This forum is for the discussion of anything to do with Prostate Cancer. There are only four rules:
No fundraisers, no commercials (although it is OK to recommend choices of treatment or medical people based on your personal research; invitations to participate in third-party surveys are also acceptable, provided there is no compensation to YANA);
No harvesting e-mail addresses for Spam;
No insults or flaming - be polite and respectful at all times and understand that there may be a variety of points of view, all of which may have some validity;
Opinions are OK, but please provide as much factual evidence as possible for any assertions that you are making
Failure to abide by these simple rules will result in the immediate and permanent suspension of your posting privileges.
Since this is an International Forum, please specify your location in your post.
Jim, nearly nine years ago I was facing the same decisions. I opted for Casodex 150 mg plus Avodart. I am more interested in QOL than being a mental and physical cripple. For me it has worked out well. Next to no side effects. Three off periods of over two years and now with my psa remaining at 0.7 for the last 8 months I am thinking of taking another break from the Casodex and remaining on the Avodart.
ADT will not cure you. Radiation is the only curative option that you have. The prostate bed will be radiated hoping that the cancer cells are there. Of course there is the possible side effects of radiation, urine flow and ED. Not an easy decision to make.
Jim,
I do not know why you are waiting. I too badly wanted to avoid the hormone treatments. Radiation is the preferred treatment and your situation is the one where radiation has been shown to be most helpful. And the outcome statistics are much better if undertaken while the PSA is as low as possible.
The radiation will target the prostate bed, but will also include somewhat lower dosages to a wider field. You want to hit the tissues that were in close proximity to the prostate before it was removed.
Jim,
The key is to find out if the PC is local or if you have micromets. Radiation is only effective for local reoccurrances.
The nomograms are an indicator of micromets. These are your stats before your initial treatment.
Reoccurances are only about 30% effective, because most reoccurances are not local. Scans such as color doppler and MRIS may be able to determine a local occurance.
JohnT
Thanks for your replies. I continue to learn more from the members of this site.
Lenny, I've read your journal and it is very interesting. I think I'm still in the denial stage. If I close my eyes perhaps it will go away.
John, I've never heard of micromets, but it is now on the list of 1001 questions for my surgeon. Prior to surgery I had a bone scan, but an MRI was not performed. I was staged a T2C N0 MX, with positive margins at the left vas deferens, small vessel, and perineural invasion. I don't understand why the surgeon has delayed, but at the same time, PSA often rises for a short period following surgery and then begins to drop off.
I've been surprised by many things involving my treatment. My surgeon is a PCA survivor and I would have expected more concern over the rising PSA. He also had radiation following surgery.
My concern with the hormone therapy is the depression. I'm pretty depressed now and certainly don't want to aggrevate that issue further. I'll update my story following the doctor visit on the eleventh. Somehow, writing my emotions and questions on this website help me sort things out.
It has been mentioned on this site before that several studies worldwide have indicated that for men with pathological aspects including positive margins, seminal vesicle invasion (SVI) and extracapsular extension (ECE) that radiation soon after surgery, usually within 120 days, has shown significant positive impact by delay of progression and reduction of further treatments. SWOG 8794 at "Saint" Google will deliver a full text free article from the Journal of the American Medical Association (JAMA) on this topic.
Those sites were an interesting read. That's why I can't understand my surgeon's delay.
By the way, tar-hoosier, I was born in Indianapolis and raised in Lafayette. Sometimes you can tell quite a bit from a website nick name. Live in South Carolina now.
Jim,
Your surgeon is probably over his head. Surgeons are not that well versed in the biology of PC. Their speciality is when the cancer is contained. If there is any chance the cancer has escaped the prostate a top prostate oncologist should be contacted for a 2nd opinion.
JohnT
Doctor appointment on May 11. Researching oncologists at the Medical College of Georgia. That's triple PSA since surgery. News I expected, but not wanted.
Jim. Call Jim O'Hara at Peachtree City, Georgia at 770-632-2899. He works for the help-line at PCRI.org and was really helpful in finding me a local medical oncologist who specialized in pc. He is local for you.
The depression issues are not so bad if you have an understanding partner. Most importantly you need to stay active . Exercise for me was the key to mental stability. Anything that takes your mind off the problem.
