Advice

[sharpcut]

I had RALP at MSK on 8/16/18 MY Pretreatment PSA was 6.23 ng/ml

Post Surgery Gleason Primary 4 Secondary 3 Total Gleason 7. Grade Group 2

Clinical Stage. T 1 C NO MX Tumor Type Adenocarcinoma Primary Tumor pT2 Organ confined Perineural Invasion identified No Lymph Node or Seminal Vessel metastasis

Post Surgery PSA was 9/18/19. PSA .07 ng/ml 10/21/19 PSA .08 ng/ml

12/5/19. PSA. .10. ng/ml................ Met MSK RO. Borys R. Mychalczak

He wants to get a combined MRI/CAT scan because of my bilateral TITANIUM RESURFACED HIPS but doesn't expect to see anything He wants to start ADT soon. Once PSA hits .2 He wants to Radiate Complete Pelvic Area Prostate Bed Pelvic Lymph Nodes with the hope that nothing has spread ! ? My GI tract is a mess I have IBS symptoms Loose stools gas" the runs". Not interested in making it worse

Getting a consultation with COC. on Monday. I would like to start the Protocol asap

Sticking to my plant based diet and getting Pectin Powder as well

In South Florida. Anyone have a good RO or MO down this way ? I am in Deerfield Beach Florida thinking of getting a second opinion

Thank You all. Happy New Year Keith

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[Tall_Allen]

The latest studies find that starting SRT when PSA reaches 0.1 or 3 consecutive rises is as good as immediate treatment.

pcnrv.blogspot.com/2019/09/...

Whether to cover the entire pelvic area is controversial. With early treatment it may not be needed, but it is still very much a judgment call. If you had positive margins, you could possibly get the prostate bed only irradiated. But with negative margins (and PNI), it increases the probability that the cancer has already escaped to the lymph nodes. I think either approach is reasonable. The same could be said for ADT vs no ADT. (BTW- "Primary 4, Secondary 3" is Grade Group 3 (not 2)).

MSK is probably among the best at radiation therapy, but it is reasonable to hear other opinions.

[sharpcut in reply to Tall_Allen]

Thank You Tall Allen I think I transposed the numbers. Post Surgery was primary 3 Secomdary 4 Would be grade 2 ?

[Tall_Allen in reply to sharpcut]

In that case, adjuvant ADT may not improve the outcome of SRT at your current PSA.

[sharpcut in reply to Tall_Allen]

Not at .1 but what about .2. As I recall he said .2 would trigger ADT in preparation for Radiation ......So at .2 Maybe ADT for 2 months prior to Radiation

[Tall_Allen in reply to sharpcut]

MSK uses a lower PSA cutoff than Spratt recommends. But if you have SRT at 0.1, I don't think even they would require adjuvant ADT.

[sharpcut in reply to Tall_Allen]

Thanks Tall Allen. Dr Mychalczak would begin Radiation after PSA .2 He definitely thinks ADT adds to the success Rate. He came up with an 8% increase in successful treatment whatever that means

[Tall_Allen in reply to sharpcut]

But what if you started SRT at 0.1 ? Would he still use ADT?

[sharpcut in reply to Tall_Allen]

Good Question. Tall Allen . I will ask him via email !!

BTW. the list of questions to ask any RO in an initial meeting that you directed me to was very helpful. Thank You

[dentaltwin in reply to Tall_Allen]

I'm confused. Why would negative margins increase the chances there has been lymphatic spread?

[Gemlin_ in reply to dentaltwin]

With positive margins, PSA probably comes from the remaining tumor tissue. With negative margins, PSA probably comes from lymph nodes (usually the first place that cancer spreads).

[dentaltwin in reply to Gemlin_]

Gotcha--thanks--that makes sense.

[jimbay]

Isn’t Gleason 4+3 grade group 3?

(3+4 is grade group 2.)

[sharpcut]

Yes Thanks jimbay