I've been going to Myers since psa rise post surgery. The psa history is in my sig, but basically it's gone from 0.132 to 0.17 over the past 17 months. Doubling time is 4.7 years since starting his treatment, calculated on the MSKCC site.

So I'm in a holding pattern on psa, but because I sense he is on a glide path to retirement I wanted to find a more local team for the future. I went to the University of Chicago hospital for a second opinion. I showed the MO the chart I made tracking psa and changes in drugs. He said I must be an engineer, and he was correct. But he didn't seem to be impressed with the fact that doubling time went from about 3 months post surgery to 4.7 years since being treated by Myers. He said I should get radiation (the standard of care) and set me up with a consult tomorrow (4/5) with their RO, and they also scheduled CT and bone scans. He was pretty matter of fact about my lingering incontinence issues would never improve after radiation. He also said they would radiate my manboobs but I don't think that's a very sure bet either.

Everything I've read here and elsewhere says those scans won't detect anything if the psa is as low as mine. Myers hasn't even suggested sending me to Sand Lake either. I'm sure they won't be cheap even with insurance coverage since it all hits the deductible now. I'm also changing insurance at the end of May when my severance package runs out, then again to medicare in September. I don't know if deductibles start over at each change of insurance, but I'm pretty sure medicare would cover most of it if I wait until September.

In any case, is there actually any benefit to running those tests at all?

I'm thinking I should go for the consultation to talk to the RO, but cancel the scans.

I hope for a quick reply since I go to see them tomorrow morning.

Thanks

I'm not a doctor, but it sure sounds like you are getting lousy advice.

Scans will show nothing with that PSA.

Your PSADT is enviable, not worrisome.

Maybe someone with far more knowledge will jump in

Mel

From March to July of 2014 my psa went from .03 to .1. I was still struggling with continence and complete ED. I didn't want to add radiation damage to the mix so I went to Myers for an alternative plan. My brother started with him about 6 months prior. By the time I first saw him, psa had risen to .132, but as you can see, hasn't really changed much since. I'm still not keen on adding radiation SE's to my situation. What I really need is to be diligent about kegels. Next is to decide what to do about the manboobs. At least then I'd feel like a mostly restored person. And probably just chalk up 100% ED as a fact of my remaining life.

I cancelled the tests but I'm going to keep the consult with the RO.

Thanks all.

I agree that the bone scan isn't likely to show much. With your T3a and GS8, there's reason to consider the possibility that it's nested in the prostate bed. You may want to have the CT to rule out the possibility that it's enlarging your pelvic LNs. If that's the case (and it probably isn't), they can radiate those too.

I'm confused by your signature - are you still taking Casodex? If you are, that would explain why it seems to be in stasis for now -- but no one can predict how long that will continue.

- Allen

Because Casodex shrinks cancer, it's unlikely that scans will show anything useful. For salvage radiation, I think that good image tracking and fast, high-accuracy linacs can go a long way towards reducing SEs. However, the unprotected urethra will be getting a full blast, possibly complicating urinary problems. Down the road, if medication doesn't help, you may want to consider a sling or an artificial urinary sphincter.

- Allen

Their results seem very good, and it sounds like you have reasonable expectations for outcomes, both cancer control and quality of life.

Rigby said...
I asked if the type of machine used is very important and he indicated it wasn't as important as doing the planning properly. Is "image-guided IMRT" state of the art for my situation?

I certainly agree with that - the plan is the most important aspect, and the care they take with it is critical. So is the luck of individual anatomy. When IGRT/IMRT is used for salvage, they can implant fiducials or transponders in the prostate bed - but not everyone does that. Some prefer to just use the cone beam CT to sight soft tissue. There is no real standard. You'd have to ask what he does. The advantage of faster linacs is that less organ motion can occur during treatment. "VMAT" linacs are particularly fast.

Rigby said...
I don't know how to read Table 3. For instance QOL domain Urinary irritation with independent variable Time to RT has a P value of .72. Does that mean the longer you wait before RT, the more likely urinary irritation will occur?

A p value of .72 means that that variable is not statistically significant in their multivariate model (i.e., with all the variables tested for significance together). To be significant, the generally accepted p value would have to be ≤0.05 (= at least 95% confidence that it is statistically significant). So the way to interpret that is that the time between RP and salvage RT had no statistically significant association with patient evaluations of urinary irritation. We see from Table 3 that of the variables they looked at together, only BMI and salvage RT dose had a statistically significant association with the two urinary domains, that BMI and African-American race were significantly associated with bowel function, and that age was significantly associated with sexual function.

- Allen

-

Image guidance generally refers to implanted markers, not just skin tattoos (which is just a rough alignment). For salvage treatment, they don't align prostate bed position within the treatment, only at the start of the treatment. The relative position of pelvic organs can change between treatments, so some ROs prefer image guidance with fiducials or transponders rather than just CT visualization of soft tissue. Motion is less of a concern with faster linacs, and when they don't have to deal with a squirrely prostate.

- Allen