I'm interested in conversations about and I want to talk about
Know exactly what you want?
Show search

Notification

Error

Biochemical recurrence?

User
Posted 02 Jul 2015 at 22:33

Very disappointed that I've had 2 consecutive rise of my PSA (0.08/0.14/0.18) since my RRP last September. Did not expect any rise to be that soon even though am aware that my medium to high risk profile ( Gleeson 4 +3, T2C with PNI (Perineural invasion) and 1mm apical surgical margin) can lead to eventual biochemical recurrence (in years to come) and possible metastasis. That's according to various  bonafide research data I've read.


Was referred to Radio Oncologist. Had a 3T Multi- Parametric MRI scan which was thankfully clear. So could there have been possible pre or post surgery local tumour cells leak which PSA would pick up but not MRI? That's my suspicion for what's it's worth . I only hope it is not distant micrometastases! That would really p..s me off!


To wait and see was not an option for me. So Oncologist and I agreed on the following plan: Hormone therapy ( for 2 years) combined with 6 weeks Radiotherapy. Started on Casodex 150mg last Friday. Will be reviewed in 4 weeks time with results of my 4th PSA. Then prepare for Radiotherapy (46 gy? )


My main concern is possible side effects of breast enlargement ( Friends/ relatives told me I could borrow my wife's bra!) and weight gain over any other. I know it varies from person to person.


As I am a fit, lean and toned 65 years old I would not want anything to mess it up! Vanity, you understand!  😜


I guess my good physical health (I have no other major medical condition) would mitigate against those side effects.


I would love any member with similar clinical profile and / or treatment plan to share their views/ experiences with me.


Any other comment/ opinion/advice, etc naturally most welcome.


Thank you and best regards,


 


Jacey

User
Posted 03 Jul 2015 at 01:23

Hi Jacey,
with PNI and a positive surgical margin, I am impressed that you held out for two years rather than just go straight for the adjuvant RT/HT straight away. My husband also held on for two years before accepting that he needed further treatment. He had only 6 months HT because he coudn't bear some of the side effects but three years later is still in the happy place of a PSA hovering at 0.03 - 0.04 so all is looking good.

Are you sure about the 46Gy? 6 weeks would be 30 fractions which are normally at least 2Gy each. John had 20 fractions (4 weeks) at 3Gy as part of a trial and had no problems.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 03 Jul 2015 at 08:28

Can't help with the practicality of your question Jacey, just to say I hope the side effects are minimal.

Like the behaviour of cancer itself, not all treatments affects all patients the same as you know, so hopefully the wife's bras can stay in her lingerie drawer!!

Best wishes for the coming treatment path

Sandra

We can't control the winds - but we can adjust our sails
User
Posted 03 Jul 2015 at 10:04

Hi Jacey

I can see it is 9 months since your RP. Looking at your profile I guess it is understandable why adjuvent RT wasnt offered.

It does seem as they are now taking the right course of action and hopefully the RT will sort out any remaining cells in the prostate bed.

Take care

Bri

User
Posted 03 Jul 2015 at 12:55

Originally Posted by: Online Community Member


Hi Jacey


I can see it is 9 months since your RP. Looking at your profile I guess it is understandable why adjuvent RT wasnt offered.


It does seem as they are now taking the right course of action and hopefully the RT will sort out any remaining cells in the prostate bed.


Take care


Bri



 


Hi Bri,


We've decided to go with full guns blazing. Is it overtreatment? I believe an aggressive approach at this stage is the right one for me.


My ultimate objective is curative or at least live for another 20 yrs!


 


Regards,


Jacey

User
Posted 03 Jul 2015 at 18:57

My apologies, I misread your timings. So soon after the op, I think the debate about whether you are embarking on adjuvant or salvage treatment is pure semantics and, as you say, results are usually very good. Statistically, anyone who needs any kind of salvage treatment is less likely to achieve total remission but the 10 years disease free stats for Europe are good.

As for the Gys, primary RT for prostate cancer is routinely given as 37 fractions of 2Gy. Adjuvant or salvage RT can be for 37 fractions or fewer, commonly 19, 20 or 21. Until recently it was believed that 2Gy was pretty much the highest dose a man could take but there have been a couple of trials - one looking to find out how high a dose can be given safely and the other to see whether side effects are better or worse with higher dose. As I said, John had 20 sessions at 3Gy and sailed through. The onco has told us since that the trial data is suggesting that the higher dose actually reduces side effects. I don't know how high they went although there was someone on here getting 2.8Gy - Bri maybe?

What was really interesting (and nothing to do with the trials) was the reading I did around the 20 sessions. I was a bit worried that he would not do so well if he was only getting 60Gy when other men get 74Gy or whatever. However, radiotherapy has a cumulative effect, in other words the 60gy delivered in high doses over a shorter time accumulates to be the equivalent of the 74Gy over a longer time. Clever stuff, isn't it!

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 03 Jul 2015 at 18:59

PS I don't think any of us would say this is over treatment Jacey

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 03 Jul 2015 at 19:46

I agree that it isn't over treatment. I actually had 3.2 gy given over 20 sessions and I too sailed through it.

Bri

Show Most Thanked Posts
User
Posted 03 Jul 2015 at 01:23

Hi Jacey,
with PNI and a positive surgical margin, I am impressed that you held out for two years rather than just go straight for the adjuvant RT/HT straight away. My husband also held on for two years before accepting that he needed further treatment. He had only 6 months HT because he coudn't bear some of the side effects but three years later is still in the happy place of a PSA hovering at 0.03 - 0.04 so all is looking good.

Are you sure about the 46Gy? 6 weeks would be 30 fractions which are normally at least 2Gy each. John had 20 fractions (4 weeks) at 3Gy as part of a trial and had no problems.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 03 Jul 2015 at 08:28

Can't help with the practicality of your question Jacey, just to say I hope the side effects are minimal.

Like the behaviour of cancer itself, not all treatments affects all patients the same as you know, so hopefully the wife's bras can stay in her lingerie drawer!!

Best wishes for the coming treatment path

Sandra

We can't control the winds - but we can adjust our sails
User
Posted 03 Jul 2015 at 10:04

Hi Jacey

I can see it is 9 months since your RP. Looking at your profile I guess it is understandable why adjuvent RT wasnt offered.

It does seem as they are now taking the right course of action and hopefully the RT will sort out any remaining cells in the prostate bed.

Take care

Bri

User
Posted 03 Jul 2015 at 12:48

Originally Posted by: Online Community Member


Hi Jacey,
with PNI and a positive surgical margin, I am impressed that you held out for two years rather than just go straight for the adjuvant RT/HT straight away. My husband also held on for two years before accepting that he needed further treatment. He had only 6 months HT because he coudn't bear some of the side effects but three years later is still in the happy place of a PSA hovering at 0.03 - 0.04 so all is looking good.


Are you sure about the 46Gy? 6 weeks would be 30 fractions which are normally at least 2Gy each. John had 20 fractions (4 weeks) at 3Gy as part of a trial and had no problems.



 


Thank you, Lyn. As usual one can count on your support, advice and considerable knowledge.


Actually it has been under a year since my surgery. Upon discovery of my margin I did contemplate and discuss with my surgeon the suitability of adjuvant therapy. He felt my 1mm margin was not significant and side-effects of further treatment had to be taken into the equation. Not an easy decision to be made at that time considering my risk profile! Maybe I could have pushed for a second opinion from a radio-oncologist!


Some studies suggest that adjuvant therapy offers similar benefits to salvage therapy (provided it's carried out within 2 yrs) in terms of progression-free survival. We'll see!


The advantage I have in starting salvage treatment now is that I fully recovered from my RRP and have been totally continent months ago. Not too bothered about more possible ED and libido loss (from ADT) though am still fairly sexually active!


Am not sure about the 46gy. That figure was briefly mentioned during my first encounter with the oncologist. The RT details have yet to be mapped out. I understand around 70 Gy is the norm? Of course it depends on the patient's clinical needs.


Regards,


Jacey

User
Posted 03 Jul 2015 at 12:55

Originally Posted by: Online Community Member


Hi Jacey


I can see it is 9 months since your RP. Looking at your profile I guess it is understandable why adjuvent RT wasnt offered.


It does seem as they are now taking the right course of action and hopefully the RT will sort out any remaining cells in the prostate bed.


Take care


Bri



 


Hi Bri,


We've decided to go with full guns blazing. Is it overtreatment? I believe an aggressive approach at this stage is the right one for me.


My ultimate objective is curative or at least live for another 20 yrs!


 


Regards,


Jacey

User
Posted 03 Jul 2015 at 18:57

My apologies, I misread your timings. So soon after the op, I think the debate about whether you are embarking on adjuvant or salvage treatment is pure semantics and, as you say, results are usually very good. Statistically, anyone who needs any kind of salvage treatment is less likely to achieve total remission but the 10 years disease free stats for Europe are good.

As for the Gys, primary RT for prostate cancer is routinely given as 37 fractions of 2Gy. Adjuvant or salvage RT can be for 37 fractions or fewer, commonly 19, 20 or 21. Until recently it was believed that 2Gy was pretty much the highest dose a man could take but there have been a couple of trials - one looking to find out how high a dose can be given safely and the other to see whether side effects are better or worse with higher dose. As I said, John had 20 sessions at 3Gy and sailed through. The onco has told us since that the trial data is suggesting that the higher dose actually reduces side effects. I don't know how high they went although there was someone on here getting 2.8Gy - Bri maybe?

What was really interesting (and nothing to do with the trials) was the reading I did around the 20 sessions. I was a bit worried that he would not do so well if he was only getting 60Gy when other men get 74Gy or whatever. However, radiotherapy has a cumulative effect, in other words the 60gy delivered in high doses over a shorter time accumulates to be the equivalent of the 74Gy over a longer time. Clever stuff, isn't it!

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 03 Jul 2015 at 18:59

PS I don't think any of us would say this is over treatment Jacey

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 03 Jul 2015 at 19:46

I agree that it isn't over treatment. I actually had 3.2 gy given over 20 sessions and I too sailed through it.

Bri

 
Forum Jump  
©2021 Prostate Cancer UK