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Thread: Next: Adjuvant Radiation

  1. #1
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    Next: Adjuvant Radiation

    Dave's recovery from 9/17/18 RALP has gone pretty well, overall...with now only minor stress incontinence, but 100% ED. We are still hoping for improvements.

    He had his first PSA at 3 mos. resulting in "undetectable" <1. Urologist was pleased with that, but still referred him to RadOnc, whom we met with yesterday. Uro & RadOnc are recommending adjuvant radiation, due to the high Gleason (4+5)9, extraprostic extension, and genetic indications. We had figured radiation would be in his future at some point, so this treatment plan was not totally unexpected. We just had hoped it might be a bit further down the road. However, we are both in agreement not to mess around waiting, so will get started on this next phase of journey.

    RO has an MRI scheduled, as well as another PSA. Those findings will indicate if HT might also be needed. While Dave is not thrilled about the radiation, the HT fills him with dread.

    Question for you guys: we were told that where ever Dave is as far as incontinence and ED, that progress will be "frozen" with the introduction of radiation. What we read seems to confirm this, but we would appreciate hearing if others perhaps had some more positive results to report? Dave's ok if he's fated to wearing a little pad forever, but he was really hoping he might eventually see some ED improvement.

    Thanks so much, we appreciate being able to read and share in everyone's experiences.

    Barb
    Age 68, no family PCa
    5/16/18 - long overdue physical PSA 10.7
    5/23/18 - PSA 16.4 / DRE normal
    7/11/18 TRUS Biopsy 12 cores Grade Group 3
    2 left cores G7 (4+3) Perineural invasion present
    2 right cores G6 (3+3)
    9/17/18 RALP - no issues, right nerves spared
    9/19/18 Path Report:
    Total Gleason Score: upgraded to 9 (4+5) / pT3a NO / tumor: 20%
    EPE: present, multifocal - right anterior & left prostate
    Negative: Margins / Urinary Bladder neck invasion / SVI / Lymphovascular Invasion / 10 lymph nodes
    9/24/18 Bone Scan normal
    RALP recovery: normal progress, with lingering perineum pain, mild stress incontinence, ED
    12/18/18 PSA <.1
    12/28/18 URO appt, with referral to RadOnc due to EPE, G9, decipher score .73 high risk
    1/11/19 RadOnc recommending adjuvant radiation
    Started ART 2/18/19...33 sessions

  2. #2
    Hi Barb. I can't address your incontinence and ED question, but I think the ART is a very good decision, given the G9, EPE, Decipher, and also the pre-surgey PSA >10. BTW what was the Decipher score?

    Wishing you both all the best,

    Djin
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. biopsies, PCA3 -
    2013 TURP (90→30 g) then PSA 2x/yr, DRE yearly
    6-06-17 DRE: nodule R, PSA rise, on finasteride: 3.6→4.3
    6-28-17 Biopsy #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 5% RLM
    Bone scan, CTs, X-rays: negative
    8-7-17 Open RP, neg. frozen sections, Duke Regional
    SM EPE LVI SVI LN(16): negative, PNI+, nerves spared
    pT2c pN0 bilat. acinar adenocarcinoma G9 (4+5) 5% of prostate (4.5 x 5 x 4 cm, 64 g)
    11-10-17 Decipher 0.37 Low Risk: 5-yr met risk 2.4%; 10-yr PCa-specific mortality 3.3%
    Dry; ED OK with sildenafil
    9-16-17 (5 weeks) PSA <0.1; Pomi-T (2/day)
    LabCorp uPSA (Roche ECLIA):
    11-28-17 (3 mo. ) 0.010
    02-26-18 (6 mo. ) 0.009
    05-30-18 (9 mo. ) 0.007
    08-27-18 (1 year) 0.018
    09-26-18 (13 mo) 0.013 (checking rise)
    11-26-18 (15 mo) 0.012
    02-25-19 (18 mo) 0.015

  3. #3
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    Thanks, Djin. The RO didn't use the term "decipher" but rather "genetic something"...and I don't believe he used a score number, but read off some figures (which we don't exactly recall), that indicated percentage of re-occurrence at various years, metastasis, overall survival. They didn't sound too encouraging, is about all we remember. Although the RO spent a good bit of time with us, it seemed like there was so much he wanted to go over, and it was a lot to take in. He encouraged us to be in touch with any questions or concerns, so we'll bring this up when next we correspond.
    Age 68, no family PCa
    5/16/18 - long overdue physical PSA 10.7
    5/23/18 - PSA 16.4 / DRE normal
    7/11/18 TRUS Biopsy 12 cores Grade Group 3
    2 left cores G7 (4+3) Perineural invasion present
    2 right cores G6 (3+3)
    9/17/18 RALP - no issues, right nerves spared
    9/19/18 Path Report:
    Total Gleason Score: upgraded to 9 (4+5) / pT3a NO / tumor: 20%
    EPE: present, multifocal - right anterior & left prostate
    Negative: Margins / Urinary Bladder neck invasion / SVI / Lymphovascular Invasion / 10 lymph nodes
    9/24/18 Bone Scan normal
    RALP recovery: normal progress, with lingering perineum pain, mild stress incontinence, ED
    12/18/18 PSA <.1
    12/28/18 URO appt, with referral to RadOnc due to EPE, G9, decipher score .73 high risk
    1/11/19 RadOnc recommending adjuvant radiation
    Started ART 2/18/19...33 sessions

  4. #4
    Top User garyi's Avatar
    Join Date
    Apr 2017
    Posts
    1,084
    I suggest you request/demand a Decipher test, especially if that wasn't what they did. Also request/demand a copy of both the test results and a GRID report.

    Radiation is most likely in the future. First share with us the next PSA and Decipher results. While quick action, given the pathology, is advisable, and HT should accompany it....how long to hormones is open to much medical debate. IMHO, less is better; one year max, but please research to topic thoroughly. RO's usually like to prescribe it with a heavy head.

    ED results vary dramatically, and recovery to some degree is not uncommon. Remember what you read is usually guys complaining, not us happy men. There are also many work arounds, but that's for another day. Dave's primary goal is to beat PCa and stay alive, not worry about erections.

    Best of luck, and keep us posted.
    72...LUTS for the past 7 years
    TURP 2/16,
    G3+4 discovered
    3T MRI 5/16
    MRI fusion guided biopsy 6/16
    14 cores; four G 3+3, one G3+4,
    CIPRO antibiotic = C. Diff infection 7/16
    Cured with Vanco for 14 days
    Second 3T MRI 1/17
    Worsened bulging of posterior capsule
    Oncotype DX GPS 3/17, LFP risk 63%, Likelihood of Low
    Grade Disease 81%, Likelihood of Organ Confined 80%
    RALP 7/13/17 Dr. Gonzaglo @ Univ of Miami
    G3+4 Confirmed, Organ confined
    pT2c pNO pMn/a Grade 2
    PSA 0.32 to .54 over 3 months
    DCFPyl PET & ercMRI Scans - 11/17
    A one inch tumor remains in prostate bed = failed surgery
    All met scans clear
    SRT, 2ADT, IMGT 70.2 Gys @1.8 per, completed 5/18
    PSA <.006 9/18, .054 11/18, .070 12/18, .067 2/19
    We'll see....what is not known dwarfs what is thought to be fact

  5. #5
    If you'd like to do more research, you could start with Topic (L) Hormone Treatment in the Subforum. There are papers on clinical trials for the treatment length in high-grade disease and use with ADT among other topics.
    Last edited by DjinTonic; 01-12-2019 at 06:31 PM.

  6. #6
    Hello Dave and Barb: To answer your questions. Yes, your continence will probably be "frozen" about where it is at the time that u go in for ART. If u can put it off for say 3-6 months, perhaps u can go into the RT with a good sense of where u are. One option would be to track his PSA using the uPSA, and try and get/buy as much time as u can. If u have HT with the radiation, which in your case is standard of care, this will stop the cancer from progressing and buy u time. Typically, u will be on ADT for 2 months prior to RT. Casodex/ lupron, etc. Honestly, they use the terms ADT/SRT like there is a big difference...I think it is more about when u begin in relation to your PSA. As far as ED, during RT the RO will be able to avoid the penile bulb, and perhaps his ED will improve over time. Tough to say for now...but with RT and ADT, sadly he will not even care.

    The good news: While your report is not the greatest, it isn't the end of the world either! You still have a chance at a cure, and if that is what u are most concerned about, leave no stone Unturned. As the saying goes...erections do u no good with your feet south of the grass. Wishing u and your husband the 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
    +LVI
    Right SV Positive
    Left SV and vasa deferentia, no tumor present
    PI 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 38Tx
    uPSA 8/10/16---2/14/19 <0.05
    Feb. 2017 Loyola Chicago
    11/15/2018 AUS 800 Implanted
    12/18/18...T Levels...Free T 42.8...Total T...262

  7. #7
    Dave and Barb: I am sorry. U had RALP in mid Sept. So it has already been 4 months...try and squeeze and few more out...if possible
    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
    +LVI
    Right SV Positive
    Left SV and vasa deferentia, no tumor present
    PI 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 38Tx
    uPSA 8/10/16---2/14/19 <0.05
    Feb. 2017 Loyola Chicago
    11/15/2018 AUS 800 Implanted
    12/18/18...T Levels...Free T 42.8...Total T...262

  8. #8
    Agree with Gary. You should get original results and reports of all your tests.

  9. #9
    Regular User
    Join Date
    Jul 2018
    Posts
    29
    Much appreciation to DjinTonic, garyi, and MichiganMan -- your encouragement and suggestions are very helpful. We will request his test info. And hopefully between that, and the upcoming MRI and PSA test, might have a better feel about Dave's situation.

    Thank you,
    Barb
    Age 68, no family PCa
    5/16/18 - long overdue physical PSA 10.7
    5/23/18 - PSA 16.4 / DRE normal
    7/11/18 TRUS Biopsy 12 cores Grade Group 3
    2 left cores G7 (4+3) Perineural invasion present
    2 right cores G6 (3+3)
    9/17/18 RALP - no issues, right nerves spared
    9/19/18 Path Report:
    Total Gleason Score: upgraded to 9 (4+5) / pT3a NO / tumor: 20%
    EPE: present, multifocal - right anterior & left prostate
    Negative: Margins / Urinary Bladder neck invasion / SVI / Lymphovascular Invasion / 10 lymph nodes
    9/24/18 Bone Scan normal
    RALP recovery: normal progress, with lingering perineum pain, mild stress incontinence, ED
    12/18/18 PSA <.1
    12/28/18 URO appt, with referral to RadOnc due to EPE, G9, decipher score .73 high risk
    1/11/19 RadOnc recommending adjuvant radiation
    Started ART 2/18/19...33 sessions

 

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