Surgery AFTER Proton Radiation Treatment

[scarlino]

Anyone here experienced cancer re activation post-Proton radiation treatment? Underwent treatment in 2013. PSA rise began in March 2015. Went 2.4 to 39 by Sept. 2015. Scans showed metasteses to one pelvic lymph node. Began Degarelix in Nov 2015. PSA dropped to .05. And lymph node shrunk 50%. Scans showed no other spots in bones. Also started Cabozantinib in Feb 2016 for clinical trial. PSA began slow rise in June 2016, but doubling every month to 8.4 in Dec 2016. Changed over to Lupron. Doctor wants MRI of Prostate, thinks that is sight of activity. If so will wantvto freeze it, then remove along with pelvic lymph nodes. I am not particularly happy with this course. Having had Radiation to prostate, I'm concerned the surgery will be very difficult and may result in poor recovery with multiple issues. Has anyone undergone this surgery post-Proton Radiation? How did it affect you? I am at MD Anderson for treatment.

[stangoldberg]

You're at one of the best places for the treatment of prostate cancer. I was a guest of the Korean government when they opened their proton beam center in Seoul. While I found proton beam therapy very encouraging, the physicians there had difficulty answering questions that I had been raising since my own prostatectomy 13 years ago.

Basically, how do people choose between many different treatment approaches? Which ones have the best chance leading to survival? Which ones posed the greatest possibility of leading to reoccurrence? It is my understanding that the questions are still unanswered.

I wrote an article on competing therapies that may be helpful to you. (bit.ly/2h96oSi).

Think about asking your docs the questions I did 13 years ago. Good luck on your decision,

[scarlino in reply to stangoldberg]

Thanks much. I would not go anywhere else in TX. I have confidence in my care, just wanting to see what other people may have experienced in post Proton Radiation prostate surgery.

[Hidden]

You might consider HIFU as a salvage treatment. Unfortunately it isn't 'coded' by Medicare so insurance won't cover it. Useful for prostate involvement but not lymph nodes so it wouldn't offer a complete fix. Good luck. I had HIFU recently and I hope I don't see recurrence any time soon ... or ever. I guess I'll find out soon enough.

[yope4]

Hello Scarlino,

I have a similar track from yours. I was diagnosed late 2011 and started Proton Therapy (44 treatments) in 2012. My PSA bottomed out at 0.5 after a 6 months of rapid decline. All of the scans I had prior to treatment were negative to mets. My PSA started to rise from 0.5 and bounced up and down from there. Again, all types of scan couldn't detect any activity, until I had an MRI with colorectal coil. It found my left iliac lymph node to be swollen twice its size and evaluated as suspicious of adenocarcinoma. A subsequent biopsy confirmed it to be PCa and negative of lymphoma. My prostate was dx no focal recurrence. I went on 3-month Lupron shot. My PSA went down from 7.8 to 0.2. And 3 months later, it was undetectable. I'm still on the Lupron (for 15 months now) and thus far it has remained undetectable.

I haven't had another scan to determine if my lymph node is no longer swollen. I'll have to check with my onc next time. Plan is to maintain my Lupron until failure. Aside from negative side effects of ADT, I have a normal life and lesser expectations of what I can do compared to before. I have accepted that and have adjusted to a new lifestyle.

I believe that when you have lymph mode involvement, it's assumed not to be local anymore. Hence, the disease requires systemic treatment. Surgery and rad are local treatments. Although, it'll be good to know if your prostate is still involved in your PSA activity (cancerous or not). You may want to ask your onc if it's judicious to wait for Lupron to do its job in its initial phase before deciding on additional local treatments as those are pretty serious. Would a 3-month wait be too long to do that?

Anderson is one of the best in the treatment of PCa and so you have to weigh that heavily in your confidence of their recommendations. At some point, like where we are, they know a thing or 2 on PCa and that makes their plan the course of action for us.

I wish you the best.

[scarlino in reply to yope4]

Thanks much for your input!