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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
    02/08/18 uPSA <0.05
    Feb. 2017-Present. Loyola University Chicago

  5. #15
    Regular User
    Join Date
    May 2017
    Posts
    32
    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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    Join Date
    Jun 2017
    Posts
    16
    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

 

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