Rising PSA after RP and Salvage Radiation

mrspjd

caseyh said:

Additional Info
What factors first lead your MD to recommend biopsy that subsequently found G 3+4? At initial dx pre RP, what was PSA, T stage

My (no longer) GP missed a nodule on my prostate during a annual physical approximately 6 months prior to it being discovered during a visit to my gastroenterologist. He advised that I get a biopsy ASAP. My PSA was 2.6 at the time. That was my last PSA reading prior to surgery. The postoperative pathology report revealed an actual 4+3=7 prostatic andenocarcinoma, predominantly involving the left posterior quadrant with small focus in the right anterior quadrant. There was no perineural invasion or extracapsular extension appreciated. The surgical margins were free from tumor. The pelvic lymph nodes (8 were biopsied) were negative for metastatic spread.
____________

Where were the two positive nodes identified/located, distal, local, specifically?

The radiologist's report describes the nodes as bilateral axillary, mediastinal, right hilar and right retrocrural lymph nodes
_____________

Can you describe more about Varian’s DART technology of IG/IMRT that was used to deliver rad to the 2 positive nodes?

From the Datolli website: DART using all methods of 4D IG-IMRT...strict immobilization is required using an individualized "alpha cradle". A SonArray 4D Ultrasound Guided System is utilized moments before each treatment to ensure that the organs are exactly positioned for the DART "beamlets."- Even the simple motion of breathing can shift the position of the prostate, which is tracked and corrected by a special respiratory gating device. These and other tools allow us to take the 4th dimension of motion into account, ensuring that the right dose is delivered at exactly the right time.
_____________

Were the nodes biopsied (laparoscopic) after being found on the Feraheme MRI (Tesla 3?) before RT?

No
_____________

Were other diagnostic tests ordered to rule out distal tumors to bone or other soft tissue?

The scans done in Orlando are as follows:
Whole body 18-FDG PET/CT scan
Whole body F-18 Sodium Fluoride PET/CT bone scan.
CT of the chest without & with contrast
CT of the abdomen and pelvis without & with contrast,
MRI of the pelvis without & with contrast
MRI of the abdomen without & with contrast
MRI of the neck without & with contrast.
3-D color flow Doppler of prostate bed (Done at Datolli)

Thank you
Casey,

Thanks for your reply. I hope you consider posting/sharing updates, including more info about your PCa/PSA history re the journey leading up to present day PCa status. IMHO, those stats & experiences, including PSA history, are critical in helping others understand and learn about the process that lead to recent testing and tx decisions.

mrspjd

caseyh said:

Thanks Tarhoosier
I have shared a lot of personal information in hopes that it may be of some help to other members of the Group. Unfortunately, the thread had deteriorated from useful information about USPIO to speculation as to why I used three labs. If it is that important, and I don't believe it is, why not just ask me why that was necessary at the time? The answer is really quite simple. I think that when things reach this level of activity, it discourages the exchange of personal information and ideas by patients and is counterproductive to what the group is trying to accomplish. I also think that we don't check our right to privacy at the door when we join a group. We all have a right to keep some facts to ourselves until we are ready to share them.

In my opinion, this thread has run it's course. Therefore, I have decided to no longer respond to posts on the thread. Thanks again to you and all who have been supportive. I remain a passionate USPIO supporter and would be more than happy to share any information I have with Patients who contact me via CSN Email.

PCa issues are real and PCa issues are stressful
Frankly, I think one of the reasons the latter half of this thread was interesting is because of the questions that were asked. Quite possibly, those questions were insightful, sophisticated, advanced and provocative, and were instrumental in eliciting info that made for a more informative, perhaps even educational, PCa discussion on this thread.

IMHO, the issue here is not about invasion of privacy, personal questions, “noise,” sharing personal info, questions asked or not asked, or being intrusive. It’s also not about any discussion or thread that has “deteriorated” or a “…thread that has run its course.” How could it be, especially when a knowledgeable, respected, veteran CSN poster (Tarhoosier) comments “This has been one of the best discussion strings ever here. I have really enjoyed it. Thanks to EVERYONE involved. Keep going!”

This is a discussion forum about PCa. Every question asked to casey (and others) was appropriate and germane to PCa and their experiences. The questions were no more of a personal, private or intrusive nature than the questions often asked of other posters by long time CSN members such as “Hopeful and Opt,” aka Ira, himself. If the “noise” (whatever that is) is too loud or too stressful, then perhaps turning off the computer might help reduce stress levels. PCa issues are real and PCa issues are stressful. It may be easier for some to ignore/avoid PCa issues in hopes that ignoring them will make them go away. They won’t. Instead of avoidance or ignoring stressful PCa issues, more effective practical strategies for coping with stress and anxiety might include Mindful Meditation, daily exercise and a healthy diet, etc.

Questions related to casey’s posts were asked with care, compassion & tact and were respectful of privacy. No answers were “forced” and all info was provided willingly...that is, until concerns were expressed about why casey’s posts were removed from another PCa forum. Here’s one more question for “casey” or “Olborne” or whatever other names he’s currently using on different PCa forums (no worries, it’s a rhetorical question): Why DID the admin of another PCa forum determine your posts to be inappropriate and remove them from that website?

If a 12 year PCa survivor limits posts to info solely about recent txs, then previous info related to past PCa/PSA/tx history and experiences are critical and extremely relevant in order for others to fully comprehend and understand present day choices and decisions, particularly when those choices are related to newer imaging and/or tx modalities. If answers are “really quite simple” as casey states, then it begs the question: Why not just skip all the drama and provide/share add’l PCa info/answers/experiences with all forum members rather than only with limited, selected, members via private email.

If anyone--patient or patient advocate--would like info about MRI w/ Feraheme (USPIO) etc., I suggest going directly to the provider’s website. I’ve heard that their patient service staff will put prospective patients in touch with men who have had the advanced imaging and RT tx. If positive lymph nodes and/or mets are identified, the RT may be done by your own (hometown) experienced & skilled RO once the imaging is complete & a report generated.

More than ever, I am an outspoken advocate for PCa awareness and education. Sharing PCa experiences & info have been a part of that process on CSN and, it continues to be part of the process elsewhere. I hold others to the same standard and expect no less from knowledgeable men AND women in the PCa trenches who share this passion. Together, I believe we will continue to make “noise” about PCa. If the noise is too loud or too stressful for some, they can ignore it or purchase ear plugs. Or, they can embrace it.

My husband and I have been on this PCa journey for the last 2+ years since his dx in Feb 2010 of T3, locally advanced, high volume intermediate-high risk PCa. His family has a history of PCa. The men in my family have a history of PCa. PJD and I have 3 adult sons who have a significantly higher risk for PCa than most young men their age due to our combined familial PCa risk factors. As a wife, mother, sister and daughter, PCa is with me 24/7. PCa is not my “hobby” nor is it used to occupy any idle time as a diversion from boredom. PCa is a passion. I hope that those who share that same passion will continue to ask germane, challenging & provocative questions related to PCa issues & topics. For many of us, the PCa education process is on-going and never ending.

Be well.

M

backinthesaddle

mrspjd said:

PCa issues are real and PCa issues are stressful
Frankly, I think one of the reasons the latter half of this thread was interesting is because of the questions that were asked. Quite possibly, those questions were insightful, sophisticated, advanced and provocative, and were instrumental in eliciting info that made for a more informative, perhaps even educational, PCa discussion on this thread.

IMHO, the issue here is not about invasion of privacy, personal questions, “noise,” sharing personal info, questions asked or not asked, or being intrusive. It’s also not about any discussion or thread that has “deteriorated” or a “…thread that has run its course.” How could it be, especially when a knowledgeable, respected, veteran CSN poster (Tarhoosier) comments “This has been one of the best discussion strings ever here. I have really enjoyed it. Thanks to EVERYONE involved. Keep going!”

This is a discussion forum about PCa. Every question asked to casey (and others) was appropriate and germane to PCa and their experiences. The questions were no more of a personal, private or intrusive nature than the questions often asked of other posters by long time CSN members such as “Hopeful and Opt,” aka Ira, himself. If the “noise” (whatever that is) is too loud or too stressful, then perhaps turning off the computer might help reduce stress levels. PCa issues are real and PCa issues are stressful. It may be easier for some to ignore/avoid PCa issues in hopes that ignoring them will make them go away. They won’t. Instead of avoidance or ignoring stressful PCa issues, more effective practical strategies for coping with stress and anxiety might include Mindful Meditation, daily exercise and a healthy diet, etc.

Questions related to casey’s posts were asked with care, compassion & tact and were respectful of privacy. No answers were “forced” and all info was provided willingly...that is, until concerns were expressed about why casey’s posts were removed from another PCa forum. Here’s one more question for “casey” or “Olborne” or whatever other names he’s currently using on different PCa forums (no worries, it’s a rhetorical question): Why DID the admin of another PCa forum determine your posts to be inappropriate and remove them from that website?

If a 12 year PCa survivor limits posts to info solely about recent txs, then previous info related to past PCa/PSA/tx history and experiences are critical and extremely relevant in order for others to fully comprehend and understand present day choices and decisions, particularly when those choices are related to newer imaging and/or tx modalities. If answers are “really quite simple” as casey states, then it begs the question: Why not just skip all the drama and provide/share add’l PCa info/answers/experiences with all forum members rather than only with limited, selected, members via private email.

If anyone--patient or patient advocate--would like info about MRI w/ Feraheme (USPIO) etc., I suggest going directly to the provider’s website. I’ve heard that their patient service staff will put prospective patients in touch with men who have had the advanced imaging and RT tx. If positive lymph nodes and/or mets are identified, the RT may be done by your own (hometown) experienced & skilled RO once the imaging is complete & a report generated.

More than ever, I am an outspoken advocate for PCa awareness and education. Sharing PCa experiences & info have been a part of that process on CSN and, it continues to be part of the process elsewhere. I hold others to the same standard and expect no less from knowledgeable men AND women in the PCa trenches who share this passion. Together, I believe we will continue to make “noise” about PCa. If the noise is too loud or too stressful for some, they can ignore it or purchase ear plugs. Or, they can embrace it.

My husband and I have been on this PCa journey for the last 2+ years since his dx in Feb 2010 of T3, locally advanced, high volume intermediate-high risk PCa. His family has a history of PCa. The men in my family have a history of PCa. PJD and I have 3 adult sons who have a significantly higher risk for PCa than most young men their age due to our combined familial PCa risk factors. As a wife, mother, sister and daughter, PCa is with me 24/7. PCa is not my “hobby” nor is it used to occupy any idle time as a diversion from boredom. PCa is a passion. I hope that those who share that same passion will continue to ask germane, challenging & provocative questions related to PCa issues & topics. For many of us, the PCa education process is on-going and never ending.

Be well.

M

Mrspjd…You say you are an
Mrspjd…You say you are an “outspoken advocate” but for the most part, your comments seem over the top and at times from my perspective you are inappropriate in your line of questions and statements to others here. I can just imagine how I would be received on the Breast Cancer site here as a man pontificating as you do….I have a cancer that you will never have and from my perspective you need to stay in “check”….

mrspjd

backinthesaddle said:

Mrspjd…You say you are an
Mrspjd…You say you are an “outspoken advocate” but for the most part, your comments seem over the top and at times from my perspective you are inappropriate in your line of questions and statements to others here. I can just imagine how I would be received on the Breast Cancer site here as a man pontificating as you do….I have a cancer that you will never have and from my perspective you need to stay in “check”….

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backinthesaddle

mrspjd said:

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mrspjd

backinthesaddle said:

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Kongo

backinthesaddle said:

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Of Course MRSPJD is a Woman
Saddle,

I am quite confident that mrspjd is a woman; not that gender should be a factor here. This forum should be broad enough to host many views and backgrounds as long as they are respectful of others and avoid violating the clearly stated terms and conditions of forum membership.

While prostate cancer is indeed a male disease it affects spouses and other family members as well. Many women come here to seek answers and advice for their loved ones and that is a good thing. Many of us know first hand that support from our spouses is a critical factor in combatting this disease and over the past two years mrspjd has frequently provided perspectives that I am sure many patients and their spouses have found illuminating and comforting.

Like Swing, I too have found some of her posts in the last several months off putting. My skin is thick enough that when she tilts swords in my direction (which seems to be often) I’m not about to strike my tent but it IS annoying and I can appreciate how newer members might be wondering WTF? In balance, despite her occasional tedious lectures delivered from a high horse, she is quite knowledgeable, usually empathetic, and adds a perspective to the forum that otherwise would be missing. I wish she would be more sensitive to the fact that many men do not want to be lectured or questioned about the deeply personal decisions they make about their treatment by the opposite sex and that does not make them misogynistic.

I hope we can all keep in mind that the overarching purpose here is to help our brothers (and sisters) who suffer from this disease one way or another and broaden our knowledge about this insidious and very complex cancer.

K

Swingshiftworker

backinthesaddle said:

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FWIW
Backinthesaddle:

I have no idea if MrsPJD is a woman or not but I don't that think it really matters whether she is or not.

Like you, I sometimes find her remarks off-putting (although probably for different reasons than you do) but she is generally well informed about PCa -- its causes and treatments -- and I generally find the information that she provides useful, even though her remarks can sometimes be a bit disconcerting (even if NOT so intended).

That said, I don't want to get into a "flame" war about her (or your behavior) here and am happy to hear what you both have to say as long as it contributes to the discussion of PCa. However, IMHO, I do NOT think that either of your contributions to this current sub-thread is of any value to the discussion of PCa and I wish that BOTH of you would just knock it off.

I have not "flagged" either of your comments for review, even though I think they BOTH deserve such treatment, and just hope that you will simply end this budding feud by not commenting further.

Just my 2 cents on the topic and I, for 1, will NOT comment further. Ciao!

JamesBurgman

These recent weeks, I can
These recent weeks, I can hardly pee even if I really feel to pee. It takes some seconds before I can start peeing, I dont know if I am also experiencing prostate cancer. What are the things that I need to consider or to test to know if I have a prostate cancer or not?

PS,
James

Swingshiftworker

JamesBurgman said:

These recent weeks, I can
These recent weeks, I can hardly pee even if I really feel to pee. It takes some seconds before I can start peeing, I dont know if I am also experiencing prostate cancer. What are the things that I need to consider or to test to know if I have a prostate cancer or not?

PS,
James

Please start a new thread
James:

Rather than add your 1st post on this forum to an old thread on an unrelated topic, I suggest that you start a new one of your own so that the members here will recognize it as such and respond accordingly.

As for whether you have PCa (prostate cancer) or not, you can only tell for sure after a biopsy (which involves taking 10-12 tissue samples directly from your prostate). However, your inability to pee may be due to BPH (enlarged prostate) and have nothing to do w/PCa.

So, I suggest that you make an appointment to see a urologist or, if you're in an HMO, see your PCP (primary care physician) and ask for a referral to one based on your symptoms.

Have you ever had your PSA level tested? If so, what was the score? If not, that's something else you need to do too.

Your PSA score(s) won't tell you whether you have PCa or not but it's the only measure we have for monitoring the status of the prostate and, if you in fact have cancer, it will be the only means of determining whether your treatment has been successful or not.

Good luck!