Just wanted to make a quick summary of my current situation 6weeks post RP.My pathology report says I have T3b N1 type of cancer,Gleason 9 and first PSA is 0.2.
Tomorrow I have my first televisit appointment with a radiation oncologist recommended by my urologist.He said I should wait to get treatment until my incontinence is under control but with a PSA of 0.2 I am worried that oncologist will suggest starting Lupron and maybe radiation. I feel like I am rushed into treatment or is this the right way of treatment?
Thank you in advance for your advice!
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VioS
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I had the same pathology as you except my PSA was .9 6 weeks after surgery. I put off radiation for about 7 months until my incontinence was good. I did start Lupron and Zytiga right away though, to keep the the little critters at bay, and my PSA went to <.1 in about 4 weeks. No side effects worth mentioning. Good luck to you!
It largely depends on your PSA-DT... would be good to discuss this study with your RO... with Gl-9, the decision may weigh more toward salvage radiation.
A second study of 635 patients with PSA-recurrence after prostatectomy at Johns Hopkins Hospital compared salvage radiation therapy (either alone or with ADT) against observation.22 In that study, salvage radiation was associated with a 3-fold increase in prostate-cancer specific survival after a median follow-up of 6 years after biochemical recurrence as compared with observation, but this improvement was limited to men with PSADT less than 6 months. Interestingly, salvage radiotherapy was still associated with significant improvement in prostate-specific survival when administered to patients with PSA above 2 ng/mL, only if those patients also had PSADT less than 6 months. No significant increase in prostate cancer–specific survival was seen in patients who were administered salvage radiation more than 2 years after PSA recurrence. In addition, ADT did not significantly improve prostate-cancer specific survival in this patient population.22 The greater impact of salvage radiation on prostate-specific survival in patients with PSADT less than 6 months was supported by an analysis of a subset of the Duke patients who had comorbidities at the time of PSA recurrence. Significant reduction in all-cause mortality was associated with salvage radiation in both patients with a PSAD
T less than 6 months (HR, 0.35; P=.042) and a PSADT greater than 6 months (HR, 0.60; P=.04), but the reduction in all-cause mortality was nearly 60% greater in the patients with PSADT less than 6 months.
What was your PSA before surgery? There are two very long shots that I would have investigated. 1) Lab error 2) Pre surgery PSA decay. With a repeat test after 2 weeks , before taking any drugs, you can rule both of them out.
If you get a 6-month shot of Lupron now, that will stop your cancer's progression to allow time for your incontinence to heal. Also a good idea to get an Axumin PET scan now (before the Lupron shot) to check for any distant metastases. If your PET scan is clear, your N1 means that you absolutely will need salvage radiation and long-term ADT (2-3 years), but, as I said, you can wait 6 months to start it if you get a 6-month shot of Lupron.
My 2nd PSA after RP is 0.29 and RO gave me prescription for Bicalutamide 50 mg for 4-6 months,two weeks after start Lupron and stay for 2 years, start Radiation in 2-3 months.
I really work hard on resolving my incontinence problem with physical therapy but it’s making little progress.
Should I ask again for the Axumin pet scan and pay out of pocket because the RO said I don’t qualify yet.
Really appreciate you and everyone else’s input on this site.
It is very expensive. The Axumin scan is approved for biochemical recurrence after prostatectomy - why wouldn't your insurance cover it? Granted, the detection rate is low at your PSA, but it should be covered. If not, it's not worth a lot of anxiety - as long as the entire pelvic lymph node field is covered by radiation.
I had the same Dx as yours about 3 years ago. I had the max radiation (79 Gy) to the gland itself AND had radiation to the pelvic region (node positive = N1) AND was given ADT treatment (casodex + lupron) for roughly 18 months.
RP was not an option for me - I was 'too far gone' (G9) for a successful RP, but I must point out that cancerous nodes are NOT dealt with via RP.
Therefore, there's a GAP in your treatment, IMO.
I think you need to address these issues with an MO / RO to ensure that you are on the right path.
Tall Allen has made some key comments that I would seriously consider.
FYI - I'm on an ADT holiday - my 'T' is back to normal and my PSA has climbed back to 1.3.
My PSA was over 300 when I started and my nadir reached undetectable while yours has yet to hit 'zero'.
This is no time to panic, but I think there's more research and feedback that you need to perform.
GAP means 'something appears to be missing or needs further evaluation".
You need to do some more reading and research. This is nothing new - WE all started out NOT knowing or understanding what was happening when we got the news.
Perhaps your medical team is waiting to see the "final results, after a suitable time lapse" - I'm no expert, therefore, waiting for several weeks IS advised before starting any other forms of treatment. Once the gland is removed, you would anticipate having trace amounts of PSA after a time delay - assuming there's still some residual left in the bloodstream that stops being produced.
Hang in there - there's a way ahead to figure out what is best 4 U .....
Your Dx (diagnosis) points to advanced / aggressive risk, but that doesn't mean it can't be 'cured' - at least you are still a candidate for a very positive outcome.
Like I said, no two patients are identical and it is hard to make concrete predictions so early on YOUR treatment path.
Side effects for ADT were most of the most common ones (not pleasant 4 me), but not everyone goes thru it the same - there's several factors to consider.
Today, I'm doing well - some think I'm in remission - time will tell .....
6 weeks is a bit early for a PSA post RP. My URO recommended 8-10 weeks. I had GL 9 stage 4...and post RP was .01 at 10 weeks. I'd suggest another reading at 8-10 weeks. My readings in the 2 subsequent quarterly PSAs have both been at .05...so the URO and MO both wish to wait and see before starting any next steps.
My PSA @ 6 weeks was 0.41. I started on Eligard. At least bit should keep it from spreading until I start radiation treatment in June. Slowly my incontinence is getting better, but it’s going to take months I believe to gain full control . I think, by what I’ve been researching you are on the right path.
Reminder: Could have, should have and would have are NO NO's here.... You appear to be in a sort of panic mode. So I could, should and would tell you that Pca is slow growing.... Take your sweet ass time to come to decisions.... DON'T PANIC.....
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