SRT in our future?

Sephie · Regular Joined: 24 Apr 2008 Posts: 31

About a month ago, I posted about my husband's August PSA, which had gone to 0.1 after being 0.0 for 17 months after surgery (stage T3a due to single extraprostectic extension). PSA redone last week and the results are now 0.3. Next Friday, we meet with a radiation oncologist. Urologist said not to panic (yet) and to redo PSA in 1 month. If it's still at 0.3 or higher, then we should consider moving forward with SRT.

The good news is that it took 17 months after surgery to show a slight upward trend and all margins and SV were negative. Surgeon cut a wider margin than necessary around the posterior where the EPE existed. Husband's PSA pre-surgery was 6.4; 1 year before it was 4.6. While there was velocity the years prior to surgery, it was slow. Final Gleason score was 3+4 with grade 4 comprising 40% of invasive tumor present (guess that's the EPE part).

So, we meet with a radiation specialist or two to see what they suggest.

We are optimistic that should SRT be required, we're catching this early on when it's still likely in the prostate bed where RT can zap the heck out of it.

Would be interested in others having similar outcomes.

Thanks, as always, for your help and advice.

Replicant · Moderator Joined: 01 Nov 2006 Posts: 741

Hi Sephie. The plan sounds great to me.
My gut feeling from reading a lot of posts from people in similar positions is that urologists are sometimes a little too relaxed about this. Many of them are not aware how important the timing is for SRT. It sounds like you have a chance to attack this at the level of 0.5 or before. That would be optimal, and a lot of people (like me) had to start a bit later.
The sooner the better, with SRT. So it's good you're going ahead with the radiation oncology consultation.

While negative margins are usually a good thing, when PSA rises after surgery, it's actually better in terms of odds of success if there were positive margins. This is because a positive margin can provide a local explanation for the rising PSA.

Negative margins doesn't mean SRT won't work. Lots of men with negative margins have successful SRT. It's just that it takes the odds of success down a bit.

If you haven't used the salvage radiation prediction tool on the MSK website, I encourage you to give it a try: http://www.mskcc.org/applications/nomograms/Prostate/SalvageRadiationTherapy.aspx

Best wishes.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

Sephie · Regular Joined: 24 Apr 2008 Posts: 31

This morning I made an appointment with a 2nd rad oncologist so we have 2 appointments next week. I figure lets pick as many brains as we can so that we can make an informed decision.

I read an article recently (don't remember who wrote it, unfortunately) on the Web that said that EPE constitutes a margin (generally posterior) but our surgeon said he cut wider than he had to in that area. Perhaps my husband did in fact have some PCa cells left there that are causing this...just a guess.

I'll keep you posted on how our appointments with the rad guys (one is actually a woman) next week.

Thanks...and take care of yourself.

Patricio · New User Joined: 12 Jun 2009 Posts: 2

My circumstances were somewhat similar to your husbands. I too had a PSA of 6.4 when I opted for surgery. The year previous it had been at 4.0. My Gleason was 3+4. I was a T3a for the same reason. No margin issue or seminal vissle issue. My PSA stayed at less than .1 for 4 years and then began to move slowly. After another 3 years it had reached 0.7 and I opted for radiation at City of Hope using Tomo Therapy. Very few side effects and I am now again at less than .1. Next month will mark 10 years since the surgery. I would suggest to your husband to have the radiation. What was a rather traumatic initial reaction to having Prostate Cancer and now looking back over the experience I am grateful for the
advance in medical technology. Good luck. Patricio

Sephie · Regular Joined: 24 Apr 2008 Posts: 31

Patricio, congratulations on your upcoming 10th anniversary - that is indeed a landmark!

Been doing some research and making a list of questions to ask each of the radiation oncologists we're meeting next week. I fully expect both of them to advise starting SRT now while we have an excellent chance at zapping those buggers once and for all.

Will keep everyone posted.

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