Rising PSA after RP and Salvage Radiation

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

No
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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)

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 said:

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backinthesaddle said:

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