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Decision taken for RT
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Terry Pinnell
May 10, 2012, 2:46:08 AM5/10/12
to
Five months after my biopsy I finally decided to go ahead with active
treatment. A VERY close call versus the alternative of active
surveillance. Especially considering the various reports indicating 15
year life expectancy remains unaltered whether patients treated or not, as
discussed here earlier.
Main factor swinging it (apart from that being the consistent
recommendation of the NHS 'multi-disciplinary team') was my conviction
that I'd continue to be worried sick if I wasn't getting treatment,
apprehensively awaiting every test and prognosis.
I started anti-androgen yesterday (Cyproterone Acetate, 2 x 100 mg daily).
That will last 3 weeks. In the middle of that period I start the first of
four 4-weekly HT injections, prior to 37 sessions of EBRT (IMRT). That
period could be extended. IOW, a fairly 'standard' RT approach.
After 3 months or so of the HT an assessment will be made whether to go
ahead and do a TURP. My urologist Mr Coker favours a 'proper' TURP as
against my initial preference for laser. Largely because the former allows
further pathology to confirm the PCa status.
He wasn't keen on my suggestion about treating the enlarged prostate with
drugs like Avodart (following discussion in sci.med.prostate.bph), because
of its still somewhat unproven pedigree, especially for 3+4 and above. And
of course another factor is that I have definitely been diagnosed with
PCa, complicating the issue.
However, he's open to laser if I later decide that's my choice. He says he
does them, although relatively few, so if I do go that route I have to
think about an alternative. But I have 3 months or so to ponder that.
Summary
-------
PSA SEP 2010 3.9
PSA SEP 2011 5.7
PSA NOV 2011 6.8
Biopsy JAN 2012 3+4=7, T1c
PSA MAR 2012 7.35
May 2012: Assessed unsuitable for brachytherapy, low flow rate
"Need a 'limited TURP'."
9 May 2012: TREATMENT DECISION, HT + focused EBRT
9 May 2012: Started 3 week course of anti-androgen (Cyproterone Acetate, 2
x 100 mg daily)
Age now 71; otherwise very fit.
--
Terry, East Grinstead, UK
treatment. A VERY close call versus the alternative of active
surveillance. Especially considering the various reports indicating 15
year life expectancy remains unaltered whether patients treated or not, as
discussed here earlier.
Main factor swinging it (apart from that being the consistent
recommendation of the NHS 'multi-disciplinary team') was my conviction
that I'd continue to be worried sick if I wasn't getting treatment,
apprehensively awaiting every test and prognosis.
I started anti-androgen yesterday (Cyproterone Acetate, 2 x 100 mg daily).
That will last 3 weeks. In the middle of that period I start the first of
four 4-weekly HT injections, prior to 37 sessions of EBRT (IMRT). That
period could be extended. IOW, a fairly 'standard' RT approach.
After 3 months or so of the HT an assessment will be made whether to go
ahead and do a TURP. My urologist Mr Coker favours a 'proper' TURP as
against my initial preference for laser. Largely because the former allows
further pathology to confirm the PCa status.
He wasn't keen on my suggestion about treating the enlarged prostate with
drugs like Avodart (following discussion in sci.med.prostate.bph), because
of its still somewhat unproven pedigree, especially for 3+4 and above. And
of course another factor is that I have definitely been diagnosed with
PCa, complicating the issue.
However, he's open to laser if I later decide that's my choice. He says he
does them, although relatively few, so if I do go that route I have to
think about an alternative. But I have 3 months or so to ponder that.
Summary
-------
PSA SEP 2010 3.9
PSA SEP 2011 5.7
PSA NOV 2011 6.8
Biopsy JAN 2012 3+4=7, T1c
PSA MAR 2012 7.35
May 2012: Assessed unsuitable for brachytherapy, low flow rate
"Need a 'limited TURP'."
9 May 2012: TREATMENT DECISION, HT + focused EBRT
9 May 2012: Started 3 week course of anti-androgen (Cyproterone Acetate, 2
x 100 mg daily)
Age now 71; otherwise very fit.
--
Terry, East Grinstead, UK
I.P. Freely
May 10, 2012, 11:42:35 AM5/10/12
to
Terry Pinnell wrote:
> Five months after my biopsy I finally decided to go ahead with active
> treatment.
I'm sure many of us concur in your case.
> Five months after my biopsy I finally decided to go ahead with active
> treatment.
> 15 year life expectancy remains unaltered whether patients treated or not
> I'd continue to be worried sick if I wasn't getting treatment,
> apprehensively awaiting every test and prognosis.
> My urologist Mr Coker favours a 'proper' TURP as
> against my initial preference for laser. Largely because the former allows
> further pathology to confirm the PCa status.
RT.
> He says he does [laser TURPS], although relatively few
CLANG CLANG CLANG go the alarm bells. If you decide to go that route,
find a provider who has done many hundreds, at least.
I.P.
colin
May 10, 2012, 1:29:25 PM5/10/12
to
Hi Terry I have been reading your decision making posts
with a PSA of 174.0 and Lymph node involvement, I was never in the
same boat as you, When first diagnosed I was seen privately by
2 oncologists, the first said that with a PSA over 20 in
His experience did not think RT would be of benefit,
The second as I had no visible bone mets would have given it a
go, on checking the scans and seeing I had diverticulitis decided
against it, two years on zoladex later I went back to the first
Oncologist's clinic on the NHS and seen a junior Oncologist, had new
scans and bone check, and was recommended RT with a chance of a cure
asked about the Diverticulitis and the high original PSA,told no
problem, my GP's reply from the oncologist, said chance of a cure was
remote, in 5 years at this clinic I have never again seen the Onc whom
I seen privately and runs the clinic.
I think the NHS will generally do something, other than risk headlines
they left me to die.
My advise would be see a consultent oncologist privately
colin
with a PSA of 174.0 and Lymph node involvement, I was never in the
same boat as you, When first diagnosed I was seen privately by
2 oncologists, the first said that with a PSA over 20 in
His experience did not think RT would be of benefit,
The second as I had no visible bone mets would have given it a
go, on checking the scans and seeing I had diverticulitis decided
against it, two years on zoladex later I went back to the first
Oncologist's clinic on the NHS and seen a junior Oncologist, had new
scans and bone check, and was recommended RT with a chance of a cure
asked about the Diverticulitis and the high original PSA,told no
problem, my GP's reply from the oncologist, said chance of a cure was
remote, in 5 years at this clinic I have never again seen the Onc whom
I seen privately and runs the clinic.
I think the NHS will generally do something, other than risk headlines
they left me to die.
My advise would be see a consultent oncologist privately
colin
Alan Meyer
May 10, 2012, 2:36:13 PM5/10/12
to
If the cancer is metatstatic, the theory is (and I think the practice
too) that radiating the prostate can't cure it.
However there is a very good chance that Terry's cancer is still local.
His PSA and Gleason scores don't indicate metastasis yet. So the
recommendation for radiation seems appropriate.
In your (Colin's) case, I haven't heard of a PSA near 174, or for that
matter a PSA above 50 or so, that was not metastatic. It's just hard to
imagine a tumor in the prostate that is big enough to generate that much
PSA.
Before getting radiation in your case, I want to know where the
oncologist thinks that much PSA is coming from, and how much tumor mass
would be required to create that much PSA, and whether that massive a
tumor was found in the scans of the prostate. If his answer to that is
"Huh?" or "I don't know how to figure tumor burden from PSA", then maybe
he doesn't know enough about prostate cancer to be making a recommendation.
Alan
too) that radiating the prostate can't cure it.
However there is a very good chance that Terry's cancer is still local.
His PSA and Gleason scores don't indicate metastasis yet. So the
recommendation for radiation seems appropriate.
In your (Colin's) case, I haven't heard of a PSA near 174, or for that
matter a PSA above 50 or so, that was not metastatic. It's just hard to
imagine a tumor in the prostate that is big enough to generate that much
PSA.
Before getting radiation in your case, I want to know where the
oncologist thinks that much PSA is coming from, and how much tumor mass
would be required to create that much PSA, and whether that massive a
tumor was found in the scans of the prostate. If his answer to that is
"Huh?" or "I don't know how to figure tumor burden from PSA", then maybe
he doesn't know enough about prostate cancer to be making a recommendation.
Alan
colin
May 10, 2012, 5:12:02 PM5/10/12
to
Hi Alan I agree with you about Terry's case, I just think a
consultant has years of knowledge, can think for himself, is peer
reviewed, and discusses cases with other consultants, some
of the others are people who have passed an exam, and probably
some of the others know as least as much as the consultants,
The problem is you don't know which of the others you are seeing,
so hedge your bets pay to see a consultant.
On Thu, 10 May 2012 14:36:13 -0400, Alan Meyer <ame...@yahoo.com>
wrote:
consultant has years of knowledge, can think for himself, is peer
reviewed, and discusses cases with other consultants, some
of the others are people who have passed an exam, and probably
some of the others know as least as much as the consultants,
The problem is you don't know which of the others you are seeing,
so hedge your bets pay to see a consultant.
On Thu, 10 May 2012 14:36:13 -0400, Alan Meyer <ame...@yahoo.com>
wrote:
Steve Kramer
May 11, 2012, 8:30:15 AM5/11/12
to
"Terry Pinnell" wrote in message
news:tgomq7t6nos2jj2ku...@4ax.com...
Five months after my biopsy I finally decided to go ahead with active
treatment.
==> Wonderful! We all have our opinions, many of which are based on sound
logic, experience, and research, but we have all always agreed that once you
have determined a course of action that you should put that decision behind
you and look forward. No second-guessing. No considerations of what would
have happened if you had done something different. This takes a huge load
off your mind. Leave the load by the side of the road.
PSA OCT 2000 @ 46
Biopsy NOV 2000 3+4=7, T2c
RRP DEC 2000 3+4=7), T3cN0M0, SVI, Neg margins
PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
EBRT MAY - JULY 2002 @ 47
PSA .34 .22 .15 .21 .32 PSAD 0.56 years
Lupron started JULY 2003 @ 48
PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.40 years
Casodex added JUL 2006 @ 51
Last PSA <0.05 Next draw AUG 2012 @ 57
Illegitimati non carborundum
news:tgomq7t6nos2jj2ku...@4ax.com...
Five months after my biopsy I finally decided to go ahead with active
treatment.
logic, experience, and research, but we have all always agreed that once you
have determined a course of action that you should put that decision behind
you and look forward. No second-guessing. No considerations of what would
have happened if you had done something different. This takes a huge load
off your mind. Leave the load by the side of the road.
PSA OCT 2000 @ 46
Biopsy NOV 2000 3+4=7, T2c
RRP DEC 2000 3+4=7), T3cN0M0, SVI, Neg margins
PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
EBRT MAY - JULY 2002 @ 47
PSA .34 .22 .15 .21 .32 PSAD 0.56 years
Lupron started JULY 2003 @ 48
PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.40 years
Casodex added JUL 2006 @ 51
Last PSA <0.05 Next draw AUG 2012 @ 57
Illegitimati non carborundum
Steve Kramer
May 11, 2012, 8:36:25 AM5/11/12
to
Wow! I forgot all about that initial PSA. You have done well to still be
kicking seven years later. How has your PSA done over that last year?
PSA OCT 2000 @ 46
Biopsy NOV 2000 3+4=7, T2c
RRP DEC 2000 3+4=7), T3cN0M0, SVI, Neg margins
PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
EBRT MAY - JULY 2002 @ 47
PSA .34 .22 .15 .21 .32 PSAD 0.56 years
Lupron started JULY 2003 @ 48
PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.40 years
Casodex added JUL 2006 @ 51
Last PSA <0.05 Next draw AUG 2012 @ 57
Illegitimati non carborundum
"colin" wrote in message news:ohpnq7dr5h9f1t2mi...@4ax.com...
kicking seven years later. How has your PSA done over that last year?
PSA OCT 2000 @ 46
Biopsy NOV 2000 3+4=7, T2c
RRP DEC 2000 3+4=7), T3cN0M0, SVI, Neg margins
PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
EBRT MAY - JULY 2002 @ 47
PSA .34 .22 .15 .21 .32 PSAD 0.56 years
Lupron started JULY 2003 @ 48
PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.40 years
Casodex added JUL 2006 @ 51
Last PSA <0.05 Next draw AUG 2012 @ 57
Illegitimati non carborundum
colin
May 12, 2012, 5:26:46 PM5/12/12
to
Hi Steve After coming off Zoladex and psa rising to 13.8
Back on zoladex aug2010 Psa since then stuck at 0.7
due another check this month
history
diagnosed november 2005 gleason 4+3 aged 62 psa =174 T3a on MRI
(extra capsular spread on left) lymph node adjacent to bladder on the
right. Bone scan clear
dexa 10/2006 normal, lumber spine (t score +0.3) hip (t score -0.5)
nov05 psa 174
casodex
jan1706 zoladex
jan2306 psa 4.0
apr1706 psa 0.8
zoladex jul1706 psa 0.4
oct0106 bone density scan normal
zoladex oct1706 psa 0.3
zoladex jan1707 psa 0.2
zoladex apr1707 psa 0.2
zoladex jul1707 psa 0.1
zoladex oct1707 psa 0.1
zoladex jan1708 psa 0.1
zoladex jan2508
MRI clear jan2908
bone scan clear
Apr3008 psa 0.1
jul3008 psa 0.5
aug1708 testical scan. result cysts.removed
nov1208 psa 6.1
jan2309 psa 14.2
feb0309 Zoladex
may2209 psa 0.7
zoladex aug2409 psa 0.3
zoladex dec2409 psa 0.3
mar1110 psa 0.5
jun0810 psa 7.2
jul2810 psa 13.8
aug2010 zoladex
zoladex sep2110 psa 3.5
zoladex nov1210 psa 1.4
zoladex feb1611 psa 0.8 weight 78.2k
zoladex may1611 psa 0.8 weight 78.11k
zoladex aug1611 psa 0.7 weight 79.1
zoladex nov0411 psa 0.7
dexa normal
zoladex feb0912 psa 0.7
Back on zoladex aug2010 Psa since then stuck at 0.7
due another check this month
history
diagnosed november 2005 gleason 4+3 aged 62 psa =174 T3a on MRI
(extra capsular spread on left) lymph node adjacent to bladder on the
right. Bone scan clear
dexa 10/2006 normal, lumber spine (t score +0.3) hip (t score -0.5)
nov05 psa 174
casodex
jan1706 zoladex
jan2306 psa 4.0
apr1706 psa 0.8
zoladex jul1706 psa 0.4
oct0106 bone density scan normal
zoladex oct1706 psa 0.3
zoladex jan1707 psa 0.2
zoladex apr1707 psa 0.2
zoladex jul1707 psa 0.1
zoladex oct1707 psa 0.1
zoladex jan1708 psa 0.1
zoladex jan2508
MRI clear jan2908
bone scan clear
Apr3008 psa 0.1
jul3008 psa 0.5
aug1708 testical scan. result cysts.removed
nov1208 psa 6.1
jan2309 psa 14.2
feb0309 Zoladex
may2209 psa 0.7
zoladex aug2409 psa 0.3
zoladex dec2409 psa 0.3
mar1110 psa 0.5
jun0810 psa 7.2
jul2810 psa 13.8
aug2010 zoladex
zoladex sep2110 psa 3.5
zoladex nov1210 psa 1.4
zoladex feb1611 psa 0.8 weight 78.2k
zoladex may1611 psa 0.8 weight 78.11k
zoladex aug1611 psa 0.7 weight 79.1
zoladex nov0411 psa 0.7
dexa normal
zoladex feb0912 psa 0.7
Steve Kramer
May 12, 2012, 8:59:21 PM5/12/12
to
That's great, Budgie. 0.7 is nothing to right home about but horizontal
graphs are.
PSA OCT 2000 @ 46
Biopsy NOV 2000 3+4=7, T2c
RRP DEC 2000 3+4=7), T3cN0M0, SVI, Neg margins
PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
EBRT MAY - JULY 2002 @ 47
PSA .34 .22 .15 .21 .32 PSAD 0.56 years
Lupron started JULY 2003 @ 48
PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.40 years
Casodex added JUL 2006 @ 51
Last PSA <0.05 Next draw AUG 2012 @ 57
Illegitimati non carborundum
"colin" wrote in message news:bgktq75aue2r9ge0s...@4ax.com...
graphs are.
PSA OCT 2000 @ 46
Biopsy NOV 2000 3+4=7, T2c
RRP DEC 2000 3+4=7), T3cN0M0, SVI, Neg margins
PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
EBRT MAY - JULY 2002 @ 47
PSA .34 .22 .15 .21 .32 PSAD 0.56 years
Lupron started JULY 2003 @ 48
PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.40 years
Casodex added JUL 2006 @ 51
Last PSA <0.05 Next draw AUG 2012 @ 57
Illegitimati non carborundum
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