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radiation after surgery

I am 58 years old and had a DaVinci radical prostatectomy nearly two years ago and just found out that my psa went up to .2 from less than .1 after surgery. My pathology showed that the cancer had penetrated the prostate capsule but the margins were negative. My initial Gleason score was 7 and psa was about 3.9.

My doctors have recommended that I undergo radiation therapy directed at my prostate bed. They told me that a c/t scan or a bone scan would not detect where the cancer was since my psa was still so low but that it was likely that it was growing near where my prostate once was.

Is this typical? Is there somewhere I can read up on any studies of this situation? I have been feeling good generally, aside from ED, and don't want to let the cancer get out of hand if I can do something about it early.

Re: radiation after surgery

Hello Mike-
My husbands situation is very much like yours. He is 57 PSA 7 prostate removed with the Da Vinci Robot May of last year. Also had extra capsular extension with clear margins and clear lymph nodes. At six months his PSA came in at .3 and three months later .7. We just had another bone scan, ct scan and a ProctaScint done to see if he has mets or if we could find out the location of the cancer before radiation treatments. Scan show no mets! You might want to check into getting a ProctaScint. It did locate an area of cancer in the logical place close to the extension. A ProctaScint helps to locate cancer in the soft tissues of your body. Now I feel confident the Radiation Oncologist has a target and we are not going thru a another procedure that is unnecessary with additional side affects. He still suffers with incontinence from his surgery and we can only hope this does not make it any worse. The dr did say we have a window of opportunity here for a cure and gave the percentage of 60-80%. Sounds good to me.
Good luck to you

Re: Re: radiation after surgery

Don't waste your time with a prostascint scan. I had one last year following a da Vinci. The scan showed nothing but an MRI showed half of my prostate remained. I'm having radiation and ADT now. It's no day at the beach but it's the just about the only choice after surgery. I'll update my story with details as soon at the treatments are over.

Paul A. from RI, USA.

Re: Re: Re: radiation after surgery

Paul,
I am interested that you are dismissive of the prostascint scan. My research has led me to believe that the scan has value when fused (overlaid?) with a MRI scan in locating tumours. Here is a link describing how it may be beneficial.
http://www.prostate-cancer.org/education/staging/Kipper_ProstaScintUpdate.html

Although the link states that the article is now longer available at that link if you enter "prostascint" in the search box at the top of the page it will bring it up.
Billmac

Re: Re: Re: Re: radiation after surgery

Billmac,
I can only speak from my own experience. I still have a significant amount of prostate tissue in me and my PSA was rising when I had the prostascint scan. The intent of the scan is to detect any PSA within the body. It detected nothing. That alone tells me that it does not work. You'd think that a test that costs $10,000 would be able to show what a $5 blood test detects. If the test shows nothing, then linking it (nothing) to an MRI will not help the diagnosis. My doctor has stopped using this test after it failed for me.

Paul A.

Re: Re: Re: Re: Re: radiation after surgery

PaulA,
thanks for the heads up on your experience with the prostascint scan. Just goes to show that nothing is certain.
Billmac

Re: radiation after surgery

Mike,
I'd suggest you go for the radiation soon, if your docs think it appropriate. Studies show that radiation results are best when the PSA is still quite low. I had surgery in July 2007 and started radiation in October, I also had extracapsular penetration. Just google on prostate salvage radiation and you'll find good stuff to read. My radiation was 23 doses to a larger than prostate bed area, and then the final doses just to the bed. I think that sort of regimen is standard now. Of course you are stuck knowing that if the cancer has spread out of the area then this will not be curative. But at the low PSA level where you are there won't likely be any way to reasonably locate it. Hence you go with the statistical likelihoods and hope for the best. I also know that some docs will suggest you get hormone treatment along with the radiation, but I didn't and I do not think that is the standard. Keep yourself on good diet and exercise during the radiation, likely you will get through it easily enough. It went very easy for me and I have no significant after effects.

Re: Re: radiation after surgery

Thanks Bill and thank you to all who have shared their thoughts and experiences. I feel much better knowing others have had similiar issues.

Re: radiation after surgery

By any chance is pomegranite juice part of your diet? My case is very similar to yours. Had daVinci in January 25, 2008. PSA has been >0.1 since. My uro is currently doing a clinical trial with pomegranite juice on those that have a rising PSA. He said I was not a canididate for the trial because it was too soon after surgery and my PSA was stable. He said to have at least 8 oz per day, so I have done that since February.

Re: radiation after surgery

Mike:
Go to the search function of this board to see the information using "swog 8794". There were two posts in March about this important trial. Or just use the term to find the full free study in JAMA.

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