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Radiotherapy trial

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User
Posted 09 Oct 2015 at 20:48

Hello,
My husband had a prostatectomy on 2nd September, (Robot)

T2c
Gleason 3+3/3+4 PSA 10
13 cores were taken and there was cancer in 12 of those cores.  5 of which were 3+4
Maximum tumour length 7mm

DRE was confirmed as 'Hard and suspicious' at first urology appointment 70g+

PSA 10
Cancer in both sides of glands

His MRI scan showed the tumour on the right abutting the capsule but 'possibly' not penetrating.

Today he went along for the histology results, unfortunately l was unable to go with him due to a stomach bug. Our son went along with him, so not alone!
The surgeon said the cancer had spread out of the prostate, but at the moment they have no idea as to the spread. He will be kept an eye on, bloods? MRI? l am unsure at the moment.

The surgeon did say they were doing a trial at the Royal Free where they may offer radiotherapy, he is sending a letter to the oncologist there, to see if he is suitable.  I thought radiotherapy was something that was given if the cancer had spread out of the capsule?  Has anyone else had radiotherapy in a similar situation?  If not do you know what other treatment would be available?
Thank you



User
Posted 09 Oct 2015 at 23:35
My OH had T3b with spread to nodes and he had RT to prostate and pelvis.

He could not have an RP operation because of this spread, so this was plan B.

I am sure that others will know more, but RT would seem like a sensible option for your OH.

all the best

Alison

User
Posted 10 Oct 2015 at 00:47

Hi Sandra,

A friend of mine had a Prostatectomy and it was found that the cancer had gone beyond where the surgeon could cut. He subsequently had HT followed by RT and some 8 years on his PSA is very low and stable. He was lucky! Much depends on whether the cancerous cells can be identified and how they have dispersed. A high quality scan might help but unless grouped in sufficient concentrations cancerous cells can be missed even in a very good scan so in such cases treating with RT could be like shooting in the dark which is another way of saying what the surgeon said. Nevertheless, I think it worth following up further opinion that may be offered at the Royal. The longer cancer has to mutate and spread the more difficult it is becomes to treat other than systemically.

Barry
User
Posted 10 Oct 2015 at 07:06

Hi I was very similar...they will be referring to the Radicals trial...if you Google it you can read what it's all about.

You don't say what his post op PSA is...do you know? They usually like it to be around the 0.03 mark or under which is obviously better.
Did they check any nodes if so where they clear?

My histology said I had a small breech and there were cancerous cells up to the margin where he had cut. I had 15 nodes removed which were all clear. but my PSA was 0.06 and they said they would have liked it to be lower...I asked to see the oncologist...she monitored my PSA..which did rise in 4 months so I had RT. That was all in 2013. I have not had any further treatment and my PSA this week was 0.02. The liklihood is that there will be some remaining cells in the prostate bed which can be sucessfully targeted by RT.
If you click on my avatar you can read my profile which is fairly up to dateyou

There is still every chance he is cureable...but it's good to be proactive

Bri

Edited by member 10 Oct 2015 at 07:07  | Reason: Not specified

User
Posted 10 Oct 2015 at 11:27

When you get the histology report, psa etc if your ok to do so share it on here and people will be able to share their experiences based upon a similar dx and treatment path

Bri

User
Posted 10 Oct 2015 at 13:19

Hi Sandra

I had RP in 2009 and RT in 2011

I have had no further treatment and my PSA = 0.01

See my profile

 

Kind regards

Ray

Edited by member 10 Oct 2015 at 13:19  | Reason: Not specified

User
Posted 10 Oct 2015 at 14:35

Originally Posted by: Online Community Member

 

The surgeon said the cancer had spread out of the prostate, but at the moment they have no idea as to the spread. He will be kept an eye on, bloods? MRI? l am unsure at the moment.

The surgeon did say they were doing a trial at the Royal Free where they may offer radiotherapy, he is sending a letter to the oncologist there, to see if he is suitable.  I thought radiotherapy was something that was given if the cancer had spread out of the capsule?  

Spread out of the capsule and spread out of the prostate mean the same thing Sandra.

 

When the prostate gets to pathology lab, they encase it in wax and then slice it very thin like a loaf of bread. They then inspect each slice to make sure all the cancer cells are well within the waxy edge. It sounds like the surgeon was explaining that the lab tests showed positive margins (ie the cancer cells were right up to the wax.) 

 

There are two ways of dealing with this -

a) wait to see whether the PSA stays low and stable - in which case the cells were up to the wax but none have been left behind inside the man. If the PSA rises in the future, then radiotherapy can be used to deal with the leftovers which might be quite tiny and usually in the area where the prostae was removed  OR

b) go for radiotherapy straight away as a sort of belt & braces approach

 

c) There is another set of men for whom the lab tests and first PSA show for definite that the cancer had already travelled. These men will usually be offered RT immediately although a recent trial has been looking at early chemo instead.

 

From what you say above, it sounds like your husband is in a or b rather than c  which is good news :-) 

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

Show Most Thanked Posts
User
Posted 09 Oct 2015 at 23:35
My OH had T3b with spread to nodes and he had RT to prostate and pelvis.

He could not have an RP operation because of this spread, so this was plan B.

I am sure that others will know more, but RT would seem like a sensible option for your OH.

all the best

Alison

User
Posted 10 Oct 2015 at 00:47

Hi Sandra,

A friend of mine had a Prostatectomy and it was found that the cancer had gone beyond where the surgeon could cut. He subsequently had HT followed by RT and some 8 years on his PSA is very low and stable. He was lucky! Much depends on whether the cancerous cells can be identified and how they have dispersed. A high quality scan might help but unless grouped in sufficient concentrations cancerous cells can be missed even in a very good scan so in such cases treating with RT could be like shooting in the dark which is another way of saying what the surgeon said. Nevertheless, I think it worth following up further opinion that may be offered at the Royal. The longer cancer has to mutate and spread the more difficult it is becomes to treat other than systemically.

Barry
User
Posted 10 Oct 2015 at 07:06

Hi I was very similar...they will be referring to the Radicals trial...if you Google it you can read what it's all about.

You don't say what his post op PSA is...do you know? They usually like it to be around the 0.03 mark or under which is obviously better.
Did they check any nodes if so where they clear?

My histology said I had a small breech and there were cancerous cells up to the margin where he had cut. I had 15 nodes removed which were all clear. but my PSA was 0.06 and they said they would have liked it to be lower...I asked to see the oncologist...she monitored my PSA..which did rise in 4 months so I had RT. That was all in 2013. I have not had any further treatment and my PSA this week was 0.02. The liklihood is that there will be some remaining cells in the prostate bed which can be sucessfully targeted by RT.
If you click on my avatar you can read my profile which is fairly up to dateyou

There is still every chance he is cureable...but it's good to be proactive

Bri

Edited by member 10 Oct 2015 at 07:07  | Reason: Not specified

User
Posted 10 Oct 2015 at 11:16

Thank you for your replies, I think I will have to wait for the letter to come from the hospital, as neither my husband or son mentioned any nodes being removed. Or the PSA level. Think they were both in shock.
The surgeon said the the cells were too small to see where they had gone, is that 'normal'
I will post again once I have the histology report. Once again thank you for your words of wisdom x

User
Posted 10 Oct 2015 at 11:27

When you get the histology report, psa etc if your ok to do so share it on here and people will be able to share their experiences based upon a similar dx and treatment path

Bri

User
Posted 10 Oct 2015 at 13:19

Hi Sandra

I had RP in 2009 and RT in 2011

I have had no further treatment and my PSA = 0.01

See my profile

 

Kind regards

Ray

Edited by member 10 Oct 2015 at 13:19  | Reason: Not specified

User
Posted 10 Oct 2015 at 14:35

Originally Posted by: Online Community Member

 

The surgeon said the cancer had spread out of the prostate, but at the moment they have no idea as to the spread. He will be kept an eye on, bloods? MRI? l am unsure at the moment.

The surgeon did say they were doing a trial at the Royal Free where they may offer radiotherapy, he is sending a letter to the oncologist there, to see if he is suitable.  I thought radiotherapy was something that was given if the cancer had spread out of the capsule?  

Spread out of the capsule and spread out of the prostate mean the same thing Sandra.

 

When the prostate gets to pathology lab, they encase it in wax and then slice it very thin like a loaf of bread. They then inspect each slice to make sure all the cancer cells are well within the waxy edge. It sounds like the surgeon was explaining that the lab tests showed positive margins (ie the cancer cells were right up to the wax.) 

 

There are two ways of dealing with this -

a) wait to see whether the PSA stays low and stable - in which case the cells were up to the wax but none have been left behind inside the man. If the PSA rises in the future, then radiotherapy can be used to deal with the leftovers which might be quite tiny and usually in the area where the prostae was removed  OR

b) go for radiotherapy straight away as a sort of belt & braces approach

 

c) There is another set of men for whom the lab tests and first PSA show for definite that the cancer had already travelled. These men will usually be offered RT immediately although a recent trial has been looking at early chemo instead.

 

From what you say above, it sounds like your husband is in a or b rather than c  which is good news :-) 

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

 
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