Seems as if My RALP Failed

Djin, and this is why his getting involved with top notch RO is so important. His Urologist's job is done, and it's up to the good folks at Fox Chase to do their thing.

Yes I realize my peril.

The first psa test in November should have been the ultrasensitive version, but it was only 6 weeks out. The gold standard test at 3 months was ultrasensitive.

Regardless, im not undetectable, i have three psa tests to prove it. I had my psa test results on the 6th, i made the appointment on the 7th for the earliest date.

To all,

I had my consult at FoxChase today.

I will say one thing. I am happy I went back to Fox Chase. I had a previous bout with cancer back in 2012. It was a sarcoma, which did not have a chance to spread due to the surgeons and RO's there. The tumor was in my lower back/upper rear end region.

So today when I met with Dr Horwitz. He had already looked at the radiation fields from that treatment and was utterly confident he could do a full on therapy with no constraints. All of my medical records from my visits with the surgeon who did my RALP, the treatments for my sarcoma, my colonosopy from 3 years ago, every bit of information about me...every scan, xray, blood test etc....for the last 7 years, all of it, was at his fingertips. He knew who I was. He knew my history. I had asked the RALP surgeon about a number of clinical trials last week and Dr H actually contacted the primary investigators on several of those trials and inquired informally (they know each other) about my eligibility. Unfortunately I was not eligible because of this specific criteria ("Prior radiotherapy to the region of the study cancer that would result in overlap of radiation therapy fields"), but he did that prior to me walking in the door.

So the point is....I was happy with the attention I received.

I was not a blank slate.

They were ready to talk to *me*.

As a bonus the previous RO who treated my sarcoma stopped in to wish me well. I thought that was really nice. It gave me a good feeling. It reminded me of success.

So the details:
As you guys figured he would, he recommended Lupron immediately and radiation treatment to start in about two months. I will get 68 Gy over 7 weeks IMRT, focused on the prostate bed, but not the nodes. He said he thought that was best after talking to the surgeon. He said that since I had 9 nodes removed and were clean, and my PSA was 0.11, chances are the cancer is close to where the prostate was.I was a little nervous about that, but I agreed. He also wanted me to continue healing from the surgery and get back to just about full continence. He said radiation will not cause incontinence but will interrupt progress.

They also wanted me to get the colonoscopy that was due back around the same time as my RALP. I am on the 3 year plan because of the sarcoma and the fact they pulled three benign polyps out back in 2016. So to be safe/thorough, that will happen in a few weeks.

I asked about chances of a cure, and he said that, given what he knows about my specific circumstance, he feels there is at least a 70% chance of a cure. That seemed high given everything I read but he did say "for your specific circumstances..." and "after talking to the surgeon who removed your prostate".

So I dropped my drawers and an experienced nurse gave me a 1 month Lupron shot and I literally didn't feel a thing. They wanted to see how well I tolerated it before they did something of longer duration (3 month).

After dinner I will buy the calcium and vitamin d supplements they recommended. Then I will head to the gym. I have dropped 40 pounds since surgery with a net 1500 calorie a day intake (between diet and exercise).

So today....I am back on offense.

Bring it.

Glad you have good plan rolling. That usually helps to reduce the anxiety. You seem to be in great hands with your medical team.

Good luck!

It is so great to have great Doctors on your side. Good move & good luck with your treatment. I am inspired to go lose 10 pounds. Thanks.

BillyBob:

The vitamin D and calcium citrate is for bone health. Hormone therapy can impact our bones apparently.

I was told to get close to these doses
Calcium citrate: 1000 mg per day
Vitamin D: 600 IU’s per day

I found Citracal....which is one pill that contains both. There are store brands/generic/no name brands that are common.

Stephen S said...
BillyBob:
The vitamin D and calcium citrate is for bone health. Hormone therapy can impact our bones apparently.
I was told to get close to these doses
Calcium citrate: 1000 mg per day
Vitamin D: 600 IU’s per day
I found Citracal....which is one pill that contains both. There are store brands/generic/no name brands that are common.

Thanks. Makes sense.

Stephen, I'm so happy you had a great experience (well, as great as it can be when we're talking about getting zapped for cancer) at Fox Chase and are getting personal and prompt attention.
I understand the difficulty of deciding whether to limit RT to the prostate bed or radiate the whole pelvis. That was the subject of much discussion between me and my RO. Like you, I was Gl 8, PSA 0.1, clean nodes. And like you, we ended up zapping just the prostate bed.
The 70 percent cure prediction comes from nomograms, I'm pretty sure. It's close to what I've been told -- 75 percent -- first by my RO and later by the MO I'm now seeing for regular followups.
I'm glad the Lupron shot itself was tolerable. For me, the worst side effect of ADT was hot flashes. If you start getting them, tell Horwitz and he can prescribe venlafaxine (Effexor) for you. It doesn't stop the hot flashes, but it reduces their severity.
Best of luck to you!

Best of luck to you Stephen. The news of PSA after RALP is difficult to take. I did ADT+SRT starting 4 months after my surgery and so far so good...