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Recurrance-Looking for information

mjbruce
Posts: 5
Joined: Nov 2009

Hello everyone,
I am officially out of the zero club. 22 months after RP, my last 2 psa's were .4 and .3(a week later tested at the same lab). My local urologist and the surgeon who performed the robotic assisted RP are in agreement that I'm having a recurrance. The drs. both suggest salvage radiation therapy

My radiation oncologist has suggested short term hormone therapy with Trelstar. Two shot lasting six months. 39 visits for the radiotherapy.

My history (off the top of my head):
1st PSA(ever)at age 50 on my regular yearly physical exam on 6/2009 was 12.9,
I was then sent to local urologist for another PSA 7/2009 which was 15.2
The biopsy soon followed. 10 of 12 cores were positive(can't remember %)
Consulted with two different surgeons and a radiology oncologist.
Was interested in Cyberknife, but they told me my Gleason was too high. Finally decided to have the RP done.
CT Scan and bone scan didn't show anything at all, it appeared as if the cancer hadn't spread.
My cancer was graded T2C. The initial the Gleason was 4+3=7.
My pre-op bloodwork showed PSA of 19.8
Surgery went well, and surgeon removed seminal vesicles and several lymph nodes. Recovered all functions within a couple of months. Use viagra ocassionally, leaky once in great while(no worse than before surgery)
Post-op pathology showed no perineural invasion, margins were clear, although the cancer was very close to the margins. No cancer in seminal vesicles or lymph nodes. There
was some capsular extension and I believe the weight of my prostate was around 29 grams. Final Gleason score was 3+4=7. All subsequent PSA's had been undetectable until 9/1/11.

I'm looking for any information about short term hormone therapy used with radiation. I'm finding some info on the web, and if anyone has had these therapies, your advice and experiences are greatly appreciated.
Thank you,
Michael

Old-timer's picture
Old-timer
Posts: 109
Joined: Apr 2011

I recommend that you not rush a decision. Check the PSA after another three months. It seems to me you could defer further treatment until the PSA reaches 1.0. That was how my urlogist dealt with my recurrence. As you probably know, there are questions about the reliability of PSA as a measure of prostate cancer.

I am not an expert on prostate cancer, but I have lived with it 20 years. I had surgery in 1991, radiation in 2005, and hormone therapy in 2008. The original surgery was successful for 13 years. The radiation was unsuccessful. Because of the hormone therapy, my cancer is now in remission. I am 85. I would be glad to comment in further detail if you wish. You may find other discussion board entries of mine by using the search engine.

Good luck to you.

mjbruce
Posts: 5
Joined: Nov 2009

Thanks for your post.
Did you have short term or long term hormone therapy?
What did they give you? How were the side effects?

tarhoosier
Posts: 182
Joined: Aug 2006

Michael:
I think that your radiologist is correct that radiotherapy with hormone deprivation will be of likely benefit to you. The first question is when to begin. You could try supplements, diet changes, weight loss and other mild non-prescription treatments for the next few months to see if some delay could be gained. This is unlikely to be a long term answer though you may wish to try it if you are willing to deal with psa anxiety and if you accept the concept of delay of treatment. You must have your psa checked regularly and certainly more often than every three months. You could try ultrasensitive tests (to 2, or 3 decimals) if you accept the added anxiety. Monthly would be best: Same lab, same protocol, same time of day for blood draw.
Any G 4 is of concern and the pathology showed close-to-the-margin and ECE (extra-capsular extension), factors for local spread. Proper radiation with the best of modern equipment in the control of a top radiologist is a kind of magic. I am convinced it would work on you. No one can predict long term results effectively, as the man who posts here just before me can attest.
There is significant information out there about adjuvant hormone treatment with radiation and the best I can say is that there is nothing that shows the results are less than radiation alone, and many trials and reports show that it is better, at least within the time period that the men were followed. Any effects from radiation are reversable, with the possible exception of delayed impotence. Ask your doctor (as they say).
It appears you had a good surgeon who did the best he could and if your radiologist is as good, or better, your long term chances of success are reasonably strong. I wish you the very best.
I am certain that the recent report that the USPSTF recommends eliminating PSA tests for men would cause you to be concerned.

ncobjim
Posts: 35
Joined: Nov 2010

Micheal
Your numbers are close to what i had. Had RP in 2006 after PSA of 4.8 with Gleason of 3 + 4 =7
Post RP went to 0.05. Stayed that way till spring of 2009. Went to 0.1 in spring of 09 then 0.2 in winter of 09. Went to 0.4 in spring of 2010. Was sent immediatly to Radiation Onc.
Had 38 IMRT treatments along with Trelstar 6 month HT. 2 shots 3 months each. Did not really have much trouble with the HT. Hot flashes were not real bad. It did cause me some bad sleeping problems but i finally got the right meds to help out till i was thru it.
In May of 2011 my PSA was 0.01. Go for another test in November. Makes it nervous time again.

Hope whatever decision you make turns out good for you.

mjbruce
Posts: 5
Joined: Nov 2009

Thanks for your encouragement and advice. Still trying to gather all of the information I can. Should know Monday if my insurance even covers the hormone therapy.
Two of the my 3 doctors are advocating the therapy, saying their experience with it has had positive results. The other, while not really against it, believes the proof of benefits aren't sufficient enough for him to go ahead and order hormone therapy.
I have to say at this point I'm leaning toward getting the shots(Insurance company may have the final say). But, like I said I'm still trying to learn more.
I'm not the watch and wait type of person. PSA anxiety was pretty brutal for me, and the pathology of my cancer leads me to believe that waiting may not be the best thing for me to do.
I,ve always been active and have been more diet conscious than ever the last 7-8 years

NCOBJIM- if you don't mind me asking, have you had any problems with delayed impotence after radiation? It's ok if you don't want to respond.
My e-mail is mnbruce@hotmail.com if you want more privacy

Tarhoosier: I take it you lived in Indiana at some time? Northeast IN, north of Ft. Wayne

CAN NOT IMAGINE! where I'd be right now if there were no PSA. I had virtually no symptoms, a little leak maybe once, twice a month, thought it was my own fault for holding it too long.
Over 2 years later now, can only guess where the cancer might be by now!

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