Adjuvant radiation

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

I have posted before. Husband had RRP on 7/14, 1 focal positive margin, possible extraprostatic extension (2 opinions differ) Gleason 4+3 in dominant nodule. Had ultrasensitive psa done after regular psa;Ultrasensitive came back as less than 0001. Steven Strum recommends just monitoring this. Medical Oncologist recommends adjuvant. We are really struggling and have to decide soon. I have read the articles about adjuvant being beneficial, also know about radiation side effects. Anyone have any similar experience or experience with adjuvant radiation under similar circumstance? Also, I have only found one study about post RP radiation effects (further effects, I should say) on ED. Can anyone direct me to further information here. Thanks so much. This is so hard. Claire
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claire1

Replicant · Moderator Joined: 01 Nov 2006 Posts: 744

Adjuvant seems to have a slight advantage in efficacy over salvage. Whether or not this slight edge is worth the risk of side effects is up to the patient and doctor. Usually the side effects are mild and temporary. A recent study backs this up. See: "Few Side Effects Found From Radiation Treatment Given After Prostate Cancer Surgery" http://www.sciencedaily.com/releases/2009/09/090928131212.htm#

My own layperson's view is that it would be okay either way. If you guys decide to wait, as long as you were ready to pounce as soon as PSA started trending upward, you wouldn't lose much in the probability of success. But you'd want to start at a level of 0.5 or below, for best results.

On the other hand, your husband might want to take a more aggressive stance, and nothing wrong with that either, as long as he understands the risk of side effects is not zero.

That's a very low initial PSA post-surgery. I didn't know ultrasensitive tests went down that many decimal places. Encouraging, I would say, if that's the real score (less than .0001).

Just my unqualified 2 cents.
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Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

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

Thanks so much for your well thought out response. We are having such a hard time deciding. My husbands first post surgical PSA was less than 008, which was considered undedectable. But, he is on Propecia, so Dr Strum said you might have to double this, but that you couldn't double something so non specific. He recommended the ultrasensitive test, saying; that could be 0001, for all you know. And it was, which he says is prognostically good. Of course, the Gleason 4+3 and the postive margin are not good. The oncologist here is strongly advising adjuvant. My husband is concerned about side effects down the road, particularly in regard to ED, which there seems to be very little literature about. Anyway, I know it is our decision to make (and needs to be soon) but it helps to get as much information as possible. So many thanks. Claire
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claire1

Hawk · Senior User Joined: 22 Nov 2006 Posts: 406

I am a bit confused. Do you mean 008 or .08 or .008

In the first post of this topic you said 001.
I think you must have meant .01 or .001 if there is such a thing as a 3 decimal test. A 001. (1.0) would clearly be time for radiation.
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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

His initial (regular) PSA was less than 0.08 He then took and ultrasensitive test, which I believe went to the third decimal. It came back less than 0.01, on their printout 0001. They said, as did Stephen Strum, that this is as low as it goes.
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claire1

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