Tuesday, January 16, 2007

The Story So Far..

I'm young, as far as this disease goes. Diagnosed shortly before my 44th birthday (whoopee!). Robotic surgery (more on that later) shortly after my birthday. At first, all seemed fine...PSA dropped to less than 0.1. But a few months later it was 0.2, and then 0.6 just before Christmas. Merry Christmas, your cancer is still there...

I grew increasingly anxious. But the problem was, I didn't have all the facts. Here's what I thought my situation was:

Gleason 3+4
PSA 9.6
Seminal vesicle invasion--unknown
Negative margins

Now, with those indicators, and a rise in PSA within 1 year--it looked like my recurrence was distant. No longer curable. Time for hormones--at 44, I was looking at a drastic change in my personal life.

But I had two crucial facts wrong. My oncologists (radiation and medical) confirmed that I had POSITIVE margins--cancer extended to the edge of the tissue that was removed and it would be a safe bet that it went further than that. So that provided a logical, and much more optimistic explanation for the rise in PSA--there was cancerous tissue left behind. If that's the case, a cure might still be possible, by radiating the prostate bed.

And, the seminal vesicles were known to be free of cancer. Again, good news, and another slight nudge to the "local" end of the local vs. distant disease question.

Of course, there are no guarantees. I could have localized AND distant disease. But my outlook is much different.

I'll start IMRT this week. It's the latest thing in radiation oncology. The radiation can be focused very precisely, and the amount of radiation can be varied and exquisitely controlled by the oncologist.

I got tattooed last week. One right above my crotch, and one on the side of each hip. Lasers will be centered on those tattoos each time to insure the radiation goes where it should.

Next will be a dry run, where X-rays will be taken with me in position as if I'm going to receive treatment. The X-Rays will be compared to a CT scan done last week, to insure everything lines up.

And then the treatments will begin--15 minutes each morning, 5 days a week.

I'll let you know how it goes.


rw said...


I read your post and just hit .2 psa after 5.5 years RP. Looking to start IMRT. Just wondering how it all worked out for you and the side effects from the radiation.

Replicant said...

Hi RW.

Take a look at my more recent postings (late 2007 and 2008). Everything has worked out very well in terms of cancer control/elimination. PSA is less than 0.1. My radiologist is now seeing me only every 6 months (at first it was 90 days), and if all goes well, we'll eventually just do annual checks.

My main side effect was proctitis, the worst of which was painful bowel movements. And I had some mild diarrhea, easily controlled I got some medication for the burning, and over a few months, got much better. I still have a gut that is more sensitive than before, but I no longer go around with Imodium in my pocket.

So overall, I'm quite relieved and happy with the treatments.

BTW, IMRT treatments themselves are EXTREMELY easy.

I hope all goes well with you.

kalif said...

I'm 60, Gleason 3+3, PSA 10.4
12% of specimen on R side.
I have to shortly decide about robotic surgery or radiation terapy of my prostate. With your experience what you sugest for me?

Replicant said...

You have a lot of options available with your numbers. I would consider them all. Do not rush. Something like 70% of Gleason 6 cancers never progress to where they threaten the men who have them.
But assuming you do want to treat this, if I were you I would consider surgery but also all the non-surgical options. Depending on where you live, proton therapy or HIFU might be the choice for you. But only you can make the choice.

A good place to start is the book "Patrick Walsh's Guide to Surviving Prostate Cancer" (2007 ed.).

If you have come down to the choice of surgery vs. radiation, consider the pros and cons in regards to your own values and desires. Surgery offers the benefit of "getting it out" and having it examined by a pathologist. Plus, you can have radiation if the cancer comes back.

Radiation (external, like IMRT, IGRT, or protons) treatment is a breeze compared to surgery. The treatments are painless, but they are not without the risk of side effects. The side effects are much less, though, than with radiation of the past.

A word about robotic surgery. If you want it, and have a very skilled robotic surgeon, no problem. But there is no evidence that outcomes are any better, or that side effects are lessened, with robotic surgery than with the traditional open surgery. Sure, the incisions are smaller, and they probably heal faster, but recent studies cast doubt on the superiority of robot-assisted surgery. Hospitals are under considerable pressure to put their expensive machines to use, so bear that in mind.
Go for the most experienced, successful surgeon you can find, if you opt for surgery. Don't concentrate on the technology. If that surgeon happens to be excellent at open surgery rather than robotic, then that's what I would go for.

But overall, with Gleason 6--relax, do your homework, don't rush into treatment before you are comfortable with all alternatives.