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5 months post Da Vinci -PSA now 0.2

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User

Posted 16 Oct 2018 at 20:17

Hi All,

I'm now 5 months on from my op. What was thought to be T2 morphed into a T3a cancer but otherwise it all went well. 6 weeks post op my PSA was tested at 0.1 (and rechecked it was actually 0.1) and then again in the last couple of weeks at 5 months and its 0.2. The surgeon is referring me for further treatment.

I haven't got this appointment yet. By the sound of it I will be radiotherapy but apparently all options will be discussed when I go see the Radiotherapist.

I'd rather not go in there blind and wondered if anyone else who has trod this path before could outline what might happen, are there any options to be aware of?

At the moment I feel good, physically and mentally. Is what's coming likely to make me feel ill?

All comments appreciated.

regards

stu k

User

Posted 16 Oct 2018 at 23:37

Sorry to see this Stu. As your first PSA post-op was detectable, it seems that this could be more than just a few cells left behind in the prostate bed. If you were my brother or friend, I would be asking the onco for a PET scan before agreeing to any salvage RT / HT ... I would want to be persuaded that there are no distant mets.

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

User

Posted 17 Oct 2018 at 05:19

Sorry you have a continuing problem.

I talked to my oncologist about potential treatment should I suffer recurrence, and he said the drill would be radiotherapy and hormone treatment for two years.

He said there are Choline PET scan facilities available, but not at his billion pound super hospital (PFI financed) here in Coventry, they have to use a scanner at a hospital in Birmingham.

Best of luck.

Cheers, John.

User

Posted 17 Oct 2018 at 06:36

PET scanning is becoming far more popular and there are even mobile units now. I was PET scanned at both Oxford and London. The idea is to properly identify the spread rather than nuke the pelvis area potentially causing other real problems , or using HT and chemo that systemically treats cancer anywhere but changes your life with side-effects. A single bone met or lymph node found can be treated easily without al the collateral damage

User

Posted 17 Oct 2018 at 09:12

Really sorry you have suffered surgery for no benefit. Your profile doesn't say what your post op pathology was other than T3. Were the margins clear? What was the final Gleason score?

If it was me I would be chasing a psma and possibly other scans to better understand what is going on.

User

Posted 18 Oct 2018 at 11:46

Thanks to all for the responses so far.

The surgeon who told me that the PSA was rising and that further therapy would be needed suggested that it would probably be radio therapy and a mild dose over a short period of time. Your responses suggest that this may be an over simplification.

I'm in a Healthcare Scheme so I'm in the process of trying to switch and see a Consultant to get a better idea of what is happening and reduce the time frame to get there. It good to be slightly more aware of the various scans even if it only helps to understand what's being said - and to ask about them if they are not offered!

The post op pathology was T3a, I don't know the post op Gleason, - up from a pre op T2c. Pre op Gleason score was 3+4 in all 10 cores of the biopsy. N0,M0,

Having done a bit more reading, Salvage Radio Therapy sounds like no fun at all :-(

regards to all

stu k

Edited by member 18 Oct 2018 at 11:47 | Reason: can't spill

User

Posted 18 Oct 2018 at 12:04

Not everyone has problems with salvage RT. John had the higher dose over 20 days rather than lower dose over 37 days and breezed through it; had his appointment every morning on the way to work, never needed to take a day off and continued with the gym and rugby throughout. The only effect was that he needed a nap at his desk a couple of times. However, he found the HT intolerable and , in the end, stopped it early.

Useful info when you see the oncologist - RT sessions are called fractions and it is given in a dose called a Gray (Gy). Traditionally, PCa RT has been given as 37 fractions of 2Gy but the trial that John was on was to look at how high a dose could be given safely and whether this could be more effective. They found that otherwise healthy men could cope with 3Gy or 3.2Gy without any extra side effects and that 19 or 20 fractions (60 - 64Gy in total) was as effective as 37 x 2Gy (74Gy in total) so this regime is now becoming more common. When you finally get to see an oncologist, if they can demonstrate to you that RT is likely to be worth having you could ask whether you will be having 20 or 37 sessions and why.

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

User

Posted 18 Oct 2018 at 13:13

Thank LynEyre, that's really useful information.

stu k

User

Posted 19 Oct 2018 at 10:40

Morning Stu,

I had a recurrence after prostatectomy and asked the Oncologist why he'd recommended 20 fractions instead of 37.He said it was because of my age (60 at the time) my level of fitness and being in good health, other than PCa. He went on to tell me that it is now accepted that this shorter duration was as effective. Hope all goes well for you.

Paul

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