primary salvage therapy

visitor · New User Joined: 15 Dec 2004 Posts: 5 Location: Washington

Status post radical prostatectomy 04/2003
initial post surgical psa approx 0.1 or less
nadir psa rose to 0.18 by 09/2004 and to 0.29 in 12/2004

Recommendation by Urologist is external beam radiation after CT scan for "planning purposes"

Questions:
Is this CT scan a staging tool or just for purposes of aiming the radiation?
Would a high resolution MRI be prudent to accurately stage and locate any nodes which appear to be cancerous? (i.e. identify any metastasis)
Should a medical oncologist be involved in addition to radiation oncologist?
Would clinical trials be suggested at this juncture?
Advice will be much appreciated!
Thank You

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Visitor

mycroft · Posted: Sat Dec 18, 2004 2:24 pm Post subject: Re: primary salvage therapy

[quote="visitor"]

Status post radical prostatectomy 04/2003
initial post surgical psa approx 0.1 or less
nadir psa rose to 0.18 by 09/2004 and to 0.29 in 12/2004

Recommendation by Urologist is external beam radiation after CT scan for "planning purposes"

****This is "salvage radiotherapy."

Questions:
Is this CT scan a staging tool or just for purposes of aiming the radiation?
****If the EBRT is intensity modulated radiotherapy (IMRT), a CT scan is part of the preliminaries. It is used to plan where to aim the radiation and in what dosage (expressed in "grays" [Gy]). IMRT, which I finished in October, is the latest and most accurate mode of EBRT. Its accuracy permits employment of higher doses of radiation than previously possible because it reduces the risk of damaging tissues one does not wish to damage. In short, it focusses the radiation where it is most needed.

See Prostate Cancer Research Institute, http://prostate-cancer.org/index.html

And read Stephen Strum's excellent _A Primer on Prostate Cancer_. Dr. Strum is a medical oncologist.

Would a high resolution MRI be prudent to accurately stage and locate any nodes which appear to be cancerous? (i.e. identify any metastasis)
****Subject to correction, I do not believe that an MRI is capable of locating metastases.

Should a medical oncologist be involved in addition to radiation oncologist?
****Depends on the capability of the rad onc. Med oncs generally enter the picture after other treatments fail, and they handle chemotherapy.

However, the timing of this message couldn't be better. I consulted a med onc just yesterday, 12/17/04, because I'm concerned about my rad onc's ability outside his specialty.

Good thing I did. Discovered that, as I suspected, he had made two critical errors with regard to my medical (as opposed to radiation) treatment. That's now being addressed.

The reason I suspected errors is that I studied, learned, and took charge of my case. Strum's book, though not my only source, is the essential foundation.

Would clinical trials be suggested at this juncture?
****I am not a medic. "Visitor" should consult with his own medical advisor about this. Having said that, I'll say further that there's nothing in his post that leads me to think that "Visitor" has reached that point. Clinical trials, AIUI, are usually populated by folks who have run out of options, and that does not appear to be "Visitor's" case.

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Regards,

Steve J

leo · Site Admin Joined: 23 Sep 2004 Posts: 1574

Hello Visitor

Thanks for posting. You certainly have lots of difficult questions.

#1 The CT can be used for both. I am not sure what your doctor is using it for, but the term "planning" can be used for radiation therapy, i.e. where they are going to use the radiation.

#2 I don't think MRI would be much of help, but it can be used. A CT is the primary tool for doing this, and the MRI may be used next

#3 As a future medical oncologist, I think that a medical oncologist should be involved early when you are contemplating other options. The oncologist will review what you've been through, and coordinate with a surgeon and radiation oncologist if necessary. Then he will offer you the treatment choices that are available, and help you make a decision.

#4 Clinical trials can be done at any point. As someone mentioned above, trials are most commonly done with people that failed everything else and have run out of options. But maybe there is a trial that offers you the standard treatment PLUS another type of treatment or placebo, and that may be interesting. You can always ask about that.

best regards,
Leo
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Leonardo F - Webmaster Cancer Forums
Disclaimer: this information is for informational purposes only. It is not medical advice.

visitor · New User Joined: 15 Dec 2004 Posts: 5 Location: Washington

Thank you mycroft and leo for your responses and valuable information. It is helpful. I will most certainly peruse the prostate cancer research information pages and obtain Dr Strum's literature. Am trying to educate myself and assure the best treatment options are employed on this PC journey every step of the way AMAP.

I wish you the very best in your treatment outcome, mycroft, and you the best success in your endeavors re medical oncology leo.

Thanks again

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