Adjuvant Therapy: How do I decide?

It is now 10 weeks since my RP surgery. The pathology report indicates a positive apical margin. With Gleason 6 and no extra capsular extension, the Surgeon suggested that there is no need for further treatment as long as the PSA remains undetectable.

I didn't feel comfortable leaving it as is so I made an appt with a radiation oncologist. He thinks that there is a good reason to do preventative radiation now.

My gut feeling is to power up all the guns early and fire hard against this monster. However I have two concerns.

1. I might be inviting side effects (Incontinence and ED) unnecessarily. I do not have these problems now.

2. The radiation oncologist told me that I will have only one chance at radiation. It can not be used again if the PSA rises in the future.

So I have conflicting opinions and I don't know how to make this decision. On one hand I am scared of losing continence or potency but on the other hand, I would hate to have a rising PSA in the future and then kick myself for not doing radiation right after surgery.

Any advice? How does one make such a decision? HELP!!

I too am in a very similar position as you. My urologist is also an oncologist and recomended that I have a 50/50 chance of PSA coming back.  I  saw an Oncologist and he recomended radiation to increase my chances of no PSA return with the margin.  I saw a radiation oncologist and as soon as I told him what my urologist/oncologist said he quickly deferred to him.  Although he did seem to give the impression that the number and length of the margin(s) was a determining factor.

You dont describe your margin in your post.  Mine was a single .5MM I understand.  I asked how many cancer cells can live in something like that and he said maybe two to three. 

I am seven months post surgical and my PSA's are undetectable so far.  My Urologist states after my six month PSA that he would like to draw another one at the one year mark.  That to me ( 6 months) is not watching it closely.  I am going to request one every three months for a long while.  It is bothersome to not be sure if you got it all.  I often say if my PSA even blinks I want to do salvage radiation of the prostate bed.

You say your Doc stated that you can not radiate if your PSA comes back.  I hope that's wrong for I based my decision on that I can.  After a period of time after surgery they call it Salvage Radiation not adjuntive radiation and I understand the latter is more powerful when there is PSA detected so I would assume you have more chance of side effects if it comes back but thats a huge IF.

I have read some posts here where some of us change our minds for the pressure of PSA coming back and not doing all we can weighs heavy on ourminds and that alone effects quality of life.

All I can say is do your research and take action based on who you are and what you feel is right.

I wish you the best in your decision.

Frank 

This stage is the most contraversial there is.  But at least my doctors have been forthright with that facts.   I think the stage pT2c guys have a tougher choice than I did.  I was the last staging designation before stage IV.  (Note you guys with "pT3c" are the same as me just a different older table).  For me with seminal vesical invasion (SVI), extraprostatic extention (EPE), and multiple positive margins, the blitz was on.  But make no bones about it, I could have stoppedthe undetectable after the surgery.

So why didn't I?  Well age for one.  I was just 44 at the time, and all the reading, and nomagrams showed me some pretty poor numbers in 5 years past surgery.  Still do but the nomagrams don't take into account my treatment options I selected.  In 7 years I had a 22% chance of being free of this disease in seven years.  My doctors sais 10% in anything after that.  I listed that nomagram below.  You pT2c guys with positive margins have better numbers there.  But it is still a tough call and adjuvant therapy does show improved numbers in later years.

SKM Nomagrams! For Post Prostatectomy!

Tony