Recent dx of Prostate Ca

Timlong

tarhoosier said:

Surgery? What?
I am saying exactly what the doctor is saying: high chance of metastasis and strong likelihood of recurrence (persistence) after surgery. BUT, I am saying that this contra-indicates surgery. If the doctor KNOWS he will be unsuccessful in curing the patient, yet believes the best choice is to undergo surgery, with all the problems, certain impotence, significant chance of incontinence (whether he admits it, this is so) he is a man looking for his own interests and not that of the patient. Radiation with hormones is the preferred choice in such cases as it avoids the surgical risks and side effects. If the doctor can explain how certain surgical failure can be best for the patient I would be interested the magical thinking with which he supports this decision.
I wish I could be more uplifting. I would create such a post if there were not so much research and data indicating that radiation with hormones is absolutely the better choice.
Do not depend on me, or anyone here for your decision. A medical oncologist who can make an opinion without bias would be the very best investment of time and money.

MRI Results for Tim.
Endo Rectal Mri results are in:

MRI Results:
Extensive peripheral zone tumor with slight bulging of left prostatic
capsule, but without gross extracapsular spread of tumor noted. No
pelvic lymphadenopathy or osseous metastases are seen.

Dr. Eun and staff has indicated this does not change the plan from Non-nerve sparing robotic surgery with pelvic and bladder lymphnode resection. Follow up with HDT and possible radiation depending on post-surg PSA.

Feedback wanted.

Jeff

tarhoosier

Timlong said:

MRI Results for Tim.
Endo Rectal Mri results are in:

MRI Results:
Extensive peripheral zone tumor with slight bulging of left prostatic
capsule, but without gross extracapsular spread of tumor noted. No
pelvic lymphadenopathy or osseous metastases are seen.

Dr. Eun and staff has indicated this does not change the plan from Non-nerve sparing robotic surgery with pelvic and bladder lymphnode resection. Follow up with HDT and possible radiation depending on post-surg PSA.

Feedback wanted.

Jeff

No opinion
Jeff:
This is not a second opinion. You have just posted the same opinion from the same doctor as before, just with more information about the patient. There is nothing about this additional information that changes anything posted in this thread.
If Hopkins recommends surgery I will be floored.

Timlong

tarhoosier said:

No opinion
Jeff:
This is not a second opinion. You have just posted the same opinion from the same doctor as before, just with more information about the patient. There is nothing about this additional information that changes anything posted in this thread.
If Hopkins recommends surgery I will be floored.

Second Opinion
Fox Chase (second opinion) indicated that if the E-MRI does not show obvious spread to the rectum they would concur with Penn's plan. Fox and Penn indicated that if in the event they see more during surgery (not seen by the MRI)such as obvious spread to the muscles or the rectum they would "Close". I think this "lets go in and have a look approach" has merit(not to be compared to Pelosi's lets pass the bill to see whats in it) and at the same time frozen sections are done to establish good margins.
It seems to me that based on Tim's age of 51 that a Multimodal Approach may be the best course of action. From my reasearch... the LOW RISK Pca patients have about the same survival in surgery/no surgery with radiation. However, in HIGH RISK Pca as in Tim's case
the morality is three times higher in patients on HT vs. surgery and twice as high in patients on radiation vs. surgery.
Granted...if he were 81 and not 51 the plan would not be Multimodal.
The third opinion is fourthcoming from Hopkins.
I will keep you all advised and thank you for the input and feedback.

Jeff

Timlong

Timlong said:

Second Opinion
Fox Chase (second opinion) indicated that if the E-MRI does not show obvious spread to the rectum they would concur with Penn's plan. Fox and Penn indicated that if in the event they see more during surgery (not seen by the MRI)such as obvious spread to the muscles or the rectum they would "Close". I think this "lets go in and have a look approach" has merit(not to be compared to Pelosi's lets pass the bill to see whats in it) and at the same time frozen sections are done to establish good margins.
It seems to me that based on Tim's age of 51 that a Multimodal Approach may be the best course of action. From my reasearch... the LOW RISK Pca patients have about the same survival in surgery/no surgery with radiation. However, in HIGH RISK Pca as in Tim's case
the morality is three times higher in patients on HT vs. surgery and twice as high in patients on radiation vs. surgery.
Granted...if he were 81 and not 51 the plan would not be Multimodal.
The third opinion is fourthcoming from Hopkins.
I will keep you all advised and thank you for the input and feedback.

Jeff

Path report for Tim post surgery
Tim had the RP last Wednesday. Non-nerve sparing with lymph nodes. He is recovering well and today Dr. Eun advised +SV and the margins and lymph nodes were negative. I have not read the report yet but I will soon. He now has a choice to either watch and wait or do radiation as a precaution to the pelvic area. So... is this a typical report for a gleason 9 with 12 of 12 positive or did he dodge a bullet?

Feedback please.......Jeff

Timlong

Timlong said:

Path report for Tim post surgery
Tim had the RP last Wednesday. Non-nerve sparing with lymph nodes. He is recovering well and today Dr. Eun advised +SV and the margins and lymph nodes were negative. I have not read the report yet but I will soon. He now has a choice to either watch and wait or do radiation as a precaution to the pelvic area. So... is this a typical report for a gleason 9 with 12 of 12 positive or did he dodge a bullet?

Feedback please.......Jeff

Pathology report..I'm more confused now.
I am more confused now than ever. I realize that positive seminal vesicles means extraprostatic extension. But if the lymphnodes and margins are negative does this mean they got it all? ...can you have negative margins and yet still have microscopic mets?

Jeff

tarhoosier

Timlong said:

Pathology report..I'm more confused now.
I am more confused now than ever. I realize that positive seminal vesicles means extraprostatic extension. But if the lymphnodes and margins are negative does this mean they got it all? ...can you have negative margins and yet still have microscopic mets?

Jeff

SVI
Jeff (Tim)
The seminal vesicle invasion (SVI) is one of the most common places to find escaping prostate cancer tumor cells. The vesicles are attached to the prostate and it is the most natural path for tumor growth. When men show this finding at pathology it means that long time remission is still possible, though with G9 the likelihood of remission is reduced.
Tumor cells (of all types and origin) may spread in ultramicroscopic amounts to any place in the body. It is impossible, at this point, to tell if lymph, blood or other paths have allowed such cancer cells to move elsewhere.
This is the wonder of psa. Men do not have to wait and wonder in exquisite agony for the arrival of symptoms to know they are in trouble. Nor do they have to undergo serious chemo and radiation without knowing the target or even the reality of recurrence. PSA tells all. There is a lot more research about adjuvant and/or salvage treatment with radiation for men such as Tim. SWOG 8794 (Saint Google can answer) is an excellent example of a practice changing trial which found that radiation within some months of surgery had long-lasting and successful results (for most).
For now he must get to work on healing and resting. That is Job #1.

Timlong

tarhoosier said:

SVI
Jeff (Tim)
The seminal vesicle invasion (SVI) is one of the most common places to find escaping prostate cancer tumor cells. The vesicles are attached to the prostate and it is the most natural path for tumor growth. When men show this finding at pathology it means that long time remission is still possible, though with G9 the likelihood of remission is reduced.
Tumor cells (of all types and origin) may spread in ultramicroscopic amounts to any place in the body. It is impossible, at this point, to tell if lymph, blood or other paths have allowed such cancer cells to move elsewhere.
This is the wonder of psa. Men do not have to wait and wonder in exquisite agony for the arrival of symptoms to know they are in trouble. Nor do they have to undergo serious chemo and radiation without knowing the target or even the reality of recurrence. PSA tells all. There is a lot more research about adjuvant and/or salvage treatment with radiation for men such as Tim. SWOG 8794 (Saint Google can answer) is an excellent example of a practice changing trial which found that radiation within some months of surgery had long-lasting and successful results (for most).
For now he must get to work on healing and resting. That is Job #1.

Thanks for all the input. Tim's Path report....
Bilaeral prostatic adenocarcinoma. Gleason score 4+5=9 with extension into
bilateral seminal vesicles and associated extensive perineural invasion.
-Tumor present at left apical margin of resection.
-Bilateral vasa deferentia with no specific patholic change.

Prostate size 39 grams
Percent of prostate involved 70%
Extraprostatic extension into SV
SV invasion present
Margin, positive, invasive, left apical
Lymph-vascular invasion: not identified
Perineural invasion: present
Patholic staging: pTNM
Primary tumor: pT3B; sv invasion
Regional lymph nodes(pn) : pNO; involved: 0/examined: 12; no regional lymph node metastasis
Distant metasasis: not applicable


So guys....help me make some sense out of this so I can better understand it and convey what it means to Tim.

Thanx.....Jeff

Kongo

Timlong said:

Thanks for all the input. Tim's Path report....
Bilaeral prostatic adenocarcinoma. Gleason score 4+5=9 with extension into
bilateral seminal vesicles and associated extensive perineural invasion.
-Tumor present at left apical margin of resection.
-Bilateral vasa deferentia with no specific patholic change.

Prostate size 39 grams
Percent of prostate involved 70%
Extraprostatic extension into SV
SV invasion present
Margin, positive, invasive, left apical
Lymph-vascular invasion: not identified
Perineural invasion: present
Patholic staging: pTNM
Primary tumor: pT3B; sv invasion
Regional lymph nodes(pn) : pNO; involved: 0/examined: 12; no regional lymph node metastasis
Distant metasasis: not applicable


So guys....help me make some sense out of this so I can better understand it and convey what it means to Tim.

Thanx.....Jeff

No Surprises Here
Jeff,

This report confirms the warnings myself and others provided about the likely outcome of surgery with the pre-treatment pathology of a Gleason 9. The SVI and positive margin indicate that the prostate cancer had spread beyond the prostate capsule. Although distant metastasis was not seen, you can be pretty sure that there is microscopic cancer in distant organs (the bones are one of the most common places) that will eventually evidence itself through rising PSA scores.

The positive margin indicates that cancer remains in the tissue immediately surrounding the prostate gland. The other downside of a positive margin is that the act of cutting through the cancer just spilled millions of pissed off cancer cells into Tim's bloodstream.

I suggest your friend speak to other doctors now (radiologists and oncologists) about the best way to address this. My guess is that they will recommend a protocol that includes hormone therapy and adjuvent radiation. (Adjuvent radiation means that it is taken before a determination of a biochemical recurrence). You may wish to review this article with your friend: http://www.medscape.com/viewarticle/574809

Prostate cancer in the lymph nodes occurs at a much lower percentage of high risk cases so that fact that it isn't there is a good thing but not necessarily a cause for celebration.

Prostate cancer outside the gland tends to grow faster than when it is inside the prostate. You can expect that early PSA scores will be higher than what you wanted and that they will continue to increase over time, indicating the growth of prostate cancer. Hormone therapy will significantly slow this growth for a number of years. Radiation to the prostate bed will also help curb the expansion of the cancer cells near to where the prostate used to be.

Hopefully your friend recovers quickly from many of the effects of surgery. Since he did not receive nerve sparing surgery he will be unable to achieve an erection without the help of an injection so his sex life is pretty much over at this point. He should be visiting an ED expert and learn about penile injections which is about the only way I know of that will enable him to regain the ability to have an erection sufficient for penetration. Orgasms are another issue altogether but the ED specialists may be able to help there as well. Hopefully he does not have to endure incontinence too. Limp and leaking is no way for a man to go through life.

In my mind, the surgery wasn't worth it. The sad part is that all the indication before surgery indicated he was still going to be between a rock and a hard spot after surgery but he went ahead and did it anyway. Sorry, but I just don't get it. The cancer in the prostate is not what kills men. It's the prostate cancer that makes it to other organs and to the bones and removing the prostate didn't do anything at all to address that. Hopefully he will consider HT and radiation which does have an ability to slow the growth of this cancer.

K

Swingshiftworker

Kongo said:

No Surprises Here
Jeff,

This report confirms the warnings myself and others provided about the likely outcome of surgery with the pre-treatment pathology of a Gleason 9. The SVI and positive margin indicate that the prostate cancer had spread beyond the prostate capsule. Although distant metastasis was not seen, you can be pretty sure that there is microscopic cancer in distant organs (the bones are one of the most common places) that will eventually evidence itself through rising PSA scores.

The positive margin indicates that cancer remains in the tissue immediately surrounding the prostate gland. The other downside of a positive margin is that the act of cutting through the cancer just spilled millions of pissed off cancer cells into Tim's bloodstream.

I suggest your friend speak to other doctors now (radiologists and oncologists) about the best way to address this. My guess is that they will recommend a protocol that includes hormone therapy and adjuvent radiation. (Adjuvent radiation means that it is taken before a determination of a biochemical recurrence). You may wish to review this article with your friend: http://www.medscape.com/viewarticle/574809

Prostate cancer in the lymph nodes occurs at a much lower percentage of high risk cases so that fact that it isn't there is a good thing but not necessarily a cause for celebration.

Prostate cancer outside the gland tends to grow faster than when it is inside the prostate. You can expect that early PSA scores will be higher than what you wanted and that they will continue to increase over time, indicating the growth of prostate cancer. Hormone therapy will significantly slow this growth for a number of years. Radiation to the prostate bed will also help curb the expansion of the cancer cells near to where the prostate used to be.

Hopefully your friend recovers quickly from many of the effects of surgery. Since he did not receive nerve sparing surgery he will be unable to achieve an erection without the help of an injection so his sex life is pretty much over at this point. He should be visiting an ED expert and learn about penile injections which is about the only way I know of that will enable him to regain the ability to have an erection sufficient for penetration. Orgasms are another issue altogether but the ED specialists may be able to help there as well. Hopefully he does not have to endure incontinence too. Limp and leaking is no way for a man to go through life.

In my mind, the surgery wasn't worth it. The sad part is that all the indication before surgery indicated he was still going to be between a rock and a hard spot after surgery but he went ahead and did it anyway. Sorry, but I just don't get it. The cancer in the prostate is not what kills men. It's the prostate cancer that makes it to other organs and to the bones and removing the prostate didn't do anything at all to address that. Hopefully he will consider HT and radiation which does have an ability to slow the growth of this cancer.

K

I Agree!
I completely agree w/Kongo's assessment of this tragic situation.

Hopefully, others in similar circumstances will learn that surgery -- at any stage -- is NOT necessarily the solution to the problem of PCa.

Timlong

Swingshiftworker said:

I Agree!
I completely agree w/Kongo's assessment of this tragic situation.

Hopefully, others in similar circumstances will learn that surgery -- at any stage -- is NOT necessarily the solution to the problem of PCa.

I hear you all loud and clear about surgery/no surgery
I understand that CSS, DPFS and BPFS percentages seem to be the same for a Gleason 9
surgery/no surgery but there are conclusions in many reports out there that say in high risk cases RP is indicated for a 51 year old man. I think this is part of an aggressive mutimodal treatment along with RT and ADT.
Tim was holding back urine right after cath removal and now (2 weeks) later has a drip now and then. As far as erections....yep, no more. He is on the pump so the pup wont atrophy. He has recovered well thanks to Dr. Eun at Penn who does great bladder necks.
Anyway guys he has a follow up next month for PSA (waiting for the Lupron to end) and I will keep you all posted.

Jeff

Timlong

Kongo said:

No Surprises Here
Jeff,

This report confirms the warnings myself and others provided about the likely outcome of surgery with the pre-treatment pathology of a Gleason 9. The SVI and positive margin indicate that the prostate cancer had spread beyond the prostate capsule. Although distant metastasis was not seen, you can be pretty sure that there is microscopic cancer in distant organs (the bones are one of the most common places) that will eventually evidence itself through rising PSA scores.

The positive margin indicates that cancer remains in the tissue immediately surrounding the prostate gland. The other downside of a positive margin is that the act of cutting through the cancer just spilled millions of pissed off cancer cells into Tim's bloodstream.

I suggest your friend speak to other doctors now (radiologists and oncologists) about the best way to address this. My guess is that they will recommend a protocol that includes hormone therapy and adjuvent radiation. (Adjuvent radiation means that it is taken before a determination of a biochemical recurrence). You may wish to review this article with your friend: http://www.medscape.com/viewarticle/574809

Prostate cancer in the lymph nodes occurs at a much lower percentage of high risk cases so that fact that it isn't there is a good thing but not necessarily a cause for celebration.

Prostate cancer outside the gland tends to grow faster than when it is inside the prostate. You can expect that early PSA scores will be higher than what you wanted and that they will continue to increase over time, indicating the growth of prostate cancer. Hormone therapy will significantly slow this growth for a number of years. Radiation to the prostate bed will also help curb the expansion of the cancer cells near to where the prostate used to be.

Hopefully your friend recovers quickly from many of the effects of surgery. Since he did not receive nerve sparing surgery he will be unable to achieve an erection without the help of an injection so his sex life is pretty much over at this point. He should be visiting an ED expert and learn about penile injections which is about the only way I know of that will enable him to regain the ability to have an erection sufficient for penetration. Orgasms are another issue altogether but the ED specialists may be able to help there as well. Hopefully he does not have to endure incontinence too. Limp and leaking is no way for a man to go through life.

In my mind, the surgery wasn't worth it. The sad part is that all the indication before surgery indicated he was still going to be between a rock and a hard spot after surgery but he went ahead and did it anyway. Sorry, but I just don't get it. The cancer in the prostate is not what kills men. It's the prostate cancer that makes it to other organs and to the bones and removing the prostate didn't do anything at all to address that. Hopefully he will consider HT and radiation which does have an ability to slow the growth of this cancer.

K

Question for you Kongo....
Your refernce to cutting through a positive margin and spilling out prostate cancer cells
doesnt seem to be a concern when a core biobsy is conducted through the rectal wall directly into a tumor mass. Any idea why surgeons are not concerned with the spread of cancers cells in this instance?

Jeff

Kongo

Timlong said:

Question for you Kongo....
Your refernce to cutting through a positive margin and spilling out prostate cancer cells
doesnt seem to be a concern when a core biobsy is conducted through the rectal wall directly into a tumor mass. Any idea why surgeons are not concerned with the spread of cancers cells in this instance?

Jeff

My view
Actually, Jeff, I would be very concerned about the potential to spread the cancer by means of a biopsy, particularly when the needle comes through the rectal wall. There have been many documented instances of prostate cancer growing along the needle tracks left by a biopsy from a prostate that has been later removed. In breast cancer, there is a 50% higher recurrence rate for women ho have repeated biopsies rather than lumpectomies.

Many, if not most, doctors deny that there is any danger from the biopsy (other than the 4-6% who end up with sepsis) but there have never have been any studies that I know about just some papers that document the phenonema of needle tracking and so forth. Who would fund this study anyway? There is no other way to determine cancer for sure today. But if you think about it, it makes sense (at least to me) that pushing a needle through a sterile, enclosed gland and pentrating a cancer tumor then withdrawing the needle certainly has the potential to spread loose cells through the blood stream or lymph system.

It's a difficult issue because in most situations you can't make a positive cancer diagnosis without that biopsy slide with the cancer cells on it so in my mind, you're damned if you do and damned if you don't.

With the case of a positive margin, you know for sure that you have just cut across a cancer tumor leaving some behind. The cells ripped off the tumor mass during surgery are going into the blood stream. Nowhere else for them to go. Our immunce system will likely get most of these cells but who wants cancer cells flowing around in the blood stream looking for a new home?

I should state again here that this is my personal opinon drawn from a lot of reading about this but I am not a doctor or have anything at all to do with the medical field except as a patient.

Good luck to you and your friend.

barry2468

Kongo said:

My view
Actually, Jeff, I would be very concerned about the potential to spread the cancer by means of a biopsy, particularly when the needle comes through the rectal wall. There have been many documented instances of prostate cancer growing along the needle tracks left by a biopsy from a prostate that has been later removed. In breast cancer, there is a 50% higher recurrence rate for women ho have repeated biopsies rather than lumpectomies.

Many, if not most, doctors deny that there is any danger from the biopsy (other than the 4-6% who end up with sepsis) but there have never have been any studies that I know about just some papers that document the phenonema of needle tracking and so forth. Who would fund this study anyway? There is no other way to determine cancer for sure today. But if you think about it, it makes sense (at least to me) that pushing a needle through a sterile, enclosed gland and pentrating a cancer tumor then withdrawing the needle certainly has the potential to spread loose cells through the blood stream or lymph system.

It's a difficult issue because in most situations you can't make a positive cancer diagnosis without that biopsy slide with the cancer cells on it so in my mind, you're damned if you do and damned if you don't.

With the case of a positive margin, you know for sure that you have just cut across a cancer tumor leaving some behind. The cells ripped off the tumor mass during surgery are going into the blood stream. Nowhere else for them to go. Our immunce system will likely get most of these cells but who wants cancer cells flowing around in the blood stream looking for a new home?

I should state again here that this is my personal opinon drawn from a lot of reading about this but I am not a doctor or have anything at all to do with the medical field except as a patient.

Good luck to you and your friend.

A view on biopsy
I have always been against biopsies for prostate. I waited until my psa rose to the point where bone mets showed themselves (my Urologist would not act otherwise) to have ADT. Like you I would not have the prostate removed under any circumstances. That was 2 years ago and other than a few side-effects I am just sailing along as usual. I am 75. Barry

Timlong

barry2468 said:

A view on biopsy
I have always been against biopsies for prostate. I waited until my psa rose to the point where bone mets showed themselves (my Urologist would not act otherwise) to have ADT. Like you I would not have the prostate removed under any circumstances. That was 2 years ago and other than a few side-effects I am just sailing along as usual. I am 75. Barry

Tim's Post RP PSA is in.
Tim met with Dr. Eun today. He has about 98% continence and has recoverd well.
His PSA is now 0.03. He will meet with an oncle soon to discuss HDT and Proton beam at Penn.
I am ramping up again into research mode for Tim and welcome your comments and feedback. Would you say this 0.03 post RP of a G9 with SVI,EPE and PNI (pt3bnomo) is promising?

Jeff

VascodaGama

Timlong said:

Tim's Post RP PSA is in.
Tim met with Dr. Eun today. He has about 98% continence and has recoverd well.
His PSA is now 0.03. He will meet with an oncle soon to discuss HDT and Proton beam at Penn.
I am ramping up again into research mode for Tim and welcome your comments and feedback. Would you say this 0.03 post RP of a G9 with SVI,EPE and PNI (pt3bnomo) is promising?

Jeff

Jeff

Yes it is. After surgery a PSA lower than 0.06 is considered at remission levels. This is to congratulate your friend and you both should enjoy a “smashed” evening out.
I hope the PSA can hold at those levels for a very long time which could mean cure.

Congratulations.
VG

Kongo

Timlong said:

Tim's Post RP PSA is in.
Tim met with Dr. Eun today. He has about 98% continence and has recoverd well.
His PSA is now 0.03. He will meet with an oncle soon to discuss HDT and Proton beam at Penn.
I am ramping up again into research mode for Tim and welcome your comments and feedback. Would you say this 0.03 post RP of a G9 with SVI,EPE and PNI (pt3bnomo) is promising?

Jeff

Agree
I agree with Vasco that it seems very promising. I hope the numbers stay low.

K

bdhilton

There are many legit studies
There are many legit studies on the outcome of having a positive margin....So much is not known...A urologist I know (told me on this forum) that most of the outcome be it surgery, radiation or nothing at all is the "luck of the draw"...I wish you the best in your journey….

http://urology.jhu.edu/newsletter/prostate_cancer410.php

".....And, even if the surgical margins are positive, this does not necessarily mean that the cancer is left behind. How can this be? "There are several different explanations why, when the margins are positive, the tumor may still be cure," says Epstein. "One is that literally you cut across the last few tumor cells" -- that what appears to be remaining cancer is actually a cross-section of the perimeter of the tumor. "And even though it looks like it's a positive margin, there's really nothing left in the patient."

Another explanation is that the act of surgery itself finishes the job, killing any remaining cells. No cut or injury to tissue happens in a vacuum; the area around the cut is affected, too. (Think of lightning striking a tree; the tree dies, but so does a ring of grass around it). "When the surgeon cuts across tissue the blood supply is cut off, there's dead tissue, and that can kill off the last few tumor cells that might have been left behind," Epstein says...."

Another interesting article and there are many... http://www.renalandurologynews.com/positive-margins-do-not-predict-prostate-cancer-mortality/article/136072/

"....Of the patients who died from prostate cancer, 85 had PSM and 95 had negative margins. Although 15-year PCSM was significantly higher for patients with PSM than for those with negative margins (11% vs. 6%), PSM was not associated with PCSM after adjusting for standard clinical parameters, year of surgery, and postoperative radiotherapy...."

Here is great one too but for me I do not give these studies 100% on their Statistical analysis but...Statistical analysis http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2430098/?tool=pmcentrez

"...Only 4 factors had a statistically significant association with incident prostate cancer: higher tomato sauce intake was associated with a decreased risk, and African–American race, a positive family history of prostate cancer, and higher α-linolenic acid intake were associated with an increased risk. In contrast, most items were significantly associated with risk of fatal prostate cancer. Specifically, recent smoking history, positive family history of prostate cancer, taller height, higher BMI, and high intake of total energy, calcium and α-linolenic acid were associated with a statistically significant increased risk, whereas higher vigorous physical activity level was associated with lower risk of fatal prostate cancer. For tomato sauce, the magnitude of the inverse association was similar for fatal as for total prostate cancer, and the smaller numbers may have prevented us from detecting a statistically significant association with fatal prostate cancer..."

ralph.townsend1

Timlong
Well the Doc is right, Throw the book at it. 12/12 Postive 4+5 gleason 9. I 6/12 positive 4+5 gleason 9 in Oct. 2008. I would get as soon or sooner a CT and bone scan to see where this monster is!!!

I'm a stage 4 or T3bN1 or metastatic prostate cancer in the lymph nodes. I'm on lupron with a drug called Zytiga. :-) MD Anderson is doing a great job. They found mine in the Lymph nodes march 2010 and kept it contain in the pelvis and PSA between 1 to 3.

But time will proably run out. reality check.

Timlong

ralph.townsend1 said:

Timlong
Well the Doc is right, Throw the book at it. 12/12 Postive 4+5 gleason 9. I 6/12 positive 4+5 gleason 9 in Oct. 2008. I would get as soon or sooner a CT and bone scan to see where this monster is!!!

I'm a stage 4 or T3bN1 or metastatic prostate cancer in the lymph nodes. I'm on lupron with a drug called Zytiga. :-) MD Anderson is doing a great job. They found mine in the Lymph nodes march 2010 and kept it contain in the pelvis and PSA between 1 to 3.

But time will proably run out. reality check.

Update on Tim
The Radiation Oncle at Penn's PBT center indicated that PBT to the prostate bed after RP is just starting to be considered at Penn though it is used elsewhere as experemental adjuvant therapy. She feels that due to the Penumbra effect they are unable to treat his prostate bed without missing areas. It seems that IMRT will more likley be able to create the "dose cloud" needed to treat the specific area. She is not happy with his post RP psa of 0.03 however has indicated the possibility that since his margins were positive the psa is being generated from the + margin left behind and perhaps IMRT could cure him. She has indicated a 66% chance of cure. This goes against everything I've researched on a G-9 with 12/12, SVI,PNE,ECE and psa 22. She is not ruling out Mets but has given him and his wife new hope for cure. Has anyone out there been given this chance for cure with these numbers?
Now, I do like the fact that Penn uses certain procedures for IMRT as follows:
1. Cat Scan/MRI Planning
2. Higher Dosages 70 Grey
3. Comb Beam CT scan prior to each session help line up each day
4. Endo rectal ballon each treatment to reduce toxcicity to the rectum and takes away
the daily variables.
So...the bottom line is PBT is out and HDT and IMRT is the plan.

tarhoosier

Timlong said:

Update on Tim
The Radiation Oncle at Penn's PBT center indicated that PBT to the prostate bed after RP is just starting to be considered at Penn though it is used elsewhere as experemental adjuvant therapy. She feels that due to the Penumbra effect they are unable to treat his prostate bed without missing areas. It seems that IMRT will more likley be able to create the "dose cloud" needed to treat the specific area. She is not happy with his post RP psa of 0.03 however has indicated the possibility that since his margins were positive the psa is being generated from the + margin left behind and perhaps IMRT could cure him. She has indicated a 66% chance of cure. This goes against everything I've researched on a G-9 with 12/12, SVI,PNE,ECE and psa 22. She is not ruling out Mets but has given him and his wife new hope for cure. Has anyone out there been given this chance for cure with these numbers?
Now, I do like the fact that Penn uses certain procedures for IMRT as follows:
1. Cat Scan/MRI Planning
2. Higher Dosages 70 Grey
3. Comb Beam CT scan prior to each session help line up each day
4. Endo rectal ballon each treatment to reduce toxcicity to the rectum and takes away
the daily variables.
So...the bottom line is PBT is out and HDT and IMRT is the plan.

Spectacular
That psa result, within the pathology reported, is a spectacularly good result. Go for the win with IMRT, but wait until all urinary function is regained. He has been delivered an astounding bit of good, no GREAT luck.