Question about ART

bestbob

He Everyone, one week post RP, pathology report shows lymph nodes and margins negative, however, have Extraprostatic extension of neoplasm is present. My question is, having PSA in 3 months, and wondering if anyone went ahead and had ART (or anything else done) prior to the 3 month psa, and if that is even possible? Any pro's or con's.

TIA, Bob

Wheel

Bob,

It certainly never hurts to plan ahead for possible scenarios, but currently although you have extraprostatic extention, it sounds like it is still considered localized especially with your negative margins and nothing in the lumph nodes. Adjuvant RT (ART) is considered standard protocol for more aggressive Gleason 8,9 and 10 after a RP. There is reason its not for Gleason 7 and under as they don’t want to overtreat as it opens more issues regarding side effects. Just getting used to side effects from RP you don’t necessarily want to make any matters worse. They also typically wait to watch your PSA for the Gleason 7 and under and as it might rise to a certain level then begin SRT. I am not sure but the reason is no long term survival benefit seen in that group between starting ART or waiting for PSA increase and doing SRT. One benefit is certainly delay of further long term effects. Also a new school of thought for the Gleason 7 is PSA driven treatment or image driven treatment waiting until a PSMA Pet picks up something and treatment could be more focused. They also have seen where a PSA might increase and stay stable. Since a body can still produce PSA a little residual cancer may not need to be treated if it is not multiplying. There are now as patients get older and not wanting any further consequential side effects seeing instead of ADT for long periods, intermittent ADT to keep the cancer in check while minimizing side effects. Just go over everything with your Doctor and although with you having likely had second opinions prior to surgery don’t hesitate to still get second opinions for treatment post surgery.

Clevelandguy

Hi,

I would think after your 3mo PSA your doctor team will start to formulate a plan if needed. ART sounds like a good idea, see what your team recommends. In my humble non medical opinion let your body heal and return to the “new” normal before any other treatment options are performed. Has your doctor recommended anything before your first PSA?

Dave 3+4

bestbob

https://csn.cancer.org/discussion/comment/1717989#Comment_1717989

Dave, appreciate your very informative comments, and between yours and wheel, and I getting more research under my belt, it makes sense to wait for Psa at 4 months. Being only 7 days postoperative, I don’t want to beat up my body anymore.
Best Regarfs,

Bob

bestbob

Wheel, as Dave’s, your comments appreciated. Everything you say makes sense, I am going to wait for Psa results. If results are good, nothing lost, if not, then look at SRT or other options. With my Gleason at 3+4 and negative margins/lymph nodes, and your info, it’s the logical choice imo. Like others, I’ve been doing a lot of research, and getting confirming replies really helps.

Thanks,

Bob

Marlon

bob, they have to identify a place to focus the treatment, not just radiate the whole area. Hence the PSA level has to be high enough to look for a target.

bestbob

Marlon, thanks, I choose to wait, and your comments make it even better to wait. Had catheter removed 2 days ago, very little leakage, maybe one of the lucky ones, and feeling better every day. Hope your doing well..

Thanks,

Bob

Wheel

Bob,

Definitely envious of you only having your catheter 6 days. I had mine 11, but unfortunately the labor day weekend began at the time I likely would have had mine out which added 4 days until my appointment

bestbob

https://csn.cancer.org/discussion/comment/1718011#Comment_1718011

Wheel, The other side of my coin is, I was worried that it was coming out too soon, and 2 - that it may have to go back in if I couldn't expel the fluid when the bladder was filled up (to pull out the cath).

Wheel

It is so interesting how Doctors do everything differently. My bladder was never filled up to pull the catheter at the time. They just pulled it and sent me home, did not even check that I could go to the bathroom. I was scared how much pain there might be when it came out and I never felt anything. I had to ask the nurse was it out. The Doctor was actually on vacation and the nurse did it. The only thing is beforehand the Doctor had ordered at the hospital a Cystogram an hour before my appointment at his office to have the catheter out to check that there was no leaking from the bladder to the reattached urethra. They filled me up with saline solution and then the radiologist I guess watched me on screen as I emptied back into the catheter bag. Once I got to the Doctors office they still waited almost an hour for the results from the hospital. Fortunately for me also minimal leaking that I posted would you know you were leaking because my pad would seem dry.