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Thread: First meeting with RO on Aug 13

  1. #11
    Good video on

    Adjuvant or Salvage RT Post RP? [2018]

    which discusses the evidence. Who definitely needs adjuvant? At the end, the toll ART takes on both erection and continence recovery vs SRT.


    A Video on the same subject by A. D'Amico [2019] (Summary of who should get ART at 8:00 into the video). Discusses a case of G8 with adverse findings post RP.


    The first results are due in 2020 of two important trials, RADICALS and RAVES, which look at ART+ADT after RP vs. waiting until a PSA of 0.1. These are the first studies specifically designed to look at adjuvant vs. early salvage.
    Last edited by DjinTonic; 08-14-2019 at 11:44 AM.
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3 -
    7-05-13 TURP (90→30 g) path neg. then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional
    SM EPE BNI LVI SVI LNI(16): negative, PNI+, nerves spared
    pT2c pN0 pMX acinar adenocarcinoma G9 (4+5) 5% of prostate (4.5x5x4 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 wk) PSA <0.1
    LabCorp uPSA, Roche ECLIA:
    11-28-17 (3 m ) 0.010
    02-26-18 (6 m ) 0.009
    05-30-18 (9 m ) 0.007
    08-27-18 (1 yr.) 0.018 (?)
    09-26-18 (13 m) 0.013 (30-day check)
    11-26-18 (15 m) 0.012
    02-25-19 (18 m) 0.015
    05-22-19 (21 m) 0.015
    08-28-19 (2 yr. ) 0.016
    Avg. = 0.013

  2. #12
    Top User
    Join Date
    Aug 2016
    Posts
    1,687
    Eagerly await the results of these studies.

  3. #13
    Experienced User
    Join Date
    Apr 2019
    Posts
    68
    Quote Originally Posted by DjinTonic View Post
    Good video on

    Adjuvant or Salvage RT Post RP? [2018]

    which discusses the evidence. Who definitely needs adjuvant? At the end, the toll ART takes on both erection and continence recovery vs SRT.


    A Video on the same subject by A. D'Amico [2019] (Summary of who should get ART at 8:00 into the video). Discusses a case of G8 with adverse findings post RP.


    The first results are due in 2020 of two important trials, RADICALS and RAVES, which look at ART+ADT after RP vs. waiting until a PSA of 0.1. These are the first studies specifically designed to look at adjuvant vs. early salvage.
    Great video, summarizes a lot of the studies in your subforum I've read! I'm certain we're headed for ART, will be seeing RO in 2 weeks. Husband may actually be getting radiation before the follow up appointment with the surgeon.
    Wife Posting, Husband D.O.B. 1975
    2/2018 - routine physical PSA 15
    3/2018 - PSA 13
    4/2018 - PSA down to 11.6, free PSA, 18%
    6/2018 - PSA 10, free PSA 20%
    7/2018 - mp- MRI done, prostate volume =22cc, "inflammation consistent with prostititis"
    11/2018 - PSA 14, free PSA 11%,
    3/2019 - PSA 12, free PSA 17%, 2nd opinion on MRI = PI RADs 3 lesion
    4/2019 - Cognitive Fusion Biopsy
    5/12 cores positive
    4 Gleason 3+3
    1 Gleason 3+4 5% (Where PIRADs 3 lesion IDd)
    Decipher Biopsy score: .07 very low risk

    Bone scan negative
    MRI 6/19 said PIRADS 4 lesion, no definite EPE

    RRP 7/19 Final Path: pT3a
    G6 - 75-90%
    G7 (3+4) - 11-25%
    24mm tumor, 30% of prostate
    EPE+, BNI+, SM + (at bladder neck), LVI-, SVI -, PNI-, Nodes -
    Decipher Post RP score: .78, high risk

  4. #14
    Senior User
    Join Date
    Nov 2018
    Posts
    242
    Busby nothing to add just wanted to wish you good luck and enjoy your vacation.
    Matt
    DOB 1955
    63 at dx
    3/2018 PSA 4.05 DRE normal refer to URO small town
    10/2018 PSA 6.28 DRE normal
    Bx 11/2018 12 cores 3 pos one 5% left mid two 50% left base
    GS 3+4=7 T1c
    Appt Mayo Clinic Phoenix Az 1/4/2019
    Dr. Paul Andrews recommend
    MRI 2/27/2019 Mayo AZ
    RALP 2/28/2019 Mayo AZ Dr. Paul Andrews
    Path: GS 3+4=7, Tertiary Gleason Pattern none, Grade Group 2
    Tumor presents moderate to extensive volume mainly on the
    posterior portion of prostate. Largest tumor nodule measures
    8 mm.
    Prostate: 21g 3.5 x 3 x 3 cm
    EPE: Absent
    Bladder Neck Invasion: Absent
    Seminal Vesicle Invasion: Pos (left seminal vesicle)
    Margins: Pos left lateral base and central base margins 2mm focus each
    Lymph Nodes involved: 0
    Lymph Nodes examined: 16
    Nerves spared right side only
    Path Staging (AJCC 8th Edition)
    Primary Tumor pT3b
    Regional lymph nodes: pNO
    Distant Metastasis: Mx
    Continence 99% 9 weeks
    ED Present
    PSA 4/17/2019 <.10
    PSA 5/2/2019 <.007
    PSA 6/10/2019 <.10
    PSA 8/1/2019 <.007

  5. #15
    Quote Originally Posted by AceVA View Post
    Great video, summarizes a lot of the studies in your subforum I've read! I'm certain we're headed for ART, will be seeing RO in 2 weeks. Husband may actually be getting radiation before the follow up appointment with the surgeon.
    Please keep us posted -- I assume you'll have your husband's first post-op PSA by the time of your RO consult. I'm interested in what he says. Assuming that PSA is acceptably low, if he had just EPE+ with G7 (3+4), I would think the verdict would be wait for a PSA rise, especially with that Decipher score.

    The BNI+, as you know from your research, puts a different spin on things. Of course if there is persistent PSA at the first test, your decision might be made for you.

    Also, if ART is the decision, let us know if there was any discussion about the usefulness of an advanced scan. However, with the ultra low Decipher, I would think pelvic-lymph node involvement would be unlikely, and this might just be a question of zapping around the area of SM+. In other words, that, except for its crappy location, this would be a run-of-the-mill G (3+4).

    Good luck!!

    Djin

  6. #16
    Senior User
    Join Date
    Nov 2018
    Posts
    242
    I asked Dr. Andrews after prostatectomy and pathology if I should have ART. He said some would say yes but he felt it was better to do psa tests every 3 months and watch for a rise in psa before doing radiation. He was honest and said there was a good chance that I would need further treatment in the future but he had no idea when. He also said there is always a chance I won't need any further treatment. So that's where I'm at right now. Guess I will wait and see for now. So far so good.
    DOB 1955
    63 at dx
    3/2018 PSA 4.05 DRE normal refer to URO small town
    10/2018 PSA 6.28 DRE normal
    Bx 11/2018 12 cores 3 pos one 5% left mid two 50% left base
    GS 3+4=7 T1c
    Appt Mayo Clinic Phoenix Az 1/4/2019
    Dr. Paul Andrews recommend
    MRI 2/27/2019 Mayo AZ
    RALP 2/28/2019 Mayo AZ Dr. Paul Andrews
    Path: GS 3+4=7, Tertiary Gleason Pattern none, Grade Group 2
    Tumor presents moderate to extensive volume mainly on the
    posterior portion of prostate. Largest tumor nodule measures
    8 mm.
    Prostate: 21g 3.5 x 3 x 3 cm
    EPE: Absent
    Bladder Neck Invasion: Absent
    Seminal Vesicle Invasion: Pos (left seminal vesicle)
    Margins: Pos left lateral base and central base margins 2mm focus each
    Lymph Nodes involved: 0
    Lymph Nodes examined: 16
    Nerves spared right side only
    Path Staging (AJCC 8th Edition)
    Primary Tumor pT3b
    Regional lymph nodes: pNO
    Distant Metastasis: Mx
    Continence 99% 9 weeks
    ED Present
    PSA 4/17/2019 <.10
    PSA 5/2/2019 <.007
    PSA 6/10/2019 <.10
    PSA 8/1/2019 <.007

  7. #17
    Quote Originally Posted by nmguy View Post
    I asked Dr. Andrews after prostatectomy and pathology if I should have ART. He said some would say yes but he felt it was better to do psa tests every 3 months and watch for a rise in psa before doing radiation. He was honest and said there was a good chance that I would need further treatment in the future but he had no idea when. He also said there is always a chance I won't need any further treatment. So that's where I'm at right now. Guess I will wait and see for now. So far so good.
    As I think I've said, IMO in your case of G7 (3+4), there is the chance the RP removed all the cancer in the prostate and SVs. If there is a PSA rise (1) you are currently at low is possible with testing, so you'll have plenty of time to see if a rise will continue and (2) even if your PSA level and rate of climb should become concerning, you can start RT as early as you and your docs decide! Yours is a case where I see great benefit in being followed with an uPSA test.

    AceVa's husband, on the other hand, may well have some cancer cells left behind after surgery -- so you are, I believe, starting from different presumptions.

    Djin
    Last edited by DjinTonic; 08-14-2019 at 04:55 PM.

  8. #18
    Senior User
    Join Date
    Nov 2018
    Posts
    242
    Thanks Djin. As always I value your post.

 

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