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Medical Forum / Diseases and Disorders / Prostate Cancer / April 2006question about radiation
My uro took out lymph glands when he took out the prostate. He has stated several times that he wants to perform 6 weeks of radiation. His reason being that I had 9's and 10's on the Gleason scale, a PSA of 36.8 and 9 of 12 biopsies showed "peri-neural invasion". However, after several scares, bone scans and CTs all came back clean. The colon "tumor" was benign. The lymph glands showed neg for PC and he took the whole prostate out and all the nerves. My question is: If on Thursday my PSA comes back clean, should I undergo radiation treatments? He wants to aim them at the soft area where the prostate used to be. I've heard of damage because of these high doses. If no PC shows up, why try to kill it? Thank-you David > My uro took out lymph glands when he took out the prostate. He has > stated several times that he wants to perform 6 weeks of radiation. His [quoted text clipped - 7 lines] > where the prostate used to be. I've heard of damage because of these > high doses. If no PC shows up, why try to kill it? Dave, A Gleason of 10 (forget the 9s and 10s) means that the greatest mass of cancer in your prostate was a 5 and the next greatest was a 5. THAT means you have the most aggressive prostate cancer known to man. You have found that cancer inside a 52-year-old body; which may feel like a 68-year-old body, but is still relatively young when it comes to cancer growth. Then throw in an almost 40 PSA, and you are in deep horse manure. I suspect your doctor is trying to match the risk with the treatment. You don't have to make a decision before Thursday, or even on Thursday, but standard thinking seems to rule out waiting for three consecutive rises in PSA. But, standard thinking can be wrong (and has proven such ever since they started coming up with "standards".)  SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06 PSA .07 .05 .06 .09 .08 .132 Non Illegitimi Carborundum Dave, I agree with Steve. You've got a bad case here and if your doctor's ideas about aggressive treatment apply to anyone, I'd think they apply to you. With a PSA of 38.6, and Gleason 10, the chance that the cancer was 100% confined to the prostate is very low. I plugged your numbers into the Sloan Kettering prostate nomogram and it said you had a 3% chance of organ confined disease. See: http://www.mskcc.org/mskcc/html/10088.cfm I wouldn't wait to see what happens. I'd go with the doctor's recommendation. It is possible that radiation won't help you because you might already have distant micrometastases that will develop no matter what you do. But without radiation, I think your chances of a recurrence are very high, and the effectiveness of radiation can only go down with the passage of time. Best of luck. Alan (snip) > I wouldn't wait to see what happens. I'd go with the doctor's > recommendation. [quoted text clipped - 5 lines] > can only go down with the passage of time. > I would add this to Alan's good advice: consult a medical oncologist and radiation oncologist ASAP and I mean *ASAP*. There is much that can be done, such as radiation + ADT or chemotherapy + ADT. But there is no time to waste. However nice a guy he may be, I would in these circumstances (and my circumstances are very like Dave's) *never* submit my fate to the ministrations of a surgeon. This has gone far, far beyond the capabilities of a surgeon. I believe that it approaches certainty that this case of PCa is at the very least systemic. Dave desperately needs an oncologist, not us, as his adviser. Regards, Steve J The most bothersome aspect of what goes on in the world of PC today is that few (less than 5%) of physicians (mostly urologists) bother to spend the 10-15 minutes to use the literature published in urologic journals and oncology journals to calculate the individual's risk for OCD (organ confined disease) vs non-organ confined disease. This is like going to sea on the open ocean and not checking out your ship or the weather but just "doing it". Physicians are not behaving as scientists and moreover, they are not translating what we know into what is done with the patient. Unfortunately, we appear to be living in a time when physician income is more important than patient outcome. Please realize that I am very positive about what can be done in the world of PC. We have wonderful tools in our toolbox, but we "ain't using them." --Medical oncologist Stephen B. Strum, MD, on p2p, 6/12/04 Also, as far as I know, they wait 3 or 4 months before radiation because the more healed up you are, the better off you are. So I don't think that is urgent for Thursday. > My uro took out lymph glands when he took out the prostate. He has > stated several times that he wants to perform 6 weeks of radiation. His [quoted text clipped - 9 lines] > Thank-you > David radiation can be looked at as an insurance policy, or another line of defense. If I were you, i would do it... Richard > My uro took out lymph glands when he took out the prostate. He has > stated several times that he wants to perform 6 weeks of radiation. His [quoted text clipped - 9 lines] > Thank-you > David Dave, Similiar scenario to a friend of mine two years ago: Gleason 10 PSA 30 RP At MD Anderson after RP, they radiated, injected Lupron and started chemo as soon as the incision healed. He is finished with Lupron this month. He is undetectable today. He is hoping that tomorrow is still undetectable. Mike > My uro took out lymph glands when he took out the prostate. He has > stated several times that he wants to perform 6 weeks of radiation. His [quoted text clipped - 9 lines] > Thank-you > David > Dave, Similiar scenario to a friend of mine two years ago: > Gleason 10 [quoted text clipped - 8 lines] > > Mike Mike, what did he have re margins, lymph? Do you know his pathological staging after RP? I believe there was lymph involement, 10 on path. As explained to me, at age 44 they started blasting away because the prognosis was not good. I'll see him tomorrow and ask. Interesting comment was that a week before his surgery he and his wife visited a new church for Easter. Low and behold he saw his surgeon sitting there. When his surgeon saw him and then at an appropriate time the surgeon went to the altar whispered to the Pastor and then he called Ken up. For the next 5 minutes the surgeon held on to Ken and prayed that his hands would be guided by God and that all would be OK. Congregation gave a bunch of Amens and then the next week Ken had his RP. Real touching testimonal.... -M >> Dave, Similiar scenario to a friend of mine two years ago: >> Gleason 10 [quoted text clipped - 12 lines] > Mike, what did he have re margins, lymph? Do you know his pathological > staging after RP? "the surgeon went to the altar whispered to the Pastor and then he called Ken up. For the next 5 minutes the surgeon held on to Ken and prayed that his hands would be guided by God and that all would be OK. Congregation gave a bunch of Amens and then the next week Ken had his RP. Real touching testimonal.... " Touching, but a violation of patient-doctor confidentiality nevertheless. The Sunday before my RP I told my Sunday School teacher, who is also a doctor and Asso. Pastor, that he could tell the Congregation that I was having surgery and for them to pray for me. I was rather appalled when he went on to say that I had prostate cancer. Because of the implications of PCa Tx, many if not most men do not exactly want that info divulged to any and all. Dave, still curious about any SVI. Bill Denton RP 2/12/02 PSA 1.1 Memphis ... > Because of the implications of PCa Tx, many if not most men do not > exactly want that info divulged to any and all. ... Most of us probably go through life blithely unaware of any of the implications. I had zero knowledge of what any of it meant until the doctor said "You have cancer," and I got busy doing research (once I got over the shock that is.) Alan Interesting Bill, ...... Prostate Cancer as an embarassment. :) > "the surgeon went to the altar whispered to the Pastor and then he > called Ken up. For the [quoted text clipped - 18 lines] > PSA 1.1 > Memphis Dave, what about your seminal vesicles? Everyone seems quick to jump on the SRT bandwagon but you have a high risk if not likelihood of systemic disease that SRT will not do a thing for. You may end up w/ a local recurrence too so SRT would be of some value in that regard, but if you die of PCa some day that won't be it anyway. I agree you should see a good med-onc. FWIW I think I know what Strum would say - forget the SRT and start ADT now. Bill Denton RP 2/12/02 PSA 1.1 Memphis > My uro took out lymph glands when he took out the prostate. He has > stated several times that he wants to perform 6 weeks of radiation. His [quoted text clipped - 9 lines] > Thank-you > David Dave, what did the pathology report from your surgery show? Dave, I am curious as to why surgery was done. Is it because you have no bone mets? My numbers were the same as yours (PSA 44/Gleason 9-4+5) but my lypmph and bone scan was positive. Chest xray was negative, so the doctor said no surgery or radiation but hormone therapy (Caodex + Lupron). I know some people start hormones along with radiation so the more aggressive your cancer is the more aggressvie you must be. A friend I met through this is your age has done, hormones, chemo (through a trial) and has a radiation consult in the next few weeks. He had no bone mets so his options are greater. Good luck Duke > Dave, I am curious as to why surgery was done. Is it because you have > no bone mets? My numbers were the same as yours (PSA 44/Gleason 9-4+5) [quoted text clipped - 6 lines] > had no bone mets so his options are greater. Good luck > Duke Duke, keep us posted on this? We have a radiation consult on the 10th. Did your friend have any mets? Lymph? > > Dave, I am curious as to why surgery was done. Is it because you have > > no bone mets? My numbers were the same as yours (PSA 44/Gleason 9-4+5) [quoted text clipped - 9 lines] > Duke, keep us posted on this? We have a radiation consult on the 10th. > Did your friend have any mets? Lymph? No mets, but I'll double check the lymph situation. He is going to Florida to see about radiation. Duke |
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