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Thread: Having second thoughts about post op RT

  1. #11
    Top User garyi's Avatar
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    Quote Originally Posted by Busby View Post
    ....Doc didn't think it would be a big deal to wait ten days. Now I'm second guessing.
    No use second guessing at this point. Go enjoy your vacation, and get ADT as soon as you get back.

    Relax...I think marijuana is legal in Oregon.
    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
    pT2 pNO pMn/a Grade Group 2
    PSA 0.32 to .54 over 3 months
    DCFPyl PET & ercMRI Scans - 11/17
    A one inch tumor still in prostate bed = failed surgery
    All met scans clear
    SRT, 2ADT, IMGT 70.2 Gys @1.8 per, completed 5/18
    Radiation Procitis, and Ulcerative Colitis flaired after 20 years
    PSA <.006 9/18, .054 11/18, .070 12/18, .067 2/19, .078 5/19, .074 7/19, .081 9/19
    We'll see....what is not known dwarfs what is thought to be fact

  2. #12
    First, enjoy your vacation. Also, you probably would have been okay starting your HT before you left, as it takes a while to kick in. As I recall, my first hot flash was a month after the first injection, and I was on a cruise!

    As has been mentioned, HT alone would stop any cancer progression, regardless of whether it is distant or local. Essentially you have two problems to address: 1) multiple PSM's, which are definitely confined to the prostate bed. And as your surgery was recent, the only way to eliminate the threat of PSM is with radiation. 2) Your cribriform, which as I understand is not automatically grade 5, but in effect boosts Gleason grade up by 1... so depending on the cells exhibiting cribriform, 3 would become 4 and 4 would become 5.

    And that's where the possibility of metastasis would enter the picture. Bear in mind that your pathology stage was 2, or "organ contained". Stage 3 is outside of the prostate, but is "locally advanced", i.e., confined to the prostate bed. Only grade 4 is distant metastasis, and would typically appear in bones (though not yet at your low PSA).

    Be aware that once you start HT then you lose the opportunity to locate distant mets. But if your goal is to use RT to eradicate the cancer cells remaining in your pelvic floor, then HT would augment the radiation but I believe about 5-10%. Without radiation, HT would only be useful for the purpose of halting the progression of circulating micrometastic cells, which at this point you probably do not have. You would only be subjecting yourself to the SE's of HT, which are extensive. So if you are going to do HT you probably should also do RT, and if you are going to do RT, it would be a good idea to also include HT. But not HT alone unless distant mets are discovered.

    As mentioned by FB Another, be on the look out for depression. It can really make life miserable. And do not allow any feelings of guilt. It won't change anything that happened in the past and will only affect your future. Good luck!
    Late 2012: PSA 4, age 62 all DRE's 'normal'
    Early 2014: PSA 9.5, TRUS biopsy (false) negative
    2015: PSA's 12 & 20, LOTS of Cipro ... Mar'16: PSA 25, changed Urologist
    Jun'16: MRI fusion biopsy, tumor right base, 6/16 cores: 2ea 15-40-100% G8(4+4)
    Aug'16: DVRP,
    "broad cut" 11 LN-,-SM, 53g 25% involved, multifocal EPE, PNI, B/L SVI, pT3b

    Jan'17:
    began Lupron ADT, uPSA's ~.03
    May'17: AMS800 implanted, revised 6/17
    Aug'17: 39 tx (70 Gy) RapidArc IGIMRT
    Jan'18-July 2019: PSA's <0.008, T~12
    Apr'18: Dx radiation colitis, Oct'18: Tx sclerosing mesenteritis
    "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+6X IT MTX via LP. Now in remission
    Read our story at CancerCoupleBlog

  3. #13
    The message from the studies on HT's side effects is that exercise is the number one way to keep them at their minimum.

    Djin
    Last edited by DjinTonic; 08-17-2019 at 08:20 PM.

  4. #14
    Top User
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    And good for depression.

  5. #15
    Quote Originally Posted by Another View Post
    And good for depression.
    Absolutely!

  6. #16
    Quote Originally Posted by DjinTonic View Post
    studies on HT's side effects is that exercise is the number one way to keep them at their minimum.
    Quote Originally Posted by Another View Post
    And good for depression.
    If only it were that simple

  7. #17
    Quote Originally Posted by RobLee View Post
    If only it were that simple
    If that doesn’t work there is always the marijuana in Oregon. Sometimes humor is all we got.
    Last edited by Duck2; 08-18-2019 at 03:31 PM.
    YOB 1957

    DX 12/18, GS 8, 4+4 6/12 cores, LL Apex 100%, LM Apex 60%, LL Mid 50%, LMM 40%, LL Base 5%, LM <5%, Right side negative.

    2/25/19 Robotic Laparoendoscopic Single Site Surgery outpatient Cleveland Clinic,

    3/6/19. Pathology - Grade Group 4 with Intraductal Carcinoma
    T3aNO, GS8, 21 mm unifocal tumor 10%. -7 Nodes, - SV, - Margins, - PNI,
    - bladder neck neg., +LVI, + EPE non focal apex/mid lateral 1mm max extension, Cribriform pattern present. Decipher .86 High Risk.

    PSA 3/27/19 .03. (29 days)
    4/25/19 <.03. (58 days)
    5/25/19 <.02. (88 days)
    9/10/2019. <.02. (198 days)

    ADT - 6/19 - 6/21
    ART - 78Gy 8/19 - 9/19

  8. #18
    Senior User
    Join Date
    Mar 2017
    Posts
    104
    Busby I had my PCa locate just within the prostate bed with No positive Margins. I did SRT and hoped it worked. I also had a great scan showing where it was. I also started ADT/HT and this does not kill any cancer cells as many believe. It only takes away the fuel that PCa thrives on, (testosterone) its believed that if you take away PCa fuel the Ca will start to die off which it does. If cells have reached distant parts of the body this treatment may stop it from getting a hold. Eventually this will fail too 1 yr 5 yr 15yrs its all an unknow with each person. The PCa will begin to turn to testosterone cells and eat itself, and we start again with new meds. In my case after 2 year of ADT the PCa started to grow again, with zero testostorone reading! But what we did find durring scans was the SRT did its job and there was no signs of PCa cells present at previous location. We also found the distant PCa locations were present long before I knew I had PCa. They way its been explained to me all we are trying to do is exstend our lives with the use of drugs and threapies. I'm good with all of that! My doctors have said it use to be most men find PCa in there mid to late 70's and they have lots to throw at it for 15 years. But like you and me we started too soon. I say throw everything at it now!
    steve d
    Diag. 56 DOB 2/59 PSA 01/14 (2.0) 6/15/15 (2.4)
    Biopsy 6/23/15 5 Gleason Score 8
    Pet Scan & Biopsy of rib Neg
    RP 10/15/15
    Path 54g 5x4.2x2.8cm 4+3=7 Tumor location quadrants Bilateral
    Extra-capsular extensions present,Semi vesicles no invasion
    Vascular invasion none, Perineural invasion identified ,Multicentricity : multifocal
    Margins involvement/Not present on inked margins lymph nodes : five negative pT3a,N0
    PSA 10/6/16 .1 1yr PSA 02/02/17 .4 PSA 02/15/17 .5
    Pet Scan 2/18/17 Neg
    PSA 03/17 .6
    03/17 Axumin trial 17.4mm recurrence rt. semi vascular bed
    03/17 Casodex + Trelstar 2yrs Casodex stopped 6/18 7/19 Trestar+Xtandi + Zoledronic Acid
    04/17 SRT (42) completed 6/3/17
    08/31/2017 PSA < .1 Last 6 uPSA <.006 uPSA 2/19 <.030 2nd BCR 5/19 <.235 5/19 <3.2 6/19 <.34 7/19 <.06
    06/10/2019 Pet w/Axumin inconclusive. Looking at Cyberknife for two possible bone Matastisis

  9. #19
    Busby, here are the two links I keep on my favorites. One seems dire, the other not so much. I suppose if you average the
    two there a 58% chance of not having BCR at 5 years.

    https://www.renalandurologynews.com/...al-recurrence/

    https://bmccancer.biomedcentral.com/...885-017-3307-4

    n= 767 vs 118. So the larger study may be more accurate.

    You will also read comments like, “Accurate determination of LVI remains crucial, according to the investigators. Retraction artefacts of surrounding stromal tissue, for example, can mimic vascular invasion“, in a lot of data.
    Last edited by Duck2; 08-19-2019 at 10:55 PM.
    YOB 1957

    DX 12/18, GS 8, 4+4 6/12 cores, LL Apex 100%, LM Apex 60%, LL Mid 50%, LMM 40%, LL Base 5%, LM <5%, Right side negative.

    2/25/19 Robotic Laparoendoscopic Single Site Surgery outpatient Cleveland Clinic,

    3/6/19. Pathology - Grade Group 4 with Intraductal Carcinoma
    T3aNO, GS8, 21 mm unifocal tumor 10%. -7 Nodes, - SV, - Margins, - PNI,
    - bladder neck neg., +LVI, + EPE non focal apex/mid lateral 1mm max extension, Cribriform pattern present. Decipher .86 High Risk.

    PSA 3/27/19 .03. (29 days)
    4/25/19 <.03. (58 days)
    5/25/19 <.02. (88 days)
    9/10/2019. <.02. (198 days)

    ADT - 6/19 - 6/21
    ART - 78Gy 8/19 - 9/19

  10. #20
    Quote Originally Posted by Duck2 View Post
    Busby, here are the two links I keep on my favorites. One seems dire, the other not so much. I suppose if you average the
    two there a 58% chance of not having BCR at 5 years.

    https://www.renalandurologynews.com/...al-recurrence/

    https://bmccancer.biomedcentral.com/...885-017-3307-4

    n= 767 vs 118. So the larger study may be more accurate.

    You will also read comments like, “Accurate determination of LVI remains crucial, according to the investigators. Retraction artefacts of surrounding stromal tissue, for example, can mimic vascular invasion“, in a lot of data.
    Busby needs to be concerned with his persistent and rising PSA and what treatment is best right now. BCR by 5 yr isn't germain (he is essentially at 0.2 and rising right now!). BCR is a return of, and rising, PSA only when it occurs after an essentially zero PSA--that is not Busby's situation.

    Djin
    Last edited by DjinTonic; 08-20-2019 at 12:15 AM.
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (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

 

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