One Month Post Surgery

I am doing much better and no pain at all. Still incontinent, but improving there also. Slept without padded underwear the other night and the padded sheet was almost dry in the morning. I did the same thing the next night and the padded sheet was wet- go figure- :)

Went to a Urologist at Cleveland Clinic Florida today, not my surgeon at U of Miami, and he remarked that if I had not had surgery and gone with RT my positive nodes probably would have remained undetected. He had originally advised me against RT because of my voiding issues. The surgery did not correct that voiding, but my urine stream is much better.

Of course, knowing I had two nodes positive doesn't solve anything. Waiting to take blood test in two weeks and see my PSA results and decide on plan of action.

His take is, microscopic cancer cells are out there away from the prostate bed so RT to prostate bed and remaining nodes may be fruitless.

My surgeon, who has not seen PSA results yet, is leaning toward Lupron and RT. I see him again in August. Will have another PSA test before seeing him.

I have a similar situation to yours. MD Anderson's radiation oncology department does Lupron and then ART.

The data is mixed. In a couple of database analyses, there seemed to be a benefit to adjuvant RT, but in another one, there was no benefit.

Impact of Adjuvant Radiotherapy on Survival of Patients With Node-Positive Prostate Cancer

The Impact of Definitive Local Therapy for Lymph Node-Positive Prostate Cancer: A Population-Based Study

Patterns of care and outcomes of radiotherapy for lymph node positivity after radical prostatectomy

(None of these was a randomized clinical trial.)

Your urologist may be right that radiation now may be futile. I think that you can make a best effort to detect distant mets with an advanced PET scan, acknowledging that your PSA is probably too low for detection. If none are found, it raises the probability that adjuvant RT will be successful. I think you should be talking to a radiation oncologist who actually has experience dealing with this kind of stuff rather than a surgeon or a urologist.

- Allen

fixed the link

Post Edited (Tall Allen) : 5/21/2016 10:27:58 AM (GMT-6)

Bobby Mac said...
Hi John -

What are your current PSA readings? The last one you post is 9/29/15.

How many Nodes were positive?

Yes, looks like I am going to do the same thing. Still waiting to have my first PSA post surgery.

Best wishes for continuing "0" PSA.

Bobby Mac

Hi Bobby - I need to change my sig to show the latest PSA, you don't have very many characters available.

I had one positive node out of 44, about 1mm in size. My PSA was undetectable about a month after surgery and remains undetectable. I consider MD Anderson to be a world-class research and treatment center and apparently their standard protocol for somebody in my situation was ADT+ART. My Radiation Oncologist would not consider radiation without Lupron. I wanted no part of Lupron after reading about the SEs but it is what it is, thankfully that's about out of my system.

The RO did say at our initial meeting there isn't good data about ADT with ART but their protocol does include both, at least it did last year.

I fixed the link to the Kaplan study. I'm sure you're right that there are subsets who benefit more than others. The other major consideration is that significantly higher doses of radiation are used now compared to what was used in those historical data analyses. They now use around 70 Gy for the prostate bed and 50 Gy for the pelvic LNs (lower, if hypofractionated), and with a fast machine, good IGRT, meticulous planning, good anatomy, and some luck, toxicity can be minimized.

LNs aren't easy to find, and the thinking had always been to use PLND only as an indicator. Some European studies suggested that extended dissection (ePLND) can sometimes be curative, slow progression, or at least significantly reduce the tumor burden. So with the advent of fluorescent dyes to aid detection, some places (like Mayo) are increasingly using ePLND, but it isn't yet standard in the US.

- Allen

Thanks Gremlin-

Wish I fit that subset - positive margins keeps me out ---

Bobby Mac