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post-op oncologist meeting

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User
Posted 14 Mar 2017 at 00:21

Hi all again.

I'm due to meet my shiny new oncologist on Wednesday.  As it currently stands, my relevant stats are: Gleason 9 (4+5), pre-op PSA 22, t3a N0 M0, RP on 17th Jan 2017.  I've not seen the full pathology report, I do know that my PSA six weeks post-op was 0.08, 1 of 10 nodes with cancer.  So, I have a list of questions....:

  1. Did it stay Gleason 9?

  2. Did it stay T3a? ie. Did the extension extend even more?

  3. Cancer in node – what gleason rating?

  4. How far from the prostate was the infected node?

  5. Seminal vesicles – was cancer in there?

  6. What margins? What are margins?

  7. What scans will help now? i.e. to show cancer in other nodes

There are other less relevant questions, but which ones do the collective wisdom of PCUK do you think I've missed?  All pointers gratefully received.

Obviously, there will be considerations of the next line(s) of treatment - my current guess is HT, followed by RT 6 months in, but I'm willing to be surprised!  Continence clinic has been attended, ED clinic referral letter is awaiting.  This is a very silly process, and I think I will put my PCa on Ebay.  One not very careful owner, collection only. 

On the plus side, I actually managed a climb finally on Sunday.  However, the 10k hill walk and swimming today may have overdone it a little.

cheers,

Graham

User
Posted 14 Mar 2017 at 23:11

Hope tomorrow's meeting goes well Graham and that your shiny new onco proves to be an asset. These relationships are so important.

Cheers

Eleanor

User
Posted 15 Mar 2017 at 08:57

Good luck Graham with your new Onco. Hope the results are good

We can't control the winds - but we can adjust our sails
User
Posted 15 Mar 2017 at 21:26

Hi all

Well, the meeting with the onco was interesting. Turns out she is a lovely and personable onco, who gave me as much time as I wanted for many questions. However, the answers weren't particularly great! So, seems the pathology report has me on T3a, N1 R1 (?), 1/10 nodes with cancer, no cancer in the seminal vesicles, positive margins. Due to the higher than hoped for PSA at this stage and the Gleason 9, she recommends HT immediately, and RT on the next week or two.

I've got a prescription for Bicalutamide (150mg) to start tomorrow, and RT . Two types of RT on offer, four weeks of prostate base or 7 weeks of pelvic area. I've no idea how I meant to make that choice! All views are most welcome.

It appears that having a 'high grade' cancer limits my options and they want to throw the kitchen sink a it. This also means I will have to have "the conversation" with my nine ear old daughter, as she will be most anxious as to why her dad has to go the hospital every day. New lifestyle, here we come.

cheers
G

User
Posted 15 Mar 2017 at 21:52

G, all the research is saying that 20 fractions at a higher dose is more effective than 37 fractions at the lower dose, and the side effects make be slightly less - if she thinks you are fit enough to handle it, then go for the 20.

Are you sure they are starting RT in a week though? It usually takes longer than that to get the planning scans done and write the computer programme????

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 16 Mar 2017 at 08:51

You're right Lyn, I think what I meant was start the whole process in a week! i.e scan, then putting fashionable dots on me etc. 

Re. the 20 fractions option, I would be happy to have that if it is an equal alternative.  The impression I got from the onco was the 20 was more narrowly focussed than the 37, which covers a wider area.  I'll be going back next week to meet her again armed with more questions and a decision.

 

 

User
Posted 16 Mar 2017 at 09:06

Originally Posted by: Online Community Member

I'll be going back next week to meet her again armed with more questions and a decision.

The most important question I ask my Onco when faced with a choice between treatments is:

"If I were your husband, which option would you want me to take?".

User
Posted 16 Mar 2017 at 09:26

I agree.  That's the question I've been using that has got me to this point!  Although asking that did result in having a spinal injection rather than a general for the plate biopsy - not sure I would go for that option again.

User
Posted 16 Mar 2017 at 09:32

Maybe that would be the case for you in your specific situation (your onco knows that better than any of us) but it wasn't the case during the trial. John had 20 fractions at 3Gy targeted at the prostate bed and bottom of his bladder. The research showed that 60Gy (20 x 3Gy) was at least as effective as 74Gy (37 x 2Gy) but with fewer side effects. Some people in the trial had 19 fractions or 20 fractions at a range of intensity from 2.4 to 3.2 but if the dose got higher than that the side effects were worse.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

 
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