Need radiation advise (positive margin)

CS53 · Regular Joined: 13 Apr 2009 Posts: 15

Another update:

Started ADT3 HT the first week of May (psa now undectable as expected) with planned adjuvant proton RT starting 8-12 weeks later. A few weeks ago I decided to consult with Dr. Mark Scholz of Prostate Oncology Specialist. I have heard he is one of the top experts on prostate cancer. I wanted to get his opinion on my plan moving forward.

DR. Scholz DRE exam revealed a small area of nodularity in the distal right prostate fossa. This is consistent with my positive margin located on the right posterior lobe.

A Color Doppler Ultrasound was performed showing approximately 7 cubic centimeters of retained prostate tissue. There was no overt hypervascularity suggestive of aggressive cancer.

Dr. Scholz ordered a more thorough pathologic review of my original slides and prostate tissue by Dr. Bostwick to determine how extensively positive the margins are and also to do some additional tumor markers such as Ki67, p53 and p27 to determine the aggressiveness of the tumor. These are proteins that can be used to predict recurrence.

Results came back with protein markers all in my favor for low recurrence. Gleason score of 6 remained the same.

What is worrisome is that very little cancer was found in my prostate biopsy. My initial biopsy pre op showed grade 3+3=6 adenocarcinoma in the right base, right mid gland and in the left mid gland. The core involvement was 30%, 25% and 5% respectively of those areas. This leads us to believe there was definitely cancer left behind in that 7 cubic centimeters of prostate tissue.

Doc says about 50% of patients who have positive margins after surgery will never have a recurrence. The benefit of radiation, which will almost certainly be curative, needs to be weight against the possibility of erectile dysfunction which may occur in about 1/3 of cases.

He is leaning towards 6 months of hormone blockade and then stop and monitor the situation over time versus immediate radiation. So now I have another decision to make. Seems like they never end. However I am happy with all the positive news and fortunate to have some options.

Sorry for the long winded post. I am looking for help once again. Any opinions, suggestions, or advise on what might be best from all the wonderful people of this forum would be greatly appreciated. Thanks soooo much.

Thanks
CS53

Operaman · Regular Joined: 01 Jun 2009 Posts: 23

CS53:

I am deciding whether to add some period of hormone blocking therapy to my upcoming adjuvant RT. I am wondering what your experience has been with the hormone therapy and side effects?
_________________
Bioposy March 2008 negative
March 19 2009 4+3=7 PSA 26 positive for 6 out of 12 cores
RRP May 20 2009 Path 4+3=7 tertiary 5
5% Mostly right lobe some left
Stage T3a 1 focally positive margin, clean nodes, clean vesicle, all tests for mets clean
June 22 PSA undetectable, course of Adjuvant RT completed in October with minor side effects, follow up in November

CS53 · Regular Joined: 13 Apr 2009 Posts: 15

Hi Operman

I have been on ADT3 now going on 7 weeks. The only side effects I have experienced so far are some hot flashes and a decreased libido. They are both something that I can live with for now. More of a minor nuisance than anything.

My suggestion would be to consider consulting with an expert prostate oncologist and or your RT doc and get their opinions on whether HT would be a good addition. A lot of studies are now showing RT combined with HT is a good way to go. It's what I decided to do. I will be doing 8-12 weeks pre and post RT.

CS53 · Regular Joined: 13 Apr 2009 Posts: 15

I am still hoping to get some advise on how best to proceed. Start RT now or stay on HT for 6 months and then monitor? Is there any increased risk to waiting and monitoring?

Most everything I read says adjuvant has the edge over salvage. However I would prefer not to over treat if it's not needed. Wish this wasn't such a difficult decision for me. Hawk? Replicant? Anyone?

Thanks
CS53

Hawk · Senior User Joined: 22 Nov 2006 Posts: 406

Adjunct or Salvage ???

It is impossible to advise unless i could know the consequences of waiting and the side-effects YOU will experience from RT.

I know this sounds stupid but, if your PSA goes up, you should have opted for Adjunct. If it does not you should have waited and sparred yourself the hassle, expense, and side-effects.

Those are the clear issues and it makes it a very difficult, personal, decision. We know how tough it is because we have had to consider all issues then flip the same same coin.

Good Luck.
_________________
History: PSA's 6.7 neg. biopsy - PSA 16.6 neg. biopsy - PSA's 8.2, 8.1, 8.7 - Biopsy. 4+4 Gleason 8. Lap RP Apr 2004, age 52 All neg margins, nodes, and structures. (T2a). Post RP PSA: every 6 mo. <.1 until Feb, 08 (46 mos) PSA .1 - I then got sensitive tests (all in 2008) showing:
Feb .06, May .09, Jun .10, Aug .10, Nov .15 -SRT

CS53 · Regular Joined: 13 Apr 2009 Posts: 15

Thanks for your input Hawk I have decided to go ahead with the RT. I gave myself all last week to think about what I should do. To make a long story short after weighing all the pro's and con's etc. I decided there is to much at stake for me not to act conservatively or take any chances.

I have decided to use proton RT at Loma Linda for a few different reasons. Potential for less side effects, higher GY dosage (74gy), I live fairly close, and there expertise in dealing with PCa.

Thanks
CS53

Hawk · Senior User Joined: 22 Nov 2006 Posts: 406

Well, for SRT I think it would be difficult to impossible to come up with a better choice.
_________________
History: PSA's 6.7 neg. biopsy - PSA 16.6 neg. biopsy - PSA's 8.2, 8.1, 8.7 - Biopsy. 4+4 Gleason 8. Lap RP Apr 2004, age 52 All neg margins, nodes, and structures. (T2a). Post RP PSA: every 6 mo. <.1 until Feb, 08 (46 mos) PSA .1 - I then got sensitive tests (all in 2008) showing:
Feb .06, May .09, Jun .10, Aug .10, Nov .15 -SRT

CS53 · Regular Joined: 13 Apr 2009 Posts: 15

Thank you hawk. Your input was very helpful and greatly appreciated!!

Thanks
CS53

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