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RRP followed by PSA Rise

hewhositsoncushions
Posts: 274
Joined: Mar 2017

HI all

So I went in on Thursday morning for my RP.

Spinals and catheters were a bit of a drama but got there in the end. Don't even remember going down or waking up.

Felt woozy for the remainder of the day which made getting used to the catheter fun.

Consultant said the surgery went well and that he managed full nerve sparing on the left hand side and the rest went perfectly. Six weeks to wait for the biopsy review.

Had lots of chats about after care and have a load of meds and laxatives to work through plus 28 days if blood thinning injections.

Have got massive bloating but not where I expected. Face was fine, abdomen slightly distended and getting floating gas in my shoulders but the suprise was, well... lets just say the word cantaloupe describes my current underwear containment needs :)

Had one porthole leak on me but we are managing that.

No sensation loss anywhere that I can feel (bloody toes hurt this morning being stuck in the DVT stockings overnight) and Mr Willy doesn't appear to have lost any feeling. No pneumatic reaction though which was not surprising.

Feel worse today I suspect as the operation meds are wearing off. Working really hard to take it easy.

Constipation is going to be my big battle - I have not gone yet and ever time I try it feels like I am tearing my innards up. Need to be patient!

Only big hit I have had was the job offer I was waiting for got pulled due to budgets. Gonna have a fight to get back to the real world soon.

I have to say I attribute a lot of the success outside of the medical team skills to the fact that I lost over a stone (more to go) and went on a hardcore training regime for two months before the op. My fitness levels are now the same as someone a lot younger, but I will need some work to recover what I am going to lose over the next month of recovery. Something to bear in mind!

Thanks for all your support, folks!

Cushions

PS - watch out for laughing and coughing.

Grinder
Posts: 440
Joined: Mar 2017

I for one really appreciate the operation of this forum and the effort that goes into running it. But please allow VdG and others the freedom to share knowledge and experiences. We are all quite aware that none of us can make definitive statements regarding diagnoses and prognoses, but we do have the valuable experience of having gone through the same operations, treatments, and procedures. And in VdG's case, intense study and accumulated knowledge that he is willing to share with others, information that is simply not available from urologists and GPs during 15 minute consultations/appointments. 

At my last consultation, a PA informed me my PSA was undetectable. It lasted but a minute and I was charged $174 for information I could have gotten over the phone. 

There are some guys on this forum that I vociferously disagree with, but I would certainly not want to censure them... But rather hear what they have to say and will dispute it if necessary.

So please don't limit access to VdG's and other's information and experiences. 

Historical note: when King James was assembling his panel of scholars and translators to translate what has become known as the KJ V Bible, he brought in scholars from many different backgrounds and religious persuasions... Why? Because they kept a sharp eye on each other not to let the other guy's denominational bias to infiltrate the stark, obvious meaning of each verse. So now, (though perhaps difficult to read for a modern audience), it is the least tainted with bias, and has the simplest most accurate meaning possible verse by verse.

This forum is similar in that we can keep an eye on each other, and if we collectively disagree with something posted, we will make it known. We have all disparate experiences that we need to share with others, and we can dispute what we recognize to be inaccurate and arrive at appropriate conclusions. Generally I find we do agree mostly.

contento
Posts: 76
Joined: Jul 2017

Grinder, well said ! I couldn't agree more. Censorship  is not the answer to those trying their best to help and support each other with our experience and knowledge. Yes I think we are all aware that we are not doctors and our opinions are just that "opinions". Let us speak our minds and we'll separate the chaff from the wheat.

hewhositsoncushions
Posts: 274
Joined: Mar 2017

I too appreciate VDG and his sterling efforts and advice. He provides a sound perspective and nothing that cannot be verified by some research.

Credit to Simone for responding and the admins deserve sympathy in that they are non specialists who I am sure want to do a good job but can't put the time in to verify stuff and need to prevent liability.

That being said, this is a forum for people with complex medical conditions and if people cannot share medical advice here, then what is the point? Reddit has a good middle ground in that trusted members can be flaired to show that they have been looked at and they know what they are talking about. That would help here.

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3293
Joined: May 2012

Hewho is correct.

I estimate that half of every post here is either a request for advice from a patient, or a suggestion from a former patient.

If every post here that began with a comment like "What I would do...." were deleted, not much would remain.

I usually cast my thoughts as what I did do, and what resulted, and what I think about it.   A layman saying he would "do x" does not seem to me to be conferring "medical advice." The readers must know better.  ('Medical advice' costs $500 a pop, whereas everything here is free !)

The position of the Administration also is less than ideal, and it seems they are doing as good a balancing act as possible, given the Rules set for these Boards.

max

hewhositsoncushions
Posts: 274
Joined: Mar 2017

Update...

3 months post RP

PSA test 0.05

99% continent

ED about as expected

I owe my consultant and his colleagues a huge debt of gratitude - I am one of the lucky ones.

hopeful and opt...
Posts: 2224
Joined: Apr 2009

Glad to read this great news!

I am happy for you

 

VascodaGama's picture
VascodaGama
Posts: 3012
Joined: Nov 2010

Great results. Let's celebrate with a glass of Cliff Richard's red. You can find it at your liquor store. I will get a bottle at his cellar neighbor to me.

Congratulations.

VG

 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3293
Joined: May 2012

To VG's suggestion regarding Cliff Richard's, I say "Dilly Dilly !"

 

(You would have to know American TV commercials to get this; the current Bud Light piece; a spoof on Game of Thrones)

 

 

contento
Posts: 76
Joined: Jul 2017

Congrats  Cushions , great result and i'm sure great relief...

ramaka
Posts: 55
Joined: Mar 2017

Congrats, Cushion! Very happy for you and your family!

Grinder
Posts: 440
Joined: Mar 2017

Since you have escaped the "pit of misery", I also say "Dilly Dilly" .

hewhositsoncushions
Posts: 274
Joined: Mar 2017

Hi guys

Thanks for the kind words. They gave me a lift!

One thing I noticed since the provisional all clear is that I have taken my foot off the gas a little and am struggling to get it back on. Before the op I was 100% healthy eating, no booze and fitness mad. Now I'm 95% healthy eating, drinking a little bit more than a little (:)) and fitness is a nightmare now I am working (including travel).

I think this is in part a reaction to the good news and not unexpected but I want to kick myself back into the race.

How do you old salts keep a tight ship on health and well being and not getting complacent?

C

hopeful and opt...
Posts: 2224
Joined: Apr 2009

Motivation has to be self actualized. It's up to you. 

You can create an environment that is healthy...for example no bad food at home....the same for booze.

As far as exercise, I simply do it every morning; it's a routine for me.

.....................

Make believe that your life depends on a heart healthy life style....................It really does.

 

best

hewhositsoncushions
Posts: 274
Joined: Mar 2017

Hi guys

Life got in the way of worrying about things but I've reached the near six month mark now and slowly hacking away at the mental obstacles and rarely think about the PCa.

The current big mental block is really wierd. By blocking out the cancer it has actually made me weaker. Sounds daft but while it was top of the list it gave me the drive to ignore and steam through all the petty b******t life throws you at work and out and about by putting everything into perspective.

I want that drive back without the fear. I need to do some deep thinking over this.

Has any one else experienced the same feeling?

C

contento
Posts: 76
Joined: Jul 2017

cushions, I also block out the Pca but I think it's made me stronger in helping me deal with life. My perspective  is a lot different these days. Situations that might have seemed insurmountable  in the past now seem relatively insignificant. I just don't worry about petty bull s...it  anymore. I think the threatening  concern of the Pca gave me , what I consider, strength. I have to say that about 2 weeks or so prior to my 6 month psa check I'm somewhat of a mess. I just had mine a few weeks ago and I was good.
Hope yours turns out good as well. --contento 

 

 

hewhositsoncushions
Posts: 274
Joined: Mar 2017

Yay! Finally found my update thread.

All is well - diet and fitness on track but stressed about this week's PSA test. Have to keep hacking away. It is interesting how deep down the fear is and it is only when you look really closely you can see your brain whizzing away under the covers goimng ****! ****! Do others find their fears are buried or on the surface regarding PSA tests?

C

hopeful and opt...
Posts: 2224
Joined: Apr 2009

LIfe goes on for me, no stress unless I am waiting for the results of PSA, biopsy or any test related to prostate cancer. After nine years, the stress is less, but still existent. Others I speak with tell me the same.

Josephg
Posts: 158
Joined: Jan 2013

I would become somewhat introverted and cranky for about a month before my recurring PSA tests.  It kind of grew like a slowly developing toothache, until I recognized what it was, and I made a conscious and concerted effort to subdue it, at least in the compny of other people.  I found that it was the worst, during the period of time that my PSA was still undetectible.  Strangely, once my PSA started to rise again, the amount of pre-PSA test anxiety and mood swings have reduced dramatically.

hewhositsoncushions
Posts: 274
Joined: Mar 2017

Well I was right to be worried.

Just had the call.

0.16.

I am having a repeat test to see if it is a false positive (given my history of a clean removal with no margins and a 3% tumour they are surprised).

I feel like crying.

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3293
Joined: May 2012

Very sorry to hear of your PSA result, hewho.  You are correct: With your biopsy and later, with your pathology results, this possible (not yet confirmed) relapse is impossible to reason out.

You studied much longer than most here, so you have the mantle of knowledge with you already.

If confirmed, salvage radiation toward cure is still very much a way to eradicate the disease fully, even with this latest result.

max

hewhositsoncushions
Posts: 274
Joined: Mar 2017

Knowledge is a double edged tool.

It is annoying that it rose so soon.

Problem is we can speculate till the cows come home but can only act on knowledge.

hewhositsoncushions
Posts: 274
Joined: Mar 2017

Also worrisome is the low starting PSA and the mucinous element as a potential land mine. But again, facts rule.

contento
Posts: 76
Joined: Jul 2017

Sorry to hear about the result. A recheck of course is necessary to confirm. It sounds like you were right on top of this given that the psa is not higher.  The same thing happened to me. I had a reoccurance after about 17 months. You'll probably do a bone and pelvic scan to rule out metastasis . If clear you'll be a candidate for salvage radiation. The expectation is that the cancer is still within the pelvic area preferably in the prostate bed. They might be able to see the cancer with a endorectal MRI but your psa is so low they might not be able to see it. No matter they'll still go ahead with the radiation and maybe HT.

Cush, it's all doable. I've done it and my psa is still non- detectable after 2 1/2 years. And I was stage 3 with a gleason of 8 !  So far I haven't had any after effects do to the radiation , though long term who knows.

I know it's crazy nerve racking and I feel for you  but you'll get through this. One step at a time.

Good Luck ... Contento

hewhositsoncushions
Posts: 274
Joined: Mar 2017

Hi Contento

I have a list of prayers in ascending order:

False positive

Remains of prostate left behind

Localised PCa

A cure for cancer because I don't want to think about the alternative

:)

I know it is not the end of the world if it has come back but I have a habit of playing stupd numbers games in my head, shaving my life expectancy every time something else goes wrong. I call myself Mt Catastrophiser :) Silly I know.

Anyway, just had a call and I am booked in for my consultant in three weeks (the joys of the NHS) and another blood test next week.

His actual action limit is 0.2 so it will be interesting to see how this plays out once I get the next blood test.

The other thing I found was that I am in the middle risk bracket for seriousness as those whose psa doubles in three months after surgery are worst set and those whose psa doubles over 18 months are better off.

Cushions

contento
Posts: 76
Joined: Jul 2017

Yes Cush I'm with you and hope for the best. My doc also used .2 ng/ml as the trigger for reoccurance. My psa doubling time was 6 months but I'm still going strong today.

It's always one thing or another..  Hang in there Cush

VascodaGama's picture
VascodaGama
Posts: 3012
Joined: Nov 2010

I would recommend you to wait for the next PSA to draw conclusions. In any case, before any decision you need to check other health issues that could interfere with an additional therapy. Radiation is linked to colitis and hormonal therapies are linked to bone health. NHS doctors will only check the matters of PCa if you do not inquire on the other issues. I wonder if you still trust the GP attending you. It has been totally unreliable in dealing your case.

Best wiches and luck in the next meeting.

VG

hewhositsoncushions
Posts: 274
Joined: Mar 2017

Vasco

I hsve a blood draw on Monday to see what the numbers are on a second try and a consult on the 20th.

I don't think I have any other health issues to worry about as I am fit for my age, no diabetes, only slightly overweight. I'll take what they throw at me treatment wise - I have a family I need to live for.

As for the treatment so far, to be honest, the main issue was the transition from the GP to the hospital as there were drop offs that I had to pick up on. In terms of actual treatment, I have no complaints apart from it being very clinical (i.e. not mental health friendly).

Where I am in the NHS pathway, the consultant steps back anyway and hands over the specialist nurses as I was on maintenance PSA tests whereby they test and call and only take action if there is a concern. In this case, they were on the ball so I cannot complain.

My main concern oddly enough is to persuade them to start SRT early as I have read that hitting it hard whilst under 0.2 and with adjuvant therapy is far more effective than waiting until 0.2 and following sequential treatment.

Just have to wait and see.

C

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3293
Joined: May 2012

He who,

I have read similiar studies, that beginning RT sooner is better than later (intuitive enough) in effecting cure of moderate relapse.   An aside, my Urology Group (in the Southeastern US, at a teaching hospital) also uses .2 as the threshold in defining relapse post RP.

HT of course is never curative, but is of assistance to the RT when added, and is not an uncommon combination. And HT has given many a man here an additional 15 years of life,

max

hewhositsoncushions
Posts: 274
Joined: Mar 2017

Max

That is where I am coming from.

Having got over the shock (well not fully) of realising I am going to die earlier than I first thought, I intend to go all out to beat this ******* back for as long as possible.

I saw my uncle die over Xmas of cancer of the everything and I do not intend to inflict that on my family, even if I have to suffer misery in the treatment process.

**** cancer.

C

VascodaGama's picture
VascodaGama
Posts: 3012
Joined: Nov 2010

Yes, ADT improves the outcome of SRT and so it does the radiation administered earlier, however, this claim is only expected if the field of radiation contains the whole cancer. One needs to be sure that the targets were properly identified, which as we know is a difficult task with present available means.

The doctors at NHS will spend little time reviewing in detail your past and present history. You need to collect this info and summarize it into the important subjects that can influence their judgments. At least copy of the biopsy report, the MRI, the pathological report on RP specimens and the PSA histology.
Without details the doctors will follow the typical protocol in SRT with a predefined field of attack. They will radiate the bed of the prostate (the fossa) and localized lymph nodes (?).

This kind of protocol is different from a treatment that includes surgery plus adjuvant radiation, which I think being your comment above. Typically the series of nodes involved is vast depending on the location of the cancer found in the biopsy. Inguinal, the iliac and pararectal at the pelvic area (anterior and posterior) may or may not be part of the protocol.

My experience with the NHS procedures is that the urologist continues to be the prime doctor providing the forms (request sheets) for other specialties under his own responsibility. Those services can be requested at an inner department or at an outsider. The scope of attack is planned by the radiologist but this guy will not go further than what has been requested or established in the urologist’s form. In such regard we may help the urologist to avoid missing any probable area. One needs to investigate about those areas that could be the cause for later recurrences.
The risk from a SRT done on guessing is if this does not cover the whole affected area which could become in fact a worse case in need of “rads over rads”.

If recurrence becomes apparent in your case (not yet verified), you are confronting a similar occurrence as that of mine in 2000. I was 50 at RP, saw biochemical failure and six month later were declared with recurrence. Everything was confusing to me and I believed in the doctor blindly. He was my god and savior from a death that did not exist.

Let us know the developments . We will try helping you.

Be the force with you.

Best wishes,

VGama

 

Old Salt
Posts: 720
Joined: Aug 2014

I believed in the doctor blindly. He was my god and savior from a death that did not exist.

 

Thanks Vasco!

hewhositsoncushions
Posts: 274
Joined: Mar 2017

First test 0.16

Second test a week later 0.17

******* furious and scared at the same time.

lighterwood67's picture
lighterwood67
Posts: 207
Joined: Feb 2018

Thanks for posting your experiences.  I go for my RP 03/20/2018.  I have been posting on the goings on with me on this site.  Will post on mine when they get done.

hewhositsoncushions
Posts: 274
Joined: Mar 2017

Good luck, mate.

I hope it goes well.

Be kind to yourself when you get out of hospital and do not overdo it!

C

VascodaGama's picture
VascodaGama
Posts: 3012
Joined: Nov 2010

Cushions,

I cannot see a reason to be furious with the results but I understand the worries. Being scared is natural as you are dealing with the unknown. The second test confirms the previous result but you should wait for a third one in three months time to assure recurrence.

My suggestion is for you not rushing believing that by doing so you solve the problem. Get second opinions and advance with something solid that you trust. You may try to go private for a consultation with a medical oncologist specialized in PCa cases. You can also request the urologist you are seeing for referrals to get a second opinion from other oncologist, within the NHS.

The traditional next step will be based on the exchanged conversations above.

Best,

VG

 

hewhositsoncushions
Posts: 274
Joined: Mar 2017

Vasco

Cheers!

Voice of reason as always.

My concern waiting three months to get a better idea of PCADT is that I am 0.17 with some potentially agressive PCa elements and an initial doubling somewhere between 7 and 9 months post op.

I understand that this places me in a grey area for good long term survivability and also that salvage done under 0.2 stands a far better chance than over.

If I wait three months for another test it may rocket and I could be stuffed.

Thoughts?

C

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3293
Joined: May 2012

Hewho,

Your PCa was relatively mild/indolent before, so (if you have PCa at all now) it should still be the same: relatively indolent (Pathology post-op:  G7, minimal volume, no positive margins, no nodular involvement).

I have read that the high-end threshold for successful start of curative RT following relapse after RP is around .5, and it seems you are far, far from that.  Results from salvage RT post-RP are described as "poor" if a PSA of 2.0 is reached before starting salvage RT. ( Dr Peter Scardino's Prostate Book, p. 450, in Chapter 20: "Rising PSA After Surgery, Radiation, or Other Therapy"  Dr. Scardino is Chairman, Department of Surgery, at Sloan Kettering Cancer Center, NYC.  I recommend that you get his book, a regular stock item at Amazon and Barnes and Noble)

Do as Vasco suggests, and do not become frantic. Remain systematic and methodological instead.  It seems thinking in great detail is an attribute you possess; use that, not fear.

max

hewhositsoncushions
Posts: 274
Joined: Mar 2017

MAx

You and Vasco are right - get over the panic and learn.

The whole threshold thing like many things seems to have lots of different opinions so I will see what my consultant says and share it.

One thing I need to do is get my head around the various forms of salvage as I am a little confused with some of the abbreviations.

Here goes:

ADT - I understand to be Androgen Deprivation Therapy, medications to reduce T to starve cancer cells. Makes sense

ART - Adjuvant Radiotherapy - I assume to be salvage RT but...

ESRT - Early Salvage Radiotherapy also exists. What is the difference? Also I assume SRT is just the generic term.

What other forms of salvage are there?

I also understand that the above can be applied in various combiations of sequence or parallel for different reasons / effects. Is that true?

Cheers

C

Grinder
Posts: 440
Joined: Mar 2017

I posted this diagram showing the whole pituitary-testes-pituitary-testes-adrenals androgen process but it is copyrighted, so the best i can do is post the link...

http://clincancerres.aacrjournals.org/content/clincanres/17/7/1649/F1.large.jpg

It helps me when i see the whole process diagrammed. Thought it might help when considering ADT treatment.

Grinder
Posts: 440
Joined: Mar 2017

Here is another link to a diagram that shows the pituitary - testes - adrenals - hormonal link and the resulting androgen stimulation of PSA production, growth, and survival of the cancerous cell.

https://d9aqs07uebq07.cloudfront.net/content/clinchem/57/10/1366/F2.large.jpg

Grinder
Posts: 440
Joined: Mar 2017

I posted this link showing a diagram of the whole hormonal androgen process, but it got pulled for some reason... trying again...

http://clincancerres.aacrjournals.org/content/clincanres/17/7/1649/F1.large.jpg

hewhositsoncushions
Posts: 274
Joined: Mar 2017

Cheers for that, Grinder!

hewhositsoncushions
Posts: 274
Joined: Mar 2017

Aww rats.

Consult on Tuesday and my head is playing really stupid games with life expectancy and what ifs ("wjy did I not have ART?") and fretting that T2c is the end of the world.

It is stupid because the logical half of me knows I have to wait and see. The monkey brain in me is sitting in a tree hooting and throwing panic poop at my logical part :)

Waiting sucks ....

hewhositsoncushions
Posts: 274
Joined: Mar 2017

Hi all

I updated the master subject to be a bit clearer and more sensible :)

So I saw the urologist consultant today - she was a bit apologetic that I had had the rise (0.05 - 0.16) but seemed to want to reassure me than only a percentage of these are due to BCR and only a percentage of those become an issue - the usual numbers game.

I have a referall to a urology consultant to discuss options - either watch and wait or SRT/SHT. I favour the latter out of the box but my OH is Mrs. Cautious and is reluctant for me to dive in. I need to make sure I listen to her but do what is right for me as I need to be here for them as long as possible.

Only downside as they could not fit me in today it will take several weeks to get to see the onco. I'm hoping I don't get a bigger rise inbetween.

C

 

contento
Posts: 76
Joined: Jul 2017

Hey Cushins, it's normal to be worried . I would be too but I doubt very much your psa would skyrocket in a couple of weeks or so. My Gleason 8 took over 6 months to go from

.1 to .2. What does your OH want to wait for ? I assume it's a specific psa threshold ? I don't think it's a bad strategy to wait a bit.

I'll propose 3 reasons

1). A slightly higher psa ( say .2 ng/ml ) is still very manageable

2). It would definately confirm reoccurance

3). Perhaps most importantly, there's a better shot that an mri could locate the cancer. I know from conversations with my radiation oncologist who told me that the success rate of salvage is much higher when they know where the cancer is located. Keep in mind that salvage radiation  would still be givin even if they can't locate the cancer but they have to cover a wider area which would be exposed to more rads than if they knew where the cancer was located ( they could focus a little more ).

also, which of course is not good, if the cancer is located in a distant location other than the pelvis area then you would most likely not receive any radiation but begin HT. I hope this is not your situation.

I know there's mental anguish and I'm sorry for that but I agree with your OH , I would wait a wee bit longer if my doc also agreed.

hewhositsoncushions
Posts: 274
Joined: Mar 2017

Hi Contento

I should have clarified - OH is Other Half, i.e. wifey. She is a cautious person whereas I am a boots first into the landing zone typer person. She thinks I should wait and see.

I am divided because as you say waiting means more chance to spot tumours but interventkion below 0.2 is supposed to give better long term outcome.

Best approach os to get to the onco asap and see what they say.

Cheers

C

VascodaGama's picture
VascodaGama
Posts: 3012
Joined: Nov 2010

In my opinion, after failed RP, the only existing "salvage treatment" is radiotherapy. Hormonal treatments in this aspect are sequential therapies and do not salvage anything. To this extent I agree with Contento's opinions. Without a gland in place or a definite target, the benefit in a salvage radiation would depend on luck alone. One can guess but no assurances are given that it will work.

Your wife may be right in regards to the % of the goodies in an earlier attack but does she know what would be the results if the treatment is done at a PSA of 0.4 ng/ml?
"Earlier" is not based on a PSA level but on the diagnosis of recurrence. In such regard the NCCN guidelines (followed worldwide) recommends to use the threshold of 0.2 ng/ml to indicate BCR and intervention at a PSA of 0.4 ng/ml. These thresholds were obtained from past experiences from a huge number of cases. Both judgments (Earlier or Thresholds) are used in salvage therapies but none of them can prove to be better than the other.

You need to confirm recurrence even if the increase is most certain indicating the end of the story. WW may not be your best choice due to the Gleason rate 4 found initially. HT would just postpone an intervention or accelerate refractory, apart from providing you an overload of symptoms. Surely you may gain time and the opportunity for other therapies to popup (now on the drawing boards). LU177 is doing wonders but got its own pitfalls too.

Let's have a beer. You get a bitter and I a lager.

Best,

VG 

 

hewhositsoncushions
Posts: 274
Joined: Mar 2017

Hi Vasco

"End of story" sounds so cheerful :)

I have so much conflicting information - the reason I had HT then RT suggested elsewhere as a standard is that it allows for tumour reduction making the RT more effective.

Also the consultant said that 30% of people get a rise after RP but a smaller percentage get full on BCR.

I am having to step back from the what ifs and life expectancy head games, cocentrate on facts and get to the onco.

C

VascodaGama's picture
VascodaGama
Posts: 3012
Joined: Nov 2010

Sometimes I do not understand your reasoning. You had RP not RT.

This time you are looking for a salvage therapy not a prime combi of HT+RT. You have no prostate in place in need of reduction. HT will sensitize the cells to turn them more susceptive in absorbing radiation (a better killing) but it also masks the PSA extending the period post treatment without knowing the final results. Some guys prefer to have these in sequential. First RT to be followed by HT if the former fails.

After RP nobody is supposed to get a rise in PSA. No gland in place no prostatic cells to make the serum. In fact it takes just ten days for the body to clean floating PSA in the blood. The first PSA after op should be less than 0.06 ng/ml indicating success. This was your case.

I hope you find answers to your doubts and get peace of mind.

Where do you live?

Best

VG

hewhositsoncushions
Posts: 274
Joined: Mar 2017

Vasco

That was badly worded - I meant "had HT and RT (as a discussion point in the previous post I made)" not "had HT and Rt (to start with)". I hope that clarifies things.

Yes, I had RP and the initial results were promising (0.05 with the cancer allegedly contained) BUT as you know, 8 months later it rose (0.16/0.17).

I have been referred to a urology oncologist because I am nearning the 0.2 mark and am still awaiting on an appointment (which I no doubt will have to expedite).

The specific reason I mentioned HT as a precursor to RT as a combined salvage therapy was that lay experts in McMillan and Prostate Cancer (similar folks to you) suggest that in the UK they are now starting to apply HT for up to six months BEFORE RT as there is trial evidence that it increases the success rate. I am guessing the theory is that the HT shrinks / kills tumour which makes the RT more effective over potentially a small application area.

You are right in that there is a risk the cancer becomes refractory early which is why I am trying to see it from all sides to make a risk aware choice.

Hope that makes sense.

Thanks again for the advice and support.

C

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