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Pt3b pathology after RP always require radiation?

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Posted 12/12/2013 1:34 PM (GMT -5)
If first psa after RT (when staged pt3b) is undetectable, is radiation always given or is salvage upon psa rise just as effective? If psa at time of biopsy and subsequent surgery was 4.5, does this bode well for slow progression even at pt3b? One radiologist said to think of worse pattern he had (tertiary 5 but G7) as being dominant and would require radiation plus 3 yrs HT. Rad doc at MD Anderson felt radiation but possibly no HT dependent upon psa. If psa is detectable, even though pre-surgery biopsy was 4.5, should lymph nodes be scanned for mets (Sand Lake Imaging) although we've been told scans cannot detect microscopic mets? I realize everything is dependent upon psa results, but sure would like advice from those who have been through this.
Posted 12/12/2013 2:17 PM (GMT -5)
I believe low psa does bode well in that circumstance,with a caveat that some aggressive cells do not produce the antigens. I also believe that tertiary should be included in treatment "planning". But if it is "known "[ not really possible to the nth degree}that there is no tertiary 5 are any 4 in the escaped cells, the treatment plan should, consider this to the same degree, that it would be considered in a contained cell differentiation. that is, there is no way anyone can tell in any postop pathology the complete extent of the disease. surgery does the best job in this. I also believe if there is aggressive tertiary found any where observable it factors differently in a negative way then if none is found at all. An excellent post op medico will hone in ALL the factors to come up wit the most balanced treatment plan. a medico of less fervor for the patient may ,just, to be safe" want to hit it with all they can, regarded less of SE's. I also believe a knowledgeable and forceful patient can change the " wiring of mediocrity to one od excellent it the medico, at least in the patients case. Please set up a signature with your post op statistics
Posted 12/12/2013 2:54 PM (GMT -5)
Dr King has shown that salvage treatment before PSA reaches .2 with 70 Gy has equivalent results to adjuvant treatment.

Tertiary pattern 5 is a high risk feature, as is the SVI and EPE. Did he have a PLND (pelvic lymph node dissection) or ePLND (extended)? If he did, and they were negative, he can just treat the prostate bed. If the PLND was positive and gave an indication that there are more infected lymph nodes left in there, I don't see a lot of value in spending the money on a lymph node scan since all his pelvic lymph nodes will be treated anyway. However, if you want to do that, they can add a boost to the known affected lymph nodes.

- Allen
Posted 12/12/2013 2:57 PM (GMT -5)
The problem seems to be that all generalities are false.

My reading convinced me that I'd have no adverse effects by waiting. I waited but pulled the trigger on radiation as soon as the numbers said it was time. HT was never discussed as part of the deal but I get the impression that much is doctor dependent. Of course what was "fact" two years ago may not be so today.

So far it's panning out.
Posted 12/12/2013 2:59 PM (GMT -5)
Mikla,
This was my journey. I was a PSA 20 post operative T3B guy. My PSA dropped to zero from the surgery. But T3B guys have a very high rate of relapse so we elected to do hormone therapy with 38 fractions of external beam radiation. I have never had a rise in PSA.

At the time of surgery for me in 2007 there was scant data on adjuvant therapies for cases like mine but all were very attractive studies. I elected to go with it but today it is a standard of care for T3B patients to use combination therapies.

All studies show that the combination of Surgery and EBRT with HT has better results than either alone. Some of the advantages require the dissection of local lymph nodes, and inguinal and iliac lymph node radiation.

But at all times it is the patients option. I do know T3B men that sequentially received therapies doing well. But the adjuvant combinations seem to always do better.

Tony
Posted 12/12/2013 4:39 PM (GMT -5)
Diagnosis info:
Tumor involves 15% of prostate, multifocal, bilateral
4+3 with tertiary 5 (4 @ 60%, 3 @ 35%, 5 @ 5%)
EXE at base, pos margin (pattern 3) at apex, SVI both sides at 1cm and 1 mm)
RP 10/31/2013
PSA at time of surgery was 4.5 (3.7 at biopsy 8/14/2013)
PSA post-surgery (to be performed 12/16/2013)
58 years old (father had Pc at 76)
No lymph/bone scans to date, but will be done in near future

Path report was not detailed in showing cell pattern for SV or EXE. Hubby was not symptomatic. Incontinence is better since surgery (stress leakage only - prevents leakage if muscles tightened upon standing/lifting). ED an issue but mindset for us both is life trumps all else.

Are we needing a miracle here?
Posted 12/12/2013 6:51 PM (GMT -5)
mbock
I was T3b and was PSA 9.4 before surgery. I was able to go 7 years before pulling the trigger on SRT when my PSA finally rose to 0.4. It is now more than three years since SRT and my PSA is still 0. I see no reason to rush into radiation, unless maybe there is some reason not to wait because of the tertiary 5.
Posted 12/12/2013 8:20 PM (GMT -5)
Being a Gleason 9 I chose to be as proactive as I could. Wish I would have been even more aggressive after surgery.
Posted 12/12/2013 8:48 PM (GMT -5)
with the stats you have, the gleason is same as mine tho mine has "only" 2 foci of tert 5 which i have been told is quite small...,still…. I am undetectable as of a year ago, due one now. you have a some negative stuff going on, but a miracle isn't required, just some solid treatment with a good medical team to control it if , in fact, that is required, which has not been verified. Good luck, nothing wrong with a miracle in any part of our lives, tho.
Posted 12/12/2013 8:51 PM (GMT -5)
one more thing, the cell pattern, while not on your report, should be knowable with, pressing your doc or pathology dept. it could ease your mind or trouble it also.
Posted 12/12/2013 9:36 PM (GMT -5)
No, unless you have evidence of recurrence (BCR), no reason to assume or have a secondary treatment.. Some men do well for years on end with similar stats, with no evidence of BCR.

David
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