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Thread: Post Op 9 months Gleason 9

  1. #11
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    Quote Originally Posted by MichiganMan16 View Post
    Hello Cajun: Thank u for the information, your case has become a bit clearer. Basically, u are me! pt3bNO. Since u have not had any HT since the 30 days of casodex before your operation, we can assume that your numbers are not being "masked" by anything. For now, I would let myself heal as much as possible, and go along for as long as I can without additional treatment. ( u do not mention your continence or any ED issues) I would monitor my PSA every 8-12 weeks, and when it goes to 0.03 or greater, I would pull the trigger. Using the uPSA test, a reading of >0.03 for high risk people like yourself is very indicative of BCR. I would get all my ducks in a row, and be ready to act when your uPSA tells u to do so. Your PSA level will be the most important factor in determining the potential of the success with ADT/SRT. For now sit tight, but be on top of this every 8-12 weeks. Best, MM
    Continence was a problem for a few weeks, really good now.
    ED 50% at best, waiting for improvement
    Age 65 PSA History 9/8/15 5.18, 10/19/15 4.54, 3/5/16 4.91, 9/9/16 4.65, 4/25/17 5.73
    Biopsy on 5/11/17 of 14 core (2) were 4/5 = Gleason 9 60% L base and (1) core 3/3 Gleason 6 5% L Trans
    Prostate: 4.6 X 3.3 X 4.1 cm (32 grams)
    On 7/28/17 had DaVinci prostatectomy at M.D. Anderson, Dr John Papadopoulos.
    Four hour drive home on 7/30/17, my friendly catheter out on 8/8/17
    24 lymph nodes removed, no cancer

  2. #12
    I just came across this book-chapter abstract, which I've added to Subforum, Thread (K):

    Adjuvant Radiation Therapy for High-Risk Post-prostatectomy Patients [2018]

    https://www.cancerforums.net/forums/...ES-amp-REPORTS

    Abstract

    Three randomized trials demonstrate a clinical benefit associated with adjuvant radiation therapy (ART) for men with pathologic T3 disease or a positive surgical margin following radical prostatectomy. Despite this benefit and national guidelines recommending offering ART to these men, utilization of ART remains low. While severe long-term toxicity secondary to ART is rare, there are warranted concerns of overtreatment, as many men with adverse pathologic features will never develop recurrent disease, and thereby have nothing to gain from additional therapy. As such, a selective salvage radiation approach is common for men with an undetectable PSA following prostatectomy. If this approach is taken, men should be followed closely to allow for consideration of early SRT, as the best available data suggest that SRT is most effective at PSA values <0.5 ng/mL, with continued improvement in outcomes at even lower PSA values. Certain men with high-risk features, including a persistently positive post-prostatectomy PSA, a PSA > 0.5 ng/mL, or Gleason score ≥ 8, may benefit from intensification of treatment with androgen deprivation therapy or other systemic therapies at the time of ART or SRT. Utilization of genomic classifiers is increasing as they allow for improved recurrence risk estimation following prostatectomy, and they are currently used as stratification variables in clinical trials to evaluate their ability to predict response to treatment.

  3. #13
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    Quote Originally Posted by DjinTonic View Post
    I just came across this book-chapter abstract, which I've added to Subforum, Thread (K):

    Adjuvant Radiation Therapy for High-Risk Post-prostatectomy Patients [2018]

    https://www.cancerforums.net/forums/...ES-amp-REPORTS
    Thank you so much, this helps.
    Age 65 PSA History 9/8/15 5.18, 10/19/15 4.54, 3/5/16 4.91, 9/9/16 4.65, 4/25/17 5.73
    Biopsy on 5/11/17 of 14 core (2) were 4/5 = Gleason 9 60% L base and (1) core 3/3 Gleason 6 5% L Trans
    Prostate: 4.6 X 3.3 X 4.1 cm (32 grams)
    On 7/28/17 had DaVinci prostatectomy at M.D. Anderson, Dr John Papadopoulos.
    Four hour drive home on 7/30/17, my friendly catheter out on 8/8/17
    24 lymph nodes removed, no cancer

  4. #14
    That is good news. If your continence is good, one less thing to worry about. As far as the ED, it will not get any better with the start of SRT, u may want to discuss this with the RO. As someone said to me before I began SRT..." a hard on does little good if u are six feet under". Not trying to be funny or minimize the situation, just kind of the price we have to pay to shoot for a potential cure. Best, MM
    DOB:Feb 1958
    PSA: 9/15: 5.9 PC/Father
    DRE: Negative
    Biopsy: 10/1/15. Second Opinion University of Chicago. 9 of 12 cores positive. G6: 5 cores, G7 ( 4+3) 4 cores
    10/12/15: Ct scan/bone scan- Negative
    Clinical Staging: 10/28/15 T2c
    ( RALP) University of Chicago 12/29/15

    Final Pathology Report; Jan. 6 2016

    15 lymph nodes; no tumor present
    gleason upgraded to 9 ( 4+5)
    EPE; present
    Lymphovascular invasion present
    Right SV Positive
    Left SV and vasa deferentia, no tumor present
    PIN
    Perineural invasion present
    PM
    pT3bNO
    uPSA 2/9/16 0.05
    uPSA 3/23/16 0.11
    Casodex: 4/1/16-8/5/16
    Lupron: 4/15/16---5/15/18
    SRT: 6/14/16...8/5/16 38 treatments completed
    8/10/16. uPSA <0.05 thru
    08/09/18 uPSA <0.05
    Feb. 2017 Loyola University Chicago

  5. #15
    Regular User
    Join Date
    May 2017
    Posts
    36
    Hi Cajun,

    For what it's worth, I was in a very similar situation to you 2 1/2 years ago. Following a disappointing pathology report, plan was to see an RO after first PSA (3 months to heal things up a bit). When results came back like yours, surgeon suggested holding off on ART. I decided to take his advice, so I never discussed with an RO. Luckily, my PSA continues to be <0.01 after over two years. At the time, I was not aware of genetic testing as an option for assessing recurrence risk. Are you considering this?

    There is another FB Davii with a similar DX and timeline as mine, if you search you can read up on his story as well. Best of luck to you, wishing you many zero's to come!
    Age at DX: 58
    PSA: 4.9
    Positive DRE
    Biopsy: 12/7/15
    Left Mid
    Adenocarcinoma 1/12 cores (45%)
    Gleason 4+3=7, CT abdomen, bone scan negative
    RALP 1/27/16 at CINJ/RWJ (New Brunswick, NJ)
    Surgeon: Dr Isaac Kim (1400+ procedures, highly recommend)
    Final Pathology: 2/1/16
    7 lymph nodes, seminal vesicles negative
    Postero-lateral (neurovascular bundle) margin involved by invasive carcinoma
    Gleason score 5+4=9 with intraductal component
    Primary tumor pT2: organ confined, high grade PIN
    Four post-op exams: PSA <0.01

  6. #16
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    Quote Originally Posted by Groot View Post
    Hi Cajun,

    For what it's worth, I was in a very similar situation to you 2 1/2 years ago. Following a disappointing pathology report, plan was to see an RO after first PSA (3 months to heal things up a bit). When results came back like yours, surgeon suggested holding off on ART. I decided to take his advice, so I never discussed with an RO. Luckily, my PSA continues to be <0.01 after over two years. At the time, I was not aware of genetic testing as an option for assessing recurrence risk. Are you considering this?

    There is another FB Davii with a similar DX and timeline as mine, if you search you can read up on his story as well. Best of luck to you, wishing you many zero's to come!
    I am not aware of genetic testing, will research. Thank You
    Age 65 PSA History 9/8/15 5.18, 10/19/15 4.54, 3/5/16 4.91, 9/9/16 4.65, 4/25/17 5.73
    Biopsy on 5/11/17 of 14 core (2) were 4/5 = Gleason 9 60% L base and (1) core 3/3 Gleason 6 5% L Trans
    Prostate: 4.6 X 3.3 X 4.1 cm (32 grams)
    On 7/28/17 had DaVinci prostatectomy at M.D. Anderson, Dr John Papadopoulos.
    Four hour drive home on 7/30/17, my friendly catheter out on 8/8/17
    24 lymph nodes removed, no cancer

  7. #17
    Newbie New User
    Join Date
    May 2018
    Posts
    3
    I would it now hard and not wait for biochemical recurrence. If you wait you may end up with metastatic disease inadvertently. RT is such that now with the modern technology, the side effects are usually minimal and manageable.

  8. #18
    As Djin and MM have pointed out, you DO have high risk pathology, primarily SVI and LVI. The SVI would prompt you to undergo ART while the cancerous cells are still in your prostate bed. The LVI indicates that they have already potentially left the area, and local radiation would not eradicate them. However, if you undergo ART to kill off the cancer that remains in you pelvis you can hope that any micromets that may have already escaped can be starved by HT and eventually die off.

    In my case, because of SVI, the entire year following RP was devoted to getting to the goal of starting ART. And even though I did experience some persistent bowel problems from RT, I still believe it was the right thing to do. With your pathology you should give it serious consideration and not wait for BCR.
    Late 2012: PSA 4, age 62 all DRE's 'normal'
    Early 2014: PSA 9.5, TRUS biopsy negative
    2015: PSA's 12, 20, Mar'16: PSA 25, changed Uro
    Jun'16: MRI fusion biopsy, tumor right base, 6/16 cores: 2-100%+2-40% G8(4+4)
    Aug'16: DaVinci RP, -SM, 11 LN-, 53g, 25% involved, PNI, 6mm EPE, BL SVI, pT3B
    Jan'17: started 18 months Lupron ADT, uPSA's ~.03
    May'17: AMS800 implanted, revised 6/17
    Aug'17: 39 tx (70 Gy) RapidArc IGIMRT
    Apr'18: Dx Radiation Colitis
    Aug'18: Dx Mesenteric mass presumed carcinoid
    Jan-Apr-July 2018: PSA's = 0.0, T=9 (still on Lupron)
    "Everyone you meet is fighting a battle you cannot see"
    Mrs: Dec 2016
    Dx stage 4 NHL/DLBCL, Primary Bone Lymphoma
    spinal RT boost+6X R-CHOP21+IT MTX via LP. Now in remission
    Read our story at CancerCoupleBlog.com

  9. #19
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    Join Date
    Jun 2017
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    17
    Quote Originally Posted by RobLee View Post
    As Djin and MM have pointed out, you DO have high risk pathology, primarily SVI and LVI. The SVI would prompt you to undergo ART while the cancerous cells are still in your prostate bed. The LVI indicates that they have already potentially left the area, and local radiation would not eradicate them. However, if you undergo ART to kill off the cancer that remains in you pelvis you can hope that any micromets that may have already escaped can be starved by HT and eventually die off.

    In my case, because of SVI, the entire year following RP was devoted to getting to the goal of starting ART. And even though I did experience some persistent bowel problems from RT, I still believe it was the right thing to do. With your pathology you should give it serious consideration and not wait for BCR.
    Thanks, meeting with my doctor on August 02 and will make a decision.
    Age 65 PSA History 9/8/15 5.18, 10/19/15 4.54, 3/5/16 4.91, 9/9/16 4.65, 4/25/17 5.73
    Biopsy on 5/11/17 of 14 core (2) were 4/5 = Gleason 9 60% L base and (1) core 3/3 Gleason 6 5% L Trans
    Prostate: 4.6 X 3.3 X 4.1 cm (32 grams)
    On 7/28/17 had DaVinci prostatectomy at M.D. Anderson, Dr John Papadopoulos.
    Four hour drive home on 7/30/17, my friendly catheter out on 8/8/17
    24 lymph nodes removed, no cancer

  10. #20
    im late to the party, but be at the ready to take additional action. with EPE, SV+, biopsy gleason 9, that is a very high risk. the moment you see a bump in that PSA, act on it, do not hesitate unless guided so by the physician(s)
    Dad Dx PCa 03/19/13
    01/25/13 Blood test revealed PSA of 4.2 referred to urologist
    02/08/13 Second PSA then DRE, normal feel to gland
    03/08/13 Results of biopsy: 5/12 cores positive for PCa +PNI Gleason 3+3=6 cT1NxMx surgery scheduled
    04/23/13 RRP: no obvious disease outside of gland
    04/30/13 Path report: Tumor involved both lobes just barely into opposite side Gleason score same as biopsy +PNI Stage upgraded to pT2c
    05/06/13 Unable to remove catheter due to leaking, attempt again two weeks later
    05/08/13 Dad collapsed going to car, workup @ local hospital revealed DVT and extensive bilateral pulmonary emboli. transferred to larger facility
    05/09/13 Dad admitted to SICU
    05/11/13 Dad admitted to regular room
    05/12/13 Discharged from Hospital
    05/20/13 Catheter finally removed
    06/18/13 First post-op PSA: <<0.04

    All PSA tests until Jan 31 2017 were <<0.04
    01/31/17 Last PSA test 0.13
    Retest in 4 months + imaging studies

 

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