hbo &questions for dagama & all

Part of the same "comedy"

Nepol

I wonder what HBO network has with your cancer case. Are you been treated at HBO facilities? Are you a film maker or an actor?

Regarding the information you share, the constant increases of the PSA post surgery confirms recurrence predictions as signaled in the pathological report, indicating extraprostatic extensions. Positive margins refer to incisions done at the glands’ capsule when dissecting the gland. It seems that there were several being the longest 1 mm in length. Both aspects written by the pathologist above could justify your present cancer spread, in other words, not contained. The margins are recent facts that would allow cancer spread in the future if the cutting area had tumours, but the extensions were there from the beginning, indicating existing spread or metastases that could exist near or at far places (distant from the gland).
This means that your initial diagnosis were not complete so that surgery were not considered unpractical by your doctor.

Your case is not new and is part of the many cases occurring every day. I also had unsuccessful RP 14 years ago with a path indicating extracapsular extensions. The goody was that they confirm the aggressiveness of my cancer as a Gs 5 (2+3) [this Gs5 class is obsolete now and was graded up since 2005 by AUA]. My salvage treatment was radiation. The protocol included a wider area to be “zipped” by the rays which included the lymph nodes at the iliac.

Your grade of cancer is higher (Gs 7; 4+3) and for that reason many physicians prefer to treat it more aggressively. They use combination therapies which have shown better outcomes. You could discuss with your doctor about any possibility in you delaying the procedure to verify such a possibility in having the radiation concurrent with neoadjuvant plus adjuvant hormonal treatment. In trials this combo has shown 35% better results than if RT were done alone.

In any case, the equipment you mention (Varian TrueBeam) is excellent. It manages to have the “job” done with the lesser risks, but the radiologist is the one deciding on the protocol (isodose planning and field of attack) which decision will influence the outcome. He should be an experienced physician.

I think you are freaking out for the treatments but such is also part of the “comedy”. We all go through the same feelings because we are dealing with the unknown. PCa is a problem but having it does not set us in the “…death row…”. The side effects from therapies are more prone to cause us “damage” than the cancer itself. Your Gleason grade 4 is the baddy in your case. It will oblige you of constant vigilance with tests. You will also have to be careful with diets including some supplements, and get involved in a fitness programme.

I am also 65 and enjoying life. The bandit is there somewhere enjoying my testosterone. We have a common thing. We are enemies believing that some day one will get killed. Until then I will spend my time worrying more with my agriculture hobby and my golf score, but I will be checking its “moves”. At the first sign I will grab my weapon. An Eligard shot.

 

Best wishes and peace of mind in your continuing journey.

VGama