Talk Cancer

Question:

Gaz, My vote is for a second opinion Alan Sydney.

– Hide quoted text — Show quoted text – Had a PSA of 26.2.  Had a RP on March 11.  Found tumor had made a small attacment to my bladder(at the bottom-behind the urethra I think is what the Dr. said), but no spread to nearby lymph nodes or to bones.  PSA at six weeks after surgery .1.  Surgeon wants to do "watchful waiting". Resident wants me to consider low dosage radiation. What would you do?  I’m leaning toward "watchful waiting".

Response:

What would you do?  I’m leaning toward "watchful waiting".

While no one can tell you what to do, either option is acceptable medical practice.  My post op pathology showed positive for lymph node involvement, and the PSA did not go to "undetectable".  While it was discussed to go to radiation right away, it was decided that I would go back on Lupron/Casodex for some time.  That brought the PSA to 0.1, and it stayed there.  16 months post op, I quit the Lupron/Casodex. Now, after over a year of not taking hormone therapy, PSA is rising. I will now proceed with further treatment. To jump right to radiation is a rather blind proposition, as there is no real idea where the cancer is.  It is assumed to be in the prostate bed.  By waiting a total now of three years, I have bought more time. If I had had radiation three years ago, I could not do it again this soon if it had failed.  I am happy with my choice to wait, but again, it is your decision, and you must live with it. By the way everyone, I am working this week on my options of where to go for treatment.  I will post my decision here when it is final. PSA last week was 1.5. Best of Luck, Dale P

Response:

Definitely talk to radio-oncology for consult!  May be that you’re cured, but may wish to flush out any stray cells…. MB

– Hide quoted text — Show quoted text – Had a PSA of 26.2.  Had a RP on March 11.  Found tumor had made a small attacment to my bladder(at the bottom-behind the urethra I think is what the Dr. said), but no spread to nearby lymph nodes or to bones.  PSA at six weeks after surgery .1.  Surgeon wants to do "watchful waiting". Resident wants me to consider low dosage radiation. What would you do?  I’m leaning toward "watchful waiting".

Response:

Had a PSA of 26.2.  Had a RP on March 11.  Found tumor had made a small attacment to my bladder(at the bottom-behind the urethra I think is what the Dr. said), but no spread to nearby lymph nodes or to bones.  PSA at six weeks after surgery .1.  Surgeon wants to do "watchful waiting". Resident wants me to consider low dosage radiation. What would you do?  I’m leaning toward "watchful waiting".

First, how old are you?  In other words, how many more years might you reasonably have had left if the prostate hadn’t gotten cancerous? Second, did the surgeon cut out that "tumor" he found on the bladder?  If so, it’s gone and less worry. Third, I believe the bottom of the scale on most "standard" (not super- sensitive) PSA tests is the .1 you got.  A result less than that is usually termed "undetectable" because it falls below the test threshhold. When I asked my urologist last week what my own "undetectable" score meant, he merely said it was below .1, and the "below" is what’s really significant. In your shoes, a prudent move might be to get another PSA test in August or September.  If the result remains at .1, you might simply re-test at 3- month intervals for a while to see if there’s any upward trend.  If you stay at .1, consider getting re-tested at 6-month intervals… but watch out for any rise in your score. Cheer up… your surgeon may be the kind who prefers not to start fixing you until there’s proof you’re actually broken  :^) My own PSA had been 25.3, but since surgery a year ago my PSA is holding steady at below .1.  And you’re only a notch above me on the scale; your next test might be lower. — Anti-Spam address: my last name at his dot com Charles Gillen — Reston, Virginia, USA

Response:

Had a PSA of 26.2.  Had a RP on March 11.  Found tumor had made a small attacment to my bladder(at the bottom-behind the urethra I think is what the Dr. said), but no spread to nearby lymph nodes or to bones.  PSA at six weeks after surgery .1.  Surgeon wants to do "watchful waiting". Resident wants me to consider low dosage radiation. What would you do?  I’m leaning toward "watchful waiting".

I would get yet another opinion from a different urologist. — Dept. of Mathematics, Northwestern Univ., Evanston, IL 60208

Response:

Had a PSA of 26.2.  Had a RP on March 11.  Found tumor had made a small attacment to my bladder(at the bottom-behind the urethra I think is what the Dr. said), but no spread to nearby lymph nodes or to bones.  PSA at six weeks after surgery .1.  Surgeon wants to do "watchful waiting". Resident wants me to consider low dosage radiation. What would you do?  I’m leaning toward "watchful waiting".

Response:

Gary, I’d do the radiation.  It ain’t gonna cure itself. I often wonder what those that go on watchful waiting are waiting for. Berky the Warrior Folie