Recent dx of Prostate Ca

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  • ralph.townsend1
    ralph.townsend1 Member Posts: 359 Member
    #42
    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.

    Cure no
    Timlong, I toally agree with you on the number's. Cure no, but hope for some future. The numbers are to high. People like us are special, in that we can help and hope for is that these Doctor's to find a cure and can save the future generations!
  • Kongo
    Kongo Member Posts: 1,166 Member
    #43
    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.

    Jargon
    The penumbra effect with proton therapy, closely related to managing the Bragg peak, is inherent to the nature of PBT. She could just as easily have said proton therapy is not appropriate for treating the prostate bed and even though they may be starting to experiment with it doesn't mean it's an effective treatment.

    All photon radiation techniques like IMRT, CK, whatever, create a "dose cloud." It's simply the convergence of where the many directed beams are located. These so-called "dose clouds" are really just a geometric concentration of the beams. A 3-d layout resembles a cloud therefore the name but there is not actually a "cloud" created. The doctor could have just as easily have said, IMRT is more appropriate.

    Throwing this type of terminology around by a radiologist is, in my opinion, silly. Patients will undoubtedly nod sagely and think, ahh...the penumbra effect...or, gimme some of those dose clouds without having a clue as to what the doctor is telling them. Doctors should be clear and concise and try to do more to explain in lay terms what is going on. The object is to educate the patient not dazzle them.

    I too agree that the post RP PSA is a great reading. Not sure what she wants. The .035 is very close to the lowest possible detectable score for an ultra-sensitive PSA test and given the likely standard deviations inherent in the test is probably fine. A single test is meaningless at this point. You need a trend. So far the trend looks good.

    Best,

    K
  • starr15
    starr15 Member Posts: 32 Member
    #44
    "The positive margin
    " 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."

    There are no data to support this assertion that I know of. Please list any peer reviewed data that does.
  • Kongo
    Kongo Member Posts: 1,166 Member
    #45
    starr15 said:

    "The positive margin
    " 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."

    There are no data to support this assertion that I know of. Please list any peer reviewed data that does.

    Here's One
    http://www.europeanurology.com/article/S0302-2838(08)01173-1/pdf/Positive+Surgical+Margins+in+Radical+Prostatectomy:+Outlining+the+Problem+and+Its+Long-Term+Consequences

    So where would you suggest that those cancer cells dislodged by cutting across a margin go?
  • Timlong
    Timlong Member Posts: 42
    #46
    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

    Is Lupron skewing the number 5 months out?
    Tim had another Post Rp PSA which is still 0.03. I wanted to know what the T-level was so his dr. ordered that also. Much to the DR's surprise the T-level is 108 and Tim is asymtomatic. Could the 3 month dose of Lupron givin 5 months ago still be skewing the numbers? As I understand a normal T-level is 380-1100. My concern is if that if the T-level is this low and the PSA is 0.03 this may indicate a castrait resistant form of prostate cancer in the works. Perhaps Tim has been Low-T for years which would mean that G-9 tumor was a most aggressive Tiger. No one ever test his T-level over the past 6 months so I guess we wont know what the baseline is. He has not pulled the trigger yet on IMRT to the prostate bed. He feels like this is cured but I keep reminding him that a G-9, 12 0f 12 positive, ECE, PNE, SVI+ and Pos margin is likely to have reoccurance.

    Jeff
  • Timlong
    Timlong Member Posts: 42
    #47
    Kongo said:

    Here's One
    http://www.europeanurology.com/article/S0302-2838(08)01173-1/pdf/Positive+Surgical+Margins+in+Radical+Prostatectomy:+Outlining+the+Problem+and+Its+Long-Term+Consequences

    So where would you suggest that those cancer cells dislodged by cutting across a margin go?

    Is Lupron skewing the number 5 months out?
    Tim had another Post Rp PSA which is still 0.03. I wanted to know what the T-level was so his dr. ordered that also. Much to the DR's surprise the T-level is 108 and Tim is asymtomatic. Could the 3 month dose of Lupron givin 5 months ago still be skewing the numbers? As I understand a normal T-level is 380-1100. My concern is if that if the T-level is this low and the PSA is 0.03 this may indicate a castrait resistant form of prostate cancer in the works. Perhaps Tim has been Low-T for years which would mean that G-9 tumor was a most aggressive Tiger. No one ever test his T-level over the past 6 months so I guess we wont know what the baseline is. He has not pulled the trigger yet on IMRT to the prostate bed. He feels like this is cured but I keep reminding him that a G-9, 12 0f 12 positive, ECE, PNE, SVI+ and Pos margin is likely to have reoccurance.

    Jeff
  • Randall72
    Randall72 Member Posts: 34
    #48
    Timlong said:

    Is Lupron skewing the number 5 months out?
    Tim had another Post Rp PSA which is still 0.03. I wanted to know what the T-level was so his dr. ordered that also. Much to the DR's surprise the T-level is 108 and Tim is asymtomatic. Could the 3 month dose of Lupron givin 5 months ago still be skewing the numbers? As I understand a normal T-level is 380-1100. My concern is if that if the T-level is this low and the PSA is 0.03 this may indicate a castrait resistant form of prostate cancer in the works. Perhaps Tim has been Low-T for years which would mean that G-9 tumor was a most aggressive Tiger. No one ever test his T-level over the past 6 months so I guess we wont know what the baseline is. He has not pulled the trigger yet on IMRT to the prostate bed. He feels like this is cured but I keep reminding him that a G-9, 12 0f 12 positive, ECE, PNE, SVI+ and Pos margin is likely to have reoccurance.

    Jeff

    Been through RP..6/11
    Been through RP..6/11 continence came back,started IMRT on 3/5/12 juust ended this past week. Had 2 PSAs since surgery,both were 0.05 No big deal side effects of IMRT mostly fatigue.I.m 57 sonn to be 58 still working my butt off LOL so be patient and strong. Also, I had all my RP and IMRT at Abington Mem Hosp Rosenfeld Cancer center. Good luck to Tim.

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