Post Prostate Surgery Radiation
Sat, 04/28/2018 - 7:50am — Q-Ball
I am now 7 weeks post surgery and had a few thoughts I wished to share and ask about.
the first is I was in a quandary about male pads and underwear. If it wasn’t for this site I would have stayed in the dark. I wanot to thank everyone for their candor and honesty, the result, boxer/brief underwear from Hanes and Tena maximum level 3 pads, work like a charm.
my biopsy should great results, with the exception of two microscopic points on the right hand nerves, coincident with lesions on the prostate. My surgeoon scrapped just enough to clean the marks, trying to save as much nerve as possible, but there was not enough to do a proper analysis.
i will be have my first psa test at the end of June, about 3.5 months post surgery. My doc does not believe about jumping into radiation if the facts presented do not warrant it. My prostate was not enlarged or inregular surface condition, his opinion ‘thinks looked great’ so wants to see what the psa yields before deciding.
does anyone have knowledge or experience with post surgery radiation? If so, is there a need for hormone therapy as well?
thanks in advance
Comments
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Hi Q-Ball. Welcome to the
Hi Q-Ball. Welcome to the club that no one wants to belong to. Your doc would not have performed the surgery if he saw the cancer had spread beyond the prostate. There is a circumstance where he would do surgery ( debulking ) but that doesn't sound like your situation. What led him to even mention radiation after surgery ? Did he see something while doing the surgery ? Your prostate pathology will give you an idea of your risk of a failed surgery ie stage, gleason, EPE, ect.... So you do have to wait for that report. Beyond that though the 3 month psa test will most likely be the determining factor as to whether the surgery successfully removed your cancer. Realize that there is always the risk regardless of pathology that there could be micro metastasis that can go undetected for years. This is not the norm but it does happen. If your psa is > .1 ng/ml then you most likely would get adjuvant radiation with or without hormone treatment.
You should get more responses from the other guys that could help you understand better.
Let's hope that your surgery was successful and radiation will be a moot point.
Good Luck --contento
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FWIW Pre and post-op PSA's
My PSA five months before surgery was 25, so it was probably higher by the time of RP.
One month post-op my PSA was <0.1 ... As I understand the PSA drops immediately after RP and soon reaches zero, unless there is adverse pathology (mets, LVI, PSM) ... I was told immediately after surgery that I would need adjuvant radiation in about six months due to SVI. It ended up being one year later.
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There are risks of spread when Perineural Invasion is found
It is common nowadays to treat recurrences with combination therapies of Radiation (RT) plus Hormonal (ADT). These are different treatments with different purposes and can be used independently of each other. The combination therapy has shown in trials to delay any biochemical failure by 15%. However, ADT is palliative and does not provide cure. RT is the one that gives the blow, but if administered in combination with hormonal, this will mask the PSA so that one can only certify successes approximately three months after stopping ADT.
I wonder the reason for delaying a PSA test so long. Surgery successes, in terms of PSA, can be measured two weeks post op. Our body takes about 20 days to clean any reminiscent floating PSA serum that at ten days is expected to be less than 0.06 ng/ml. Having a PSA test done now (7 weeks post op), apart from confirming RP success, it will serve as the basic value to compare with a later result to evaluate recurrence. Your story seems worrisome for the comments about cancer in the nerves. You can always visit a local laboratory, draw blood and request a PSA test by your own for peace of mind.
From your above comments, I think that your doctor refers to the pathologist's findings of Perineural Invasion (at two locations). Surely he (the surgeon) could not identify by the open eye those microscopic spots. The worrisome in a positive Perineural Invasion finding is that there is a higher chance that the cancer has spread outside the prostate via that route (very common in spreadings). I wonder why you have risked having a surgery with nerve spare technique if the cancer has been found and identified at those areas. For the moment, only the PSA can provide you a clue on the mystery.
Please read this article from a trustful source;
Best wishes,
VGama
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Believe
Q-Ball,
I agree with all responses given above. As Vasco noted (I did not yet read his link however) perineural escape is among the most common conduits for micro-metastatis -- metastatic escape from the gland that the doctors "never saw." In your case, a bit of the cancer was detected in the nerve sheathing. (In more egregous, blatant metastasis, the route of escape is more easily visible, such as through positive margins, or cancer in the bladder neck.)\
Your doctor delaying your first PSA post-op makes no clinical sense to me at all. Also as V noted, it would be of value to have earlier PSA data for later reference. I do not recall anyone here reporting no PSA testing after a month had pased. Mine first was within two weeks post op.
It is quite possible that you will never have metastatic involvement. The problem is that, on the other hand, maybe you will. With such a tiny degree of cancer detected in the bundle, your first PSA very likely will be zero or close to zero, whether the disease got out or not. This leaves you will the sufficient cause to act as if there was escapse as a precautionary measure. Your doctor does not like to "rush things?" That might be easier for him to live with than for you. I believe I would get a second post-op evaluation of your situation after your PSA results are returned. Many men here developed metastatic disease following what appeared to be escape-free RPs. And be aware that very specific PSA-level guidelines exist for when salvage RT should be begun post RP if relapse is indicated.
A third complement: Vasco's comments on the relative merits of RT and HT is spot on. Only the RT is curative. Me, I would NOT add HT, because it will mask PSA developments.
You do not give your diagnostic specifics: Your pre-op PSA, Gleason, etc. That information can also suggest what actions are now most reasonable. Higher pre-op PSAs and Gleason results obviously more strongly suggest the potential need for aggressive actions post-op than lower pre-op results would.
max
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Contents, thank you for thecontento said:Hi Q-Ball. Welcome to the
Hi Q-Ball. Welcome to the club that no one wants to belong to. Your doc would not have performed the surgery if he saw the cancer had spread beyond the prostate. There is a circumstance where he would do surgery ( debulking ) but that doesn't sound like your situation. What led him to even mention radiation after surgery ? Did he see something while doing the surgery ? Your prostate pathology will give you an idea of your risk of a failed surgery ie stage, gleason, EPE, ect.... So you do have to wait for that report. Beyond that though the 3 month psa test will most likely be the determining factor as to whether the surgery successfully removed your cancer. Realize that there is always the risk regardless of pathology that there could be micro metastasis that can go undetected for years. This is not the norm but it does happen. If your psa is > .1 ng/ml then you most likely would get adjuvant radiation with or without hormone treatment.
You should get more responses from the other guys that could help you understand better.
Let's hope that your surgery was successful and radiation will be a moot point.
Good Luck --contento
Contents, thank you for the response. The pathology did come back with flying colors. My surgeon told me he touched nothing on the left side as it pertains to nerves an only slightly scaled the surface of the nerves on the right, coincidental with two lesions on the prostate. Pathology reported there was not enough taken to analyze, so we wait for the psa.
i was told that the ’norm’ today is to do preventive radiation after surgery to get anything that might be missed. My guy is not of this opinion if things look good, which was his assessment. Haven,t spoken with him in detail yet and am curious about the hormone treatment, the one thing I have no desire to partake in, unless absolutely necessary
0 -
Can never have enough data toBelieve
Q-Ball,
I agree with all responses given above. As Vasco noted (I did not yet read his link however) perineural escape is among the most common conduits for micro-metastatis -- metastatic escape from the gland that the doctors "never saw." In your case, a bit of the cancer was detected in the nerve sheathing. (In more egregous, blatant metastasis, the route of escape is more easily visible, such as through positive margins, or cancer in the bladder neck.)\
Your doctor delaying your first PSA post-op makes no clinical sense to me at all. Also as V noted, it would be of value to have earlier PSA data for later reference. I do not recall anyone here reporting no PSA testing after a month had pased. Mine first was within two weeks post op.
It is quite possible that you will never have metastatic involvement. The problem is that, on the other hand, maybe you will. With such a tiny degree of cancer detected in the bundle, your first PSA very likely will be zero or close to zero, whether the disease got out or not. This leaves you will the sufficient cause to act as if there was escapse as a precautionary measure. Your doctor does not like to "rush things?" That might be easier for him to live with than for you. I believe I would get a second post-op evaluation of your situation after your PSA results are returned. Many men here developed metastatic disease following what appeared to be escape-free RPs. And be aware that very specific PSA-level guidelines exist for when salvage RT should be begun post RP if relapse is indicated.
A third complement: Vasco's comments on the relative merits of RT and HT is spot on. Only the RT is curative. Me, I would NOT add HT, because it will mask PSA developments.
You do not give your diagnostic specifics: Your pre-op PSA, Gleason, etc. That information can also suggest what actions are now most reasonable. Higher pre-op PSAs and Gleason results obviously more strongly suggest the potential need for aggressive actions post-op than lower pre-op results would.
max
Can never have enough data to make a sound analysis.
pre op psa was 7
gleason was 3+4
core samples on the right side were 6 out of 12 at Gleason 3+4
left side completely clean
pathology report was all margins and lymph nodes clean
surface of prosthetic smooth
size of Prost are considered small for age and condition.
overall reasons my surgeon is waiting
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addendum
3.5 months seems a bit early to make a definitive PSA test. Someone can correct me if I am wrong, but it does take time for the antigen to completely dissipate and be removed from the blood stream. I would imagine the higher the PSA concentration, the longer it takes. My PSA was 18 pre-op and about 3.0 two to three months post-op and undetectable after 6 months. And 18 is relatively low for BPH, prostatitis, and PC.
Curious about other early draw scores witbin 2 to 3 months and higher pre-op scores.
EDIT: I was wrong about these scores. So this post was inaccurate to say the least. Note below actual PSA score post-op was .22.
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Q-Ball, I want to respond toQ-Ball said:Contents, thank you for the
Contents, thank you for the response. The pathology did come back with flying colors. My surgeon told me he touched nothing on the left side as it pertains to nerves an only slightly scaled the surface of the nerves on the right, coincidental with two lesions on the prostate. Pathology reported there was not enough taken to analyze, so we wait for the psa.
i was told that the ’norm’ today is to do preventive radiation after surgery to get anything that might be missed. My guy is not of this opinion if things look good, which was his assessment. Haven,t spoken with him in detail yet and am curious about the hormone treatment, the one thing I have no desire to partake in, unless absolutely necessary
Q-Ball, I want to respond to your comment about it being the "norm" to get radiation after surgery as a preventive measure. Radiation is a primary treatment option. Usually when your first detected with Pca the primary treatment options are surgery or radiation. Unless things have changed very recently it is not normal to get radiation after surgery unless you had a failed surgery or your pathology was such that your at a very very high risk for reoccurrence. So yet again let's hear from the guys to chime in on this.
I also saw you commented a few times about HT. HT is mostly reserved as a pallitive treatment when Pca has spread beyond the prostate. In most cases the cancer can be contained with hormones for a period of time usually years. However, HT is also used in conjunction with radiation , starting prior to RT, so as to shrink the tumor making it more receptive to receive the radiation. This method can be used as either a primary treatment or as a salvage treatment after a reoccurrence. Some of the guys object to adding the HT as part of the radiation option because it lowers the psa temporarily ( it lingers for a few months post treatment ) and thus delays the results of the treatment. And I guess some object to the side effects of HT like no sex drive, hot flashes, fatigue ect...all temporary though
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I would think soocontento said:Q-Ball, I want to respond to
Q-Ball, I want to respond to your comment about it being the "norm" to get radiation after surgery as a preventive measure. Radiation is a primary treatment option. Usually when your first detected with Pca the primary treatment options are surgery or radiation. Unless things have changed very recently it is not normal to get radiation after surgery unless you had a failed surgery or your pathology was such that your at a very very high risk for reoccurrence. So yet again let's hear from the guys to chime in on this.
I also saw you commented a few times about HT. HT is mostly reserved as a pallitive treatment when Pca has spread beyond the prostate. In most cases the cancer can be contained with hormones for a period of time usually years. However, HT is also used in conjunction with radiation , starting prior to RT, so as to shrink the tumor making it more receptive to receive the radiation. This method can be used as either a primary treatment or as a salvage treatment after a reoccurrence. Some of the guys object to adding the HT as part of the radiation option because it lowers the psa temporarily ( it lingers for a few months post treatment ) and thus delays the results of the treatment. And I guess some object to the side effects of HT like no sex drive, hot flashes, fatigue ect...all temporary though
thats what I mean That is what I’m afraid of having to do radiation after surgery....I would kick myself In The butt for not just doing radiation ..radition is a treatment and so is surgery one or the other
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