process is a breeze. My surgeon was adamant about me getting the adjuvant treatment. Sloans Rad/Onc said no way dont do it - only if it rises. I talked to a couple of researchers from Northwestern University that did a adjuvant research study and they said absolutely do it. It can get confusing but your heart will tell you whats best. Don't be afraid to get 2nd and 3rd opinions. Either way your on top of things and will be living a long life because of it. Dave P. > Dave, > It sure sounds like we were in the same boat. Thanks for your insight. I [quoted text clipped - 93 lines] >>> >>> I appreciate your input. > if my PSA becomes detectable, it's a no brainer. Even then there are challenges: Define "detectable". By what method . . . PSA? Scans? Which scans? By whose interpretations? And why "detectable", when many very big names say "detectable, schmectable; only PAIN (OK, "symptoms") warrants adjuvant treatment". > I did go to the rad/onc. > He's the one the "highly encouraged me to consider adjuvant". My onc did, too, with the support of a whole team of oncs. My detailed, highly researched rebuttal changed their minds for my case. There's almost always room for technical debate and personal preferences, which is why we should be heavily and informedly involved in the process and the decisions. I'll have a TON of additional research, soul-searching, and prioritization to accomplish when my PSA starts creeping up again, so my oncs, my wife, and I can decide when and how to proceed from there. The fact that my PSA doubled from one blade of grass (.006) to two (.012) last quarter (one year post-op) triggers nothing. (Four blades of grass next quarter might get me reading.) I.P. >I am hoping that some of you pseudo experts can give me your opinions, or > at least point me in the right direction. > ... Steve, I am about as pseudo an expert as any you'll find, which I guess qualifies me to give you an opinion. It is possible that you will experience negative side effects from radiation. You may take a second hit to potency. You may experience proctitis. You may get longer term side effects down the road. However, in spite of all that, I think I'd be inclined to follow the rad onc's advice. The factors inclining me that way are 1) the positive margin, 2) your relatively young age, and 3) the Gleason 4+3 - in that order. Before making the final decision, you might do the following: 1. Ask the rad onc for a specific treatment plan. How much radiation would he give you, where would he aim it, what type of machine would he use, what sort of follow up would he recommend. 2. Maybe see a second rad onc elsewhere for a second opinion. Get a plan from him too, and have him review the first doctor's plan. You already have two experts recommending radiation - your urologist and your rad onc. If another expert both recommend adjuvant radiation and both recommend roughly the same treatment plan, then you've got ... > Before making the final decision, you might do the > following: [quoted text clipped - 10 lines] > radiation and both recommend roughly the same treatment > plan, then you've got Rats. Pressed the wrong key combination and sent the message before I finished it Point 2 should have gone on to say: If another expert both recommends adjuvant radation and roughly the same treatment plan, then you're getting a real consensus on what to do. Seeing two rad oncs will also give you a chance to make a choice about which one you want to do your treatment. Hopefully, you'll like and trust both. But if not, you can choose the one you trust more. Best of luck. Alan Thank you to all who have given their input. It's clear that there are two distinct camps. I'm going to have to get in one of them. It's frustrating when I hear that Dave P was told by his doc to get adjuvant treatment, then Sloan said no, then Northwestern said yes. It's like the betamax/VHS battle. I'd like to be on the right side. I guess my hopes for a "drink two beers and wake up in the morning cured" treatment plan will not come to fruition. I will keep reading here for more opinions and insight. In the meantime, best wishes to all of you and your families during this holiday season. > there are two distinct camps. I'm going to have to > get in one of them. It's frustrating . . . that Dave P > was told by his doc to get adjuvant treatment, then > Sloan said no, then Northwestern said yes. > I'd like to be on the right side. It took me weeks of research to feel sure about my choice re ADT. and I sure as hell wasn't going to make that choice until I felt sure about it. WAY too much at stake to make it in haste, and some effects -- good and bad -- may not be reversible. Every case and especially every pt is unique, so only YOU can define YOUR "right side". That ain't going to happen overnight unless you have one INCONTROVERTIBLE criterion AND can find IRREFUTABLE evidence regarding it. Both are unlikely. I.P. |
Reply to this Message |
 Sign In
 Join
 My Latest Posts My Monitored Threads My Blog My Photo Gallery My Profile My Homepage Start New Thread Enable EMail Alerts Rate this Thread
|
©2008 Advenet LLC Privacy Policy - Terms of Use
This website includes both content owned or controlled by Advenet as well as content owned or controlled by third parties.