Prostatectomy

[Bobbythefish]

I had mine removed in july last year and my PSA has gone up and they say some cells have been left in .Will radiotherapy kill the cells.

[Dr_WHO]

Depending on what your PSA level is, you may want to ask for CT/bone scans. This could direct the best treatment options. Note, if your PSA level is to low, the scans may not pick up anything. Some types of scans, like PET C11 are more sensitive, but very few hospitals offer them.

As to the best treatment to kill the cancer, all I can offer you is advice which you can then discuss with your medical team.

Radiation may kill, or at least slow down the cancer if it is still in the pelvic bed area. A dual approach, radiation combined with hormonal therapy may work even better. You may want to discuss with your team going on hormonal therapy a little before you start radiation. Hormonal treatment works by depriving the cancer of testosterone which it needs to "feed". That would starve the cancer cells weakened by the radiation. Is is an option to treat the cancer it has spread past the pelvic area (i.e. past where they normally radiate). Note, hormonal treatments like Lupron can vary in duration from three months to years.

Wishing you the best!

[Bobbythefish in reply to Dr_WHO]

My PSA has gone from 0.01 to 0.15 since july if that's any help

[Dr_WHO in reply to Bobbythefish]

Thank you. It looks like it may be to low for scans to pick up any cancer. Still discuss with your doctors hormonal in addition to radiation.

Let's hope that it does not go up any higher!

[mike72 in reply to Bobbythefish]

Hi Bobby, has anyone suggested you have any more tests?

[Bobbythefish in reply to mike72]

What tests

[mike72 in reply to Bobbythefish]

Mine went up a little 4yrs ago, and I was sent to Oncology. They got another blood test, and an MRI scan. No evidence of anything, except maybe a bit of tissue around. It's just that in my case no further action. But now it's up to 0.14 from around 0.11---.012, so it's back again. It is, I am assured by my GP, just the normal protocol. Can't help but notice quite a few contributors to this site seem not to have a Urology Dept who specialise in Prostate Cancer

I am a patient at the Nottingham City Hospital, who are very good. Maybe that's why they want to monitor so closely.

[Hidden in reply to mike72]

Interesting Mike that you say you've noted others saying that Urology depts don't seem to know much about prostate cancer! Maybe its those who don't actually do the surgery. I'd say that was true of mine, I actually taught them a few things. They didn't seem to know about "nerve sparing" and also I must have been their first ever patient who experiences erectile incontinence and climacturia! I'd like to hear from others about their experiences especially about the information they have been given (or not given), I'm doing a study of it.

[Hidden in reply to Hidden]

My urologist originally said I'd live 39 months.Now at 25 months and no visible signs I hope he was wrong..Mine is a master surgeon.He was pissed on my non op diagnosis and actually told me because he wasn't going to make any money on me. Well he did surgeries putting and replacing tubes and stints ,then I made him happy with an orchiectomy.My ono made some crucial decisions in My treatment that differed from the urologist opinion..One being R. T instead or chemo ..That was good for me.. Urologist are not as informed as a great prostate cancer specialist..I do owe being here to everyone that has ever helped me ..Including my Urologist..Everyone does There best..

[shealy]

The latest and greatest treatment recently is to go with ADT plus RT and also Docetaxel. The three are supposed to be the potential curative plan for locally advanced PCA.

[Muzzman in reply to shealy]

This is the treatment I am currently having. Back in March my first PSA was 232!! After a month on Zoladex implant it has come down to 49 so going the right way. Had a truss biopsy that gave a Gleason of 4+3. CT scan showed an enlarged pelvic wall lymph node so the team suggested the hormone, Docetaxel and radiotherapy treatment. Had my second chemo yesterday and touch wood the side effects to date have not been as bad as expected. I'm due for 6 chemo's 3 weeks apart. I'll get my next PSA level in a couple of weeks so hopefully it will have fallen again, dreaming of the day it's in the 0. .. range a lot of you talk about on here. Happy to help with any questions on this treatment plan.

Murray.

[Hidden]

Bobby, I had mine removed 5 years ago and they say some cells were left in. They say that because I have detectable levels of PSA. Logically since only prostate cells produce PSA, there must be cells left. BUT, medics I believe often say things assuming that you know exactly what they mean, so if you're not sure you have to ask them. The point is, there may be prostate cells left, but they aren't necessarily cancer cells. They could be just normal prostate cells. The surgeon has to be careful removing the gland because the upper and lower parts connect with your bladder sphincters. If they damage them, then there will be serious incontinence. So they might leave a few normal cells.

If the cells are cancer cells then you would expect to see your PSA rising. Urologists seem to vary considerably in what they say about this, but to my knowledge if your PSA rises in 3 consecutive tests (about 6 weeks apart), that might indicate further investigation. Further, it seems to be generally accepted that if it reaches 0.2 this is a recurrence.

So just knowing that they left some cells in, in itself doesn't really mean anything, what's happening to your PSA?

Furthermore, after your glands removed they send it to a lab and get a report which says whether the cancer cells have spread beyond the margins of the tissue they've removed. If there are, then this is called "positive margins". Did they tell you this?

[MelbourneDavid]

Timz's questions about the pathology report on the margins is very relevant. If there was a positive margin (cancer at the edge of the removed tissue) then there is likely cancer in the prostate bed and salvage radiation is likely to cure it.

The other important factors are your Gleason score on the pathology report, whether there was extracapsular extension, and your highest PSA before surgery.

Can you tell us these and the surgical margin result?

Even if the margins were negative (clear of cancer) radiation is the standard response to a fairly low but rising PSA after surgery like yours and has about a 50-50 chance of finishing off the cancer if it's not too aggressive. It depends on where the remaining cancer is.

This is definitely a scary time. If you can get to an oncologist who is expert in prostate cancer (a generourinary oncologist) they can give you good advice.

[Hidden]

I wasn't a candidate for surgery.R T and adt helped me to It his point of no signs..That's were we all want to be .. With luck it will help and with a lot of faith and treating yourself well you can have success..After near death , I'm riding the tide of good news while it lasts..My reality is that I can never drop my guard against P. C..It a devious aponenant.Fight hard in order to stay on top..