Post Op PSA

nalexander

Hi All

My dad was diagnosed with PC in April 2009. He was told he was a Gleason 6 (3+3), PSA 5.5 with 2 out of 12 biopsies positive. He had the diVinci Robotics in Nov 2009 and was told he was actually a Gleason 7 (3+4) and the cancer was more aggressive than they originally told him. It had moved into the seminal vesicle but his margins were clear. We just got his 3 month post op PSA and he is at .1. His doctor is recommending radiation. Just wondering if anyone out there could offer their experience with radiation after surgery. Also wondering if anyone else had seminal vesicle involvement and what your outcome has been? My dad is recovering very well from surgery and has minimal side effects. We hate to see him add radiation to this since he is doing so well but we want to do anything and everything possible to keep his cancer from coming back.

Thank you for your responses.
Nicole

lewvino

Sonny and a few others have
Sonny and a few others have had radiation following surgery and I'm sure they will respond.
I would recommend getting the radiation and nipping it before it has a chance! Just my opinion. I have Gleason 7 (3+4) positive margin, some involvment in the nerve bundle. Just got my news today that six month psa is 0.

Best withes to you and your dad.

Larry age 55

randy_in_indy

lewvino said:

Sonny and a few others have
Sonny and a few others have had radiation following surgery and I'm sure they will respond.
I would recommend getting the radiation and nipping it before it has a chance! Just my opinion. I have Gleason 7 (3+4) positive margin, some involvment in the nerve bundle. Just got my news today that six month psa is 0.

Best withes to you and your dad.

Larry age 55

Larry - GREAT NEWS - you flunked with flying ZERO's
Glad to hear of that news!!!! Now keep FLUNKING!

randy_in_indy

Nicole
Many times the biopsy gleason score raises with post op pathology. Mine did. I have a question for you though....you say you are getting the 3 month PSA results now...10 months after the operation you stated he had in April of 2009. Can you please elaborate on that before I give my take?

Thanks

randy in indy

nalexander

randy_in_indy said:

Nicole
Many times the biopsy gleason score raises with post op pathology. Mine did. I have a question for you though....you say you are getting the 3 month PSA results now...10 months after the operation you stated he had in April of 2009. Can you please elaborate on that before I give my take?

Thanks

randy in indy

Hi Randy
My dad was
Hi Randy

My dad was diagnosed in April but did not have surgery until Nov 2009. He had surgery on Nov 13, 2009 so we just got his 3 month PSA results today. Sorry for the confusion.

Nicole

Trew

Rad
Looks to me like your dad is going to join the radiation club. Nice group. Personally, if the doctor's recommend radiation- do it. End stage PC must be avoided at all costs. It gets very nasty at the end.

I think my first PSA post op was .67- that was before the first shot. The Doc in Lansing didn't make too much out of it, but the Doctor in Loma Linda didn't like it and it was one of the factors used to push me out of proton treatment into the radiation dept.

I wish your dad well.

randy_in_indy

nalexander said:

Hi Randy
My dad was
Hi Randy

My dad was diagnosed in April but did not have surgery until Nov 2009. He had surgery on Nov 13, 2009 so we just got his 3 month PSA results today. Sorry for the confusion.

Nicole

Ah Nicole - sorry I re-read it was clear I just missed it
I did not have any positive margins and my first PSA of 6 weeks was non-detectable so I am in the clear SO FAR.... Here is one thing I heard when talking to a very well respected Oncologist trained at General Mass radiation dept - well thought of. You want to let the Da Vinci procedure heal for as long as you can prior to radiation for 2 reasons:

1. less damage to the good tissue receiving the radiation and
2. It suposedly freezes the position you are in as far as incontinence and ED at time you start the rad treatments....seems like I have read on here from personal experience the point of recovery on incontinence and ED actually regresses some after radiation starts.

My advice is to Seek out additional Oncologists hopefully sepcializing in Prostate cancer with a good reputation and success rate and get a consult. Arm yourself with the most amount of information from as many identified and certified experts as you can find.

Hope this helps

Randy in indy

WHW

I Had Surgery and Then Radiation
Nicole,

As you can see from my signature line, I was Gleason 7 (3+4) at diagnosis and changed to Gleason 7 (4+3) at path report. A 4+3 is a more aggressive cancer than the 3+4. I had positive margins and extraprostatic extension. All not really good signs. I have however talked with guys who had worse post-path reports and are still pulling zeroes years later. They never had the need to follow up the surgery with anything else.

There has been a lot of discussion about when to pull the trigger on following surgery with radiation. Numbers are thrown around like .1, .4, .5, 1.0, you name it and someone's doctor uses that number as guideline.

My thirty day test was .4, followed by a .53 and .6 very closely thereafter. I talked it over with my Radiation Oncologist at MD Anderson Cancer Center in Orlando, and he said it was my call. He did not have a magic number and had started radiation anywhere from .2 to 2.0.

Personally, I think your dad's doctor is being a little bit on the aggressive side. You don't say whether the doctor was the surgeon, is your dad's Uro or what. That info would be helpful to us in evaluating your situation. Whatever the case is, your dad needs to consult with a Radiation Oncologist that is well versed in dealing with PCa. That is where you will find the true guidance and evaluation of your dad's situation.

Your dad has just barely healed from the surgery, it might be a little early to jump in the Radiation pool. You say your dad is recovering well with minimal side effects. Is he fully continent? Most ROs won't start rad until the patient is continent. The rad can worsen the situation if the patient is incontinent. My RO asked that right up front and told me that he would not start the rad until I had regained continence.

I did elect to go with the rad and fairly soon too. I started at 74 days post surgery. But my numbers were climbing much more rapidly that your fathers. I didn't suffer many side effects during the treatments, but did go through a spell for the 3 weeks following. The build up of the rad takes it's toll on the urinary tract and the bladder. I experienced extreme urgency and frequency just short of the point of incontinence. I can see where an incontinent person would have had great difficulties.

Today I am 5 weeks post treatment and everything is back to normal as far as urinary issues. I am still dealing with the ED from the surgery, but things are improving. I know that in time the effect of the rad may cause further ED issues, but we'll just wait and see.

I hope this info has been helpful. Bless you for being there for your dad,

Sonny

60 years old when diagnosed
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
Gleason Score (3+4) 7 in all positive cores
da Vinci 9/17/09
Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5%
positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT completed 1/15/10 35 treatments- 70Gy

gjeck6874

Post-Op Radiation
Hi Nicole,

Diagnosed with a PSA in Nov. '03 of 4.0 and 5.8 in Jan. '04 w/biopsy indicating cancer in my prostate; I had my radical postatectomy in March 2004. The post-operation pathological report indicated that my Gleason Score was 7 (3+4) and although the surgical margins were clear; the tumor had broken thru the capsule. I was informed that the cancer had not left the localized area of my prostate.

The recomendation was to have a series of 37 external beam radiation treatments aimed at the prostate bed region which I began in May '04 and finished in July '04.(5x/week w/none on weekends).

In regards to my radiation side effects, I tolerated the treatments quite well. I was lucky that the irritations to my "back-side" were minimal and I had no loss of continence. I looked at this treatment as assurance that the cancer NOT re-occuring would go from 40% to 85% .

My PSA has been 0.1 the entire time after the operation & radiation. However, in December 2009 PSA rose to 0.2 and after a second test this week it has stayed at 0.2 ... But that's another story ...

Hope this helps out in your decision making.

Geoff K.

tarhoosier

SWOG 8794
Nicole;
Your father may wish to read the results of the clinical trial SWOG 8794. This trial started in the 1990's and followed men much like your father with surgery and possible residual cancer. This trial was conducted by Ian Thompson and Don Trump, among others, and they are the top researchers in our field in North America. The results of this trial must be taken seriously. The results were published in JAMA (Journal of AMA) and is free and available on the web. There has also been a more recent update of the results. This trial is mature and the authors believe the results should change the standard of care for men who are like your father appears to be. This is the best and highest level of evidence and proof available. Every man is his position should be aware of this trial and the recommendations therefrom.

nalexander

WHW said:

I Had Surgery and Then Radiation
Nicole,

As you can see from my signature line, I was Gleason 7 (3+4) at diagnosis and changed to Gleason 7 (4+3) at path report. A 4+3 is a more aggressive cancer than the 3+4. I had positive margins and extraprostatic extension. All not really good signs. I have however talked with guys who had worse post-path reports and are still pulling zeroes years later. They never had the need to follow up the surgery with anything else.

There has been a lot of discussion about when to pull the trigger on following surgery with radiation. Numbers are thrown around like .1, .4, .5, 1.0, you name it and someone's doctor uses that number as guideline.

My thirty day test was .4, followed by a .53 and .6 very closely thereafter. I talked it over with my Radiation Oncologist at MD Anderson Cancer Center in Orlando, and he said it was my call. He did not have a magic number and had started radiation anywhere from .2 to 2.0.

Personally, I think your dad's doctor is being a little bit on the aggressive side. You don't say whether the doctor was the surgeon, is your dad's Uro or what. That info would be helpful to us in evaluating your situation. Whatever the case is, your dad needs to consult with a Radiation Oncologist that is well versed in dealing with PCa. That is where you will find the true guidance and evaluation of your dad's situation.

Your dad has just barely healed from the surgery, it might be a little early to jump in the Radiation pool. You say your dad is recovering well with minimal side effects. Is he fully continent? Most ROs won't start rad until the patient is continent. The rad can worsen the situation if the patient is incontinent. My RO asked that right up front and told me that he would not start the rad until I had regained continence.

I did elect to go with the rad and fairly soon too. I started at 74 days post surgery. But my numbers were climbing much more rapidly that your fathers. I didn't suffer many side effects during the treatments, but did go through a spell for the 3 weeks following. The build up of the rad takes it's toll on the urinary tract and the bladder. I experienced extreme urgency and frequency just short of the point of incontinence. I can see where an incontinent person would have had great difficulties.

Today I am 5 weeks post treatment and everything is back to normal as far as urinary issues. I am still dealing with the ED from the surgery, but things are improving. I know that in time the effect of the rad may cause further ED issues, but we'll just wait and see.

I hope this info has been helpful. Bless you for being there for your dad,

Sonny

60 years old when diagnosed
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
Gleason Score (3+4) 7 in all positive cores
da Vinci 9/17/09
Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5%
positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT completed 1/15/10 35 treatments- 70Gy

A little more info..
Thank you for all the responses. We are trying to arm ourselves with as much info as possible on how to deal with PC. My dad's doctor who is recommending radiation is his surgeon. He did tell my dad that he is being aggressive but feels he should be considering it went into the seminal vesicle. We have an appointment with a Radiation Oncologist on March 4th who comes highly recommended. We will see what he thinks.

Recovery wise my dad is almost 4 months out of surgery and has no incontinence. He was one of the lucky ones that had control from the day he got his catheter removed. As far as ED goes my mom has shared with me that it is a work in progress.

Personally I think my dad should do the radiation. Because it went to the seminal vesicle I think we should be agressive. My family knows all to well about radiation though. My mom is a 14 year colon/rectal cancer survivor who has horrible bladder damage from her radiation. She is just short of incontinent so it will be heartbreaking for us if that happens to my dad too. But in the big picture my mom is still here enjoying her grandkids and that is what matters! I would rather have my dad with us with side effects than not at all!

Thanks again to everyone for the responses.

Nicole