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Medical Forum / Diseases and Disorders / Prostate Cancer / October 2003Timing of prostate bed radiation
How soon after RRP is radiation of the prostate bed usually done when CA is found to have escaped the capsule and Gleason is 9 (4+5)? Pete Naturally, that's up to your uro, onc, and you. But, when my uro saw seminal vesicle involvement in December 2000, he figured I'd be doing radiation by June 2001. I ended up not needing it until May 2002, but I believe the December to June timeframe would be in your ballpark.  SignatureSteve Kramer PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 PSA .1 .1 .1 .3 .4 .8 EBRT 05-07/2002 @ 47 PSA .3 .2 .2 .2 .3 Erection 05/12/2003 @ 48 Begin Lupron 07/21/2003 @ 48 PSA .1 > How soon after RRP is radiation of the prostate bed usually done when CA > is found to have escaped the capsule and Gleason is 9 (4+5)? Pete Pete My "9" was excaping fhrough the perenial region of the capsule and my Uro referred me for a second opinion to an oncologist. They both agree that EBRT to the bed is needed as soon as the body heals after surgery, 6 months. In the meantime they are giving me HT anti androgens so the cancer doesn't spread in that period. The "9"s are virulent. Have a look at the pictures in the phoenix5.org site and visualise these nasties gettng a foot/cell hold. Hank B Schokker Age 53 (183 cm @ 110Kg) & Health is good PSA 2000/03 3.28 7.8 8.7 9.4 Biopsies (1) Oct 2002 inconclusive (2) Jun 03 Gleason score of 4+4=8 Isotopic Bone Density Scan in June 03 All Clear RPP 1 Sept 03 Gleason 9 Multi focal, at margins,& perennial invasion (clear lymph & almost at Vas Def) Catheter out 16 Sept & DRY PSA 0.1 EBRT scheduled for Early 2004 HT from 15 Oct 03 One day's happiness is better than a lifetime of misery. BE HAPPY.!!! My urologist referred me to the radiologist 4 months after RPS. I have a Gleason 8 (5+3) and my post surgery PSA was 0.08, followed a month later at 0.11. He stated his philosopy in treating aggressive cancers was to "shoot first, ask questions later." He gave me 50% odds that the cancer was still in the prostatic bed and that the radiation would be successful. I have had only 2 treatments so far of the scheduled 35. The radiologist gave me the same odds for success, but cautioned, "you should be prepared to live with cancer for the rest of your life." I am praying for success, but obviously, the odds are not what I would like them to be. John > Pete > [quoted text clipped - 30 lines] > > One day's happiness is better than a lifetime of misery. BE HAPPY.!!! John, Welcome to the newsgroup. As you can see below, I started the same way. My Gleason was only a 7 and it took almost a year for the PSA to start back up, but otherwise, we're similar. And, my uro has been able to keep my PSA under 0.8 for over 3 years and for all but spike, it's been <0.1 to 0.37 for the entire time. Right now, it's <0.1 again with great expectations of a decade or more time for medicine to come up with a cure. So, do not despair. BTW, radiation is a breeze. It'll about to a necessary inconvenience. SignatureSteve Kramer PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 PSA .1 .1 .1 .3 .4 .8 EBRT 05-07/2002 @ 47 PSA .3 .2 .2 .2 .3 Erection 05/12/2003 @ 48 Begin Lupron 07/21/2003 @ 48 PSA .1 > My urologist referred me to the radiologist 4 months after RPS. I have a > Gleason 8 (5+3) and my post surgery PSA was 0.08, followed a month later at [quoted text clipped - 48 lines] > > > > One day's happiness is better than a lifetime of misery. BE HAPPY.!!! Thanks for your welcome, Steve. I have been lurking here for a while, and I know you have contributed a lot to this group. I had my 3rd radiation treatment this morning and got a tiny bit of bad news: I had always assumed that my patholigical Gleason score was the same as my clinical score, since no one told me anything different. Turns out that my patholigical Gleason was 9 rather than the 8 I had assumed it was. Very unusual, I would think, since my PSA was only 4, and I was staged as a T1c clinically. (I am 46, black, and this was the first PSA series I had ever been given!) I'm also a little surprised that I was given two biopsies to confirm, but perhaps they wanted to determine whether surgery was a viable possibility for me? I am just a little more shaken by the Gleason score news in that I only came on it accidentally when I mentioned to my radiologist that my Gleason was 8, and he corrected me. He didn't back off the 50/50 prognosis of a potential cure, but somehow I think that is probably optimistic. He mentioned that the pathology report showed the cancer "right at the margin" and it couldn't be determined if it had actually breached the capsule. Guess I just have to put all my misgivings and fears on hold until the series of radiation treatments is over and I get another PSA reading. It will be difficult, but then, what other choice is there? Thanks for the support you and others have given guys like me who are still pretty green about the science and technology of PCa. It helps to know that others have been there and have had the courage to move forward. John > John, > [quoted text clipped - 69 lines] > > > > > > One day's happiness is better than a lifetime of misery. BE HAPPY.!!! > I had my 3rd radiation treatment this morning and got a tiny bit of bad > news: I had always assumed that my patholigical Gleason score was the same [quoted text clipped - 5 lines] > to confirm, but perhaps they wanted to determine whether surgery was a > viable possibility for me? Your whole case is strange. You were the first person I've seen to report a Gleason with numbers more than one apart (5+3). You had a 4, 9, and T1c? That too is strange, although Hank Schokker is close with his 9.4 and 9. I'm sure you know that 46 is too young for PCa, though that's how old I was and my dad was 4 years younger. At 46, and RRP is the only way to go, unless there is cancer found elsewhere. > I am just a little more shaken by the Gleason score news in that I only came > on it accidentally when I mentioned to my radiologist that my Gleason was 8, > and he corrected me. He didn't back off the 50/50 prognosis of a potential > cure, but somehow I think that is probably optimistic. I dunno. I've found radiologist to be more .... truthful? .... than urologists. If he says 50/50, I suspect it's 50/50. > He mentioned that the pathology report showed the cancer "right at the > margin" and it couldn't be determined if it had actually breached the > capsule. If it breached the capsule, the treatment would be EBRT, which is what you're doing anyway. I wouldn't worry about it. SignatureSteve Kramer PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 PSA .1 .1 .1 .3 .4 .8 EBRT 05-07/2002 @ 47 PSA .3 .2 .2 .2 .3 Erection 05/12/2003 @ 48 Begin Lupron 07/21/2003 @ 48 PSA .1 Thanks for the reassurance, Steve. It does help. I have done enough research on the web to sense that my PCa is an unusual one. But bear in mind, the fact that I am African-American (BTW, adopted, hence the non-A-A name) means that statistically prostate cancer strikes earlier and with more virulence than with Caucasians. I also learned that the most virulent of PCa's are often accompanied by relatively low PSA levels. I also had some pretty odd blood counts prior to surgery that no one has explained. My thrombocytes were only 80 prior to surgery and they gave me 2 units of platelets pre-Surgery because of risk of blood loss. I don't remember the exact counts, but BOTH WBC and RBC were low as well. All have improved now, but all are still in the very low normal range. I can't help wonder if this is somehow related to PCa--no one suggested this, but I still wonder. Anyway, I am moving on with hope that things turn out well. No different from most newly diagnosed cases here probably. John > > I had my 3rd radiation treatment this morning and got a tiny bit of bad > > news: I had always assumed that my patholigical Gleason score was the [quoted text clipped - 33 lines] > If it breached the capsule, the treatment would be EBRT, which is what > you're doing anyway. I wouldn't worry about it. I knew that PCa was more common in blacks than in whites. It is least common in orientals. But, orientals become more susceptible when they move into Western culture, so who knows? But, on this NG, you'll find you need not define yourself as to color. All we see is black and white and an occasional underlined blue. We had one bigot show up about six months back and ran him back to the NGs more to his liking. That's not to say we are all of a mind here. If I mentioned the three greatest presidents in the 20th century were Republican, the usually mild-mannered Leonard Evans would have me for lunch. We all get along so well because all we discuss is a little walnut-sized gland that seems to be (or was) the same shape, color, and location for every one of us. SignatureSteve Kramer PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 PSA .1 .1 .1 .3 .4 .8 EBRT 05-07/2002 @ 47 PSA .3 .2 .2 .2 .3 Erection 05/12/2003 @ 48 Begin Lupron 07/21/2003 @ 48 PSA .1 > Thanks for the reassurance, Steve. It does help. I have done enough > research on the web to sense that my PCa is an unusual one. But bear in [quoted text clipped - 60 lines] > > If it breached the capsule, the treatment would be EBRT, which is what > > you're doing anyway. I wouldn't worry about it. > Thanks for the reassurance, Steve. It does help. I have done enough > research on the web to sense that my PCa is an unusual one. But bear in > mind, the fact that I am African-American (BTW, adopted, hence the non-A-A > name) means that statistically prostate cancer strikes earlier and with more > virulence than with Caucasians. I think the meaning of this is still not clear. African American men are less likely to have regular PSA tests, for example. Some of the increased incidence and other characteristics of these cancers among such men is genetic, but some is also based on external factors. The genetics is very complicated since "African Americans" are a very diverse group genetically. Most have some significant element of European ancestry. Even in Africa, the populations are among the most diverse genetically of any humans. This is explained by the fact that the human species started off in Africa, and the African populations have had the most time on one continent to diversify. In the US, "African American" is not a biolocially defined group but defined via our history of slavery and racism. Americans, even those who don't consider themselves biased, tend not to see this vast genetic diversity and group people together based on rather superficial characteristics. Anyway, my point is that since your personal history is a bit different, the statistics which apply in general to "African Americans" may not in fact apply to you. Hi John...Lots of interesting work is going on in the area of PCa. It seems that every week there is some new discovery or technique that extends life or improves the quality of life. We all take some deep breaths and continue on our path. Some of your comments caught my eye... > I had always assumed that my patholigical Gleason score was the same > as my clinical score, since no one told me anything different. Turns out > that my patholigical Gleason was 9 rather than the 8 I had assumed it was. It is relatively difficult to grade PCa due to the diffuse, multifocal nature of most PCa tumors. There's not one big solid tumor to examine. It becomes even more difficult when all you have to examine are small biopsy fragments. Thats one of the reasons that PCa should be examined by a PCa expert (there are roughly a dozen or so around the US). Because many people don't have their Gleason Score determined by one of these experts, there is a documented "undergrading" of PCa from biopsy specimens. In turn, the GS from the pathologic specimen often comes in higher, as apparently occurred in your case. > Very unusual, I would think, since my PSA was only 4, and I was staged as a > T1c clinically. (I am 46, black, and this was the first PSA series I had > ever been given Actually, PCa tumors with high GS "leak" less PSA than lower GS tumors. That is why low PSA in the presence of PCa is usually indicative of higher stage PCa. > He mentioned that the pathology report showed the cancer "right at the > margin" and it couldn't be determined if it had actually breached the > capsule. I don't understand this. A critical part of the pathologists work is to determine if the tumor is close to the margin or has penetrated the margin. In my case they determined that one of the tumors was only 0.01 mm from the margin. You might want to speak to your doc about your situation. You should be able to get a clearer answer. Looking at your earlier post, I noticed you say your post-surgery PSA went from 0.08 to 0.11 in a month. I don't know any of the details behind this, like were the tests run at the same lab, did the doc do a DRE before the second one, etc., but while I certainly would be thinking about recurrence if it were my data, I might have liked to see one more rise before I started secondary treatment. Also, assuming recurrence, did you have any tests run to try to differentiate local versus systemic recurrence before selecting a secondary treatment method. Some of the tests usually recommended for this include PAP (Prostatic Acid Phosphatase), TGF-B1 plasma levels, Pyrilinks-D and ProstaScint-CT or ProstaScint-MRI fusion. Docs don't know everything, remember, "50% of them graduated in the bottom half of their class." It's important for the patient to learn as much as he or she can about the disease confronting them and to ask tough questions and expect good answers back from their docs...best wishes and good health, Ron > Guess I just have to put all my misgivings and fears on hold until the > series of radiation treatments is over and I get another PSA reading. It > will be difficult, but then, what other choice is there? I think we are all bascially in the same boat, only some of us seem closer to the edge than others. Although my PSA has been "undetectable" for three years now, a possible recurrence is as usual, only one PSA test away. You can always look at this particular glass as half full or half empty. In your case, there is a good chance your cancer, if not cured, can be kept under control for an extended period of time. Meanwhile, we all hope and pray that researchers will come up with a cure for even the worst case scenarios. That is not a vain hope since they do seem to be making significant progress. I would be willing to bet that within five to ten years, researchers will come up with what we need. Meanshile, keep your spirits up, and good luck. > Thanks for the support you and others have given guys like me who are still > pretty green about the science and technology of PCa. It helps to know that [quoted text clipped - 119 lines] >>>> >>>>One day's happiness is better than a lifetime of misery. BE HAPPY.!!! >Subject: Timing of prostate bed radiation >From: bowichpapa@webtv.net [quoted text clipped - 3 lines] >How soon after RRP is radiation of the prostate bed usually done when CA >is found to have escaped the capsule and Gleason is 9 (4+5)? Pete My radiation began six months after surgery. Orginal psot-op Gleason reported 8 but later reported 9, microscopic traces of cancer found in seminal vesicles. For best results, Radiation should be done 3 months after RP for positive margins or suspected positive margins. My Uro wanted to wait 6 months to heal properly. Research is clear that you should get the radiation before the psa reaches 2.0. The lower the psa the better. There is a significant probability of success if the psa is below.4 when radiation begins. This is from the research I did before radiation after RP. I guess it comes down to if the remaining PC is in the prostate bed and enough radiation is used to kill it - the effective dose is 64gy> for Radiation after RP. As I had said before, it seems like this may be the Decade of the Cure. Medicine and research are advancing at such a fast rate that a cure or a med to slow PCa down is near. Lets all pray it comes in the next few years. It can happen. Then we all can worry about our cholesterol etc... Best wishes, Dave P > How soon after RRP is radiation of the prostate bed usually done when CA > is found to have escaped the capsule and Gleason is 9 (4+5)? Pete I had RRP in March 2002 then got radiation in Aug.2002. My Uro.said it's best to wait about 5 months or so following the surgery. I had cancer that spread to the seminal ves. > How soon after RRP is radiation of the prostate bed usually done when CA > is found to have escaped the capsule and Gleason is 9 (4+5)? Pete |
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