Adjuvant radiation

zumbles123 · Regular Joined: 24 Jul 2009 Posts: 15 Location: Powell

Hello.My husband underwent RRP on 7/14. Gleason downgraded to 4+3 (primary) and two secondary nodules of Gleason 3+3. Extraprostatic extension and 2mm positive margin in the region of the primary tumor. Total tissue involved 12.5%. Post op PSA 0.08. We are now getting ultrasensitive test, per advise of Stephen Strum (online, p2p). Saw a medical Oncologist here in Columbus Ohio (travelled to Detroit for RRP) and he recommends hormone tx and 2 weeks of adjuvant radiation. Are there questions we need to be asking in terms of types of hormones, types of radiation? Has anyone had similar experiences, or recommendations as to specifics of radiation and hormone treatments that are effective but less cruel in side effects. My husband has already got much of his continence and (with help) some of his sexual functioning back. Is there anything that will hit him less hard, or any words of hope about this line of attack? Thanks in advance for your response. Claire
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claire1

Operaman · Regular Joined: 01 Jun 2009 Posts: 25

Claire:

In some ways the harder you hit the harder you are hit. Most treatment that you will be considering will have side effects, and the more intense the treatment the more so the effects. After RRP though my PSA went to 0 the adverse findings of my post op pathology certainly suggested further treatment. For me it consisted of high PSA before surgery (24), Gleason of 4+3 with tirtiary of 5 extra capsular extension and a focally positive margin.

As a result of the surgery in May I still have ED but have recovered full continence.

Given the choices you listed, I decided to have adjuvant RT which will get to 6400 gr over 32 treatments. Although my surgeon and 1 Radiation oncologist suggested hormone therapy with the Rt I have declined this. I found great statistical advantage in the radiation but almost no support for the HT in adjuvant situation.

If your husband's PSA does not reach undetectable then you might look at it as a salvage type situation in which there is quite a bit of support for HT with RT.

As with so much in the PCa world there is not yet a definitive answer/treatment, and you two will be deciding finally on what to do.

In my situation, after the post op path report we visited two radiation oncologists and two medical oncologists in major hospital centers in Chicago. It gave me a wider variety of choices than I was hoping for but was very useful in getting as educated as I could from different points of view.
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Bioposy March 2008 negative
March 19 2009 4+3=7 PSA 26 positive for 6 out of 12 cores
RRP May 20 2009 Path 4+3=7 tertiary 5
5% Mostly right lobe some left
Stage T3a 1 focally positive margin, clean nodes, clean vesicle, all tests for mets clean
June 22 PSA undetectable,
course of Adjuvant RT completed in October with minor side effects
PSA 12/06/09 <0.05 (undetectable)

johnT · Senior User Joined: 27 Apr 2009 Posts: 234

2 weeks of radiation seems short; most treatments are at least 5 weeks.
Your oncologist should recommend what HT to use. The standard protocol is ADT3, Lupron, Casodex and Proscar for about 24 months. There are sde affects to these treatments. The Prostate Cancer Research Institute web site has a list of side affects and how to minimize them.
JohnT
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psa at diagnosis 40 in nov-08
gleason 6 and 7
Treatment choice seeds and IMRT

Hawk · Senior User Joined: 22 Nov 2006 Posts: 424

I think the adjunct/salvage radiation are the only real tried and true chance for a total cure. It should have little or no impact on continence issues and a delayed 12 - 24 month impact on erectile functioning. The extent is variable.

My biggest concern is the VERY small amount of radiation you mention. Memorial Sloan-Kettering Cancer Center recommends 40 treatments for a total of 72 Gray which is 7200 rad. Studies show this amount gives better results and I had almost no immediate side effects. The treatments were a breeze.

Please strongly question the Gray dosage of radiation and research recommended doses.
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History: PSA's 6.7 neg. biopsy - PSA 16.6 neg. biopsy - PSA's 8.2, 8.1, 8.7 - Biopsy. 4+4 Gleason 8. Lap RP Apr 2004, age 52 All neg margins, nodes, and structures. (T2a). Post RP PSA: every 6 mo. <.1 until Feb, 08 (46 mos) PSA .1 - I then got sensitive tests (all in 2008) showing:
Feb .06, May .09, Jun .10, Aug .10, Nov .15 -SRT

zumbles123 · Regular Joined: 24 Jul 2009 Posts: 15 Location: Powell

Thanks for your responses. I also though "2 weeks" of radiation sounded short., and was confused about the need for HT with adjuvant radiation. We are near a big cancer clinic in Columbus, OH, and I couldn't get a recommendation for a medical oncologist specializing in Prostate cancer. We wound up with one I am uncertain about. Nonetheless, we will met with a radiation oncologist at this center and see what he says. We may have to consult with someone else instead. This whole process has been very scary, in terms of the disparity of information you get from doctors and knowing who to rely upon for accurate information. The message boards like this one are an invaluable part of this process, because people are so responsive and so imformed. Thanks again. Clair
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claire1

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