1. < Prostate Cancer

treatment decision for post prostatectomy unclear

Posted by Ronoir @ronoir, Aug 3, 2016

Greetings everyone, I,m a Gleason 9 with invasion/envolvement in 5 of 41 biopsied lymph nodes, seminal vesicle, periprostatic cap and margins. My prostatectomy was performed Dec. last year with 3 mo. post op p.s.a. @ .08 subsequent #'s were 0.1, 0.12 and presently 0.15 on p.s.a. I have several Dr.'s opinion vacillating between radiation, hormones or both as treatment. the problem I have with radiation is this: I have no prostate, therefore no tumor to focus a beam onto leaving salvage radiation across the entire prostate bed including healthy tissues. Given the extent of my cancer that was removed during my surgery the probability it (cancer) has gone beyond the pelvic region are very high (75%) meaning salvage radiation would be of little to zero value. I am going forward with hormone therapy soon knowing it will only slow down the cancer growth, not kill it. M y major concern with radiation is the bladder, rectum and other healthy tissue involvement and manifestations e.g., incontinence, other cancers. Any advice either personal or through acquaintances will be very much appreciated. Seize the Day!

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Martin Jensen, Volunteer Mentor | @predictable | Aug 3, 2016

@ronoir, your reasoning is sound, and I couldn't steer you any other way. I hope @johnwburns is on hand today to give his reaction and advice. A friend of mine found an article from Harvard was helpful in thinking through his options for dealing with suspected recurrence: http://www.harvardprostateknowledge.org/how-to-handle-a-relapse-after-treatment-for-prostate-cancer.

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2 replies
JohnWBurns | @johnwburns | Aug 3, 2016

Apologies in advance if I resend you anything.
I looked further into ADT vs ADT with radiation and found a few recent studies. However, the vexing thing about dealing with these treatments is that there is no massive Framingham-like study to hang your hat on. At the end of the day its up to the patient and the doctor he trusts most to make the call.
From these brief notes its seem like there is bias toward ADT+radiation for more aggressive cancers with positive nodes. I don't see any correlation with PSA levels but I assume that they are framed against the usual reference for recurrence 0.2 - 0.4. The bias is probably toward the lower end with a Gleason 9.
http://www.ncbi.nlm.nih.gov/pubmed/25957435
http://www.ncbi.nlm.nih.gov/pubmed/25683831
This one talks about targeted radiation of the nodes themselves using sBRT and is goes into the work done at Mayo using Choline C11 imaging.
https://prostatecancerinfolink.net/2015/03/18/salvage-treatment-of-recurrent-lymph-node-positive-prostate-cancer-in-the-modern-era/
Don't be put off by the survival rate palaver.

Have you asked a doctor about how intense the radiation would be for salvage w/ADT? The lower the cumulative dose, the less chance of downstream effects on the bladder/colon. If you do get radiation, don't take any anti-oxidants prior to or during treatment per my radiation oncologist and things I have read to support it as it will dampen the clinical effect on the cancer.

This is a huge topic and please don't interpret what I send as any kind of conclusion. I'm just trying to supplement your analysis.

I had a lot of stuff jump out when I searched on 'salvage radiation prostate cancer with positive lymph nodes'.

The risk of bladder and other tissue complications down the road is there and, like all things to do with this, it has to be weighed accordingly. Bottom line always come back to the skill of the clinicians doing the treatment as the biggest mitigating factor.

Personally, after looking at what's being done in a lot of places, I would go to Mayo Rochester, and not because this is a Mayo site. There are a number of clinics that are purported to be leading edge, and I'm sure are, but Rochester seems to have the edge. I can't quantify that precisely. Its just what I get from gleaning a lot of stuff.

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2 replies
Ronoir | @ronoir | Aug 3, 2016
In reply to @predictable "@ronoir, your reasoning is sound, and I couldn't steer you any other way. I hope @johnwburns..." + (show)
@predictable

@ronoir, your reasoning is sound, and I couldn't steer you any other way. I hope @johnwburns is on hand today to give his reaction and advice. A friend of mine found an article from Harvard was helpful in thinking through his options for dealing with suspected recurrence: http://www.harvardprostateknowledge.org/how-to-handle-a-relapse-after-treatment-for-prostate-cancer.

Jump to this post

predictable, thank you for the link to the Harvard article which is full of<br>helpful information. ill make copies for my son and daughter and continue<br>my efforts. Respectfully, Ron.<br><br>

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Martin Jensen, Volunteer Mentor | @predictable | Aug 3, 2016
In reply to @predictable "@ronoir, your reasoning is sound, and I couldn't steer you any other way. I hope @johnwburns..." + (show)
@predictable

@ronoir, your reasoning is sound, and I couldn't steer you any other way. I hope @johnwburns is on hand today to give his reaction and advice. A friend of mine found an article from Harvard was helpful in thinking through his options for dealing with suspected recurrence: http://www.harvardprostateknowledge.org/how-to-handle-a-relapse-after-treatment-for-prostate-cancer.

Jump to this post

You're welcome, Ron. By the way, it is I who is respectful. You're carrying the load very well.

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flor | @flor | Aug 4, 2016

FROM WHAT I HAVE EXPERIENCED WITH MY HUSBAND . I THINK YOU SHOULD GO WITH<br>LUPRON THERAPY. HE IS DOING VERY WELL AFTER 15 YEARS OF TAKING IT AND HIS<br>PSA IN UNDETECTABLE.<br>

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Ronoir | @ronoir | Aug 4, 2016
In reply to @johnwburns "Apologies in advance if I resend you anything. I looked further into ADT vs ADT with..." + (show)
@johnwburns

Apologies in advance if I resend you anything.
I looked further into ADT vs ADT with radiation and found a few recent studies. However, the vexing thing about dealing with these treatments is that there is no massive Framingham-like study to hang your hat on. At the end of the day its up to the patient and the doctor he trusts most to make the call.
From these brief notes its seem like there is bias toward ADT+radiation for more aggressive cancers with positive nodes. I don't see any correlation with PSA levels but I assume that they are framed against the usual reference for recurrence 0.2 - 0.4. The bias is probably toward the lower end with a Gleason 9.
http://www.ncbi.nlm.nih.gov/pubmed/25957435
http://www.ncbi.nlm.nih.gov/pubmed/25683831
This one talks about targeted radiation of the nodes themselves using sBRT and is goes into the work done at Mayo using Choline C11 imaging.
https://prostatecancerinfolink.net/2015/03/18/salvage-treatment-of-recurrent-lymph-node-positive-prostate-cancer-in-the-modern-era/
Don't be put off by the survival rate palaver.

Have you asked a doctor about how intense the radiation would be for salvage w/ADT? The lower the cumulative dose, the less chance of downstream effects on the bladder/colon. If you do get radiation, don't take any anti-oxidants prior to or during treatment per my radiation oncologist and things I have read to support it as it will dampen the clinical effect on the cancer.

This is a huge topic and please don't interpret what I send as any kind of conclusion. I'm just trying to supplement your analysis.

I had a lot of stuff jump out when I searched on 'salvage radiation prostate cancer with positive lymph nodes'.

The risk of bladder and other tissue complications down the road is there and, like all things to do with this, it has to be weighed accordingly. Bottom line always come back to the skill of the clinicians doing the treatment as the biggest mitigating factor.

Personally, after looking at what's being done in a lot of places, I would go to Mayo Rochester, and not because this is a Mayo site. There are a number of clinics that are purported to be leading edge, and I'm sure are, but Rochester seems to have the edge. I can't quantify that precisely. Its just what I get from gleaning a lot of stuff.

Jump to this post

Much appreciation John for all of that invaluable information which will<br>surely be helpful in my decision making. Best of Regard's Ron<br><br>

REPLY
JohnWBurns | @johnwburns | Aug 4, 2016
In reply to @johnwburns "Apologies in advance if I resend you anything. I looked further into ADT vs ADT with..." + (show)
@johnwburns

Apologies in advance if I resend you anything.
I looked further into ADT vs ADT with radiation and found a few recent studies. However, the vexing thing about dealing with these treatments is that there is no massive Framingham-like study to hang your hat on. At the end of the day its up to the patient and the doctor he trusts most to make the call.
From these brief notes its seem like there is bias toward ADT+radiation for more aggressive cancers with positive nodes. I don't see any correlation with PSA levels but I assume that they are framed against the usual reference for recurrence 0.2 - 0.4. The bias is probably toward the lower end with a Gleason 9.
http://www.ncbi.nlm.nih.gov/pubmed/25957435
http://www.ncbi.nlm.nih.gov/pubmed/25683831
This one talks about targeted radiation of the nodes themselves using sBRT and is goes into the work done at Mayo using Choline C11 imaging.
https://prostatecancerinfolink.net/2015/03/18/salvage-treatment-of-recurrent-lymph-node-positive-prostate-cancer-in-the-modern-era/
Don't be put off by the survival rate palaver.

Have you asked a doctor about how intense the radiation would be for salvage w/ADT? The lower the cumulative dose, the less chance of downstream effects on the bladder/colon. If you do get radiation, don't take any anti-oxidants prior to or during treatment per my radiation oncologist and things I have read to support it as it will dampen the clinical effect on the cancer.

This is a huge topic and please don't interpret what I send as any kind of conclusion. I'm just trying to supplement your analysis.

I had a lot of stuff jump out when I searched on 'salvage radiation prostate cancer with positive lymph nodes'.

The risk of bladder and other tissue complications down the road is there and, like all things to do with this, it has to be weighed accordingly. Bottom line always come back to the skill of the clinicians doing the treatment as the biggest mitigating factor.

Personally, after looking at what's being done in a lot of places, I would go to Mayo Rochester, and not because this is a Mayo site. There are a number of clinics that are purported to be leading edge, and I'm sure are, but Rochester seems to have the edge. I can't quantify that precisely. Its just what I get from gleaning a lot of stuff.

Jump to this post

Your welcome Ron. I went through something very similar to what you're experiencing and in fact it is still going on so I can identify. Hope that some of the collective info here does actually help. Best.

REPLY
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