Re: psa up after radical prostectomy

October 14, 2008

>

> Hi, My husband had a radical prostectomy one year ago. last psa

> was .02 3 months then.04 at 6 months . This psa was .53 then with

> redo .44 (He did have hernia sugery 3 months ago.)

> Anybody else with similar scenario? what options are next

> Thanks

> Have a happy and healthy

>

sorry for the double post. Before surgery his Gleason was 4+5

October 14, 2008

>

> Hi, My husband had a radical prostectomy one year ago. last psa

> was .02 3 months then.04 at 6 months . This psa was .53 then with

> redo .44 (He did have hernia sugery 3 months ago.)

> Anybody else with similar scenario? what options are next

> Thanks

> Have a happy and healthy

>

sorry for the double post. Before surgery his Gleason was 4+5

October 14, 2008

tennismema wrote:

> Hi, My husband had a radical prostectomy one year ago. last

> psa was .02 3 months then.04 at 6 months . This psa was .53

> then with redo .44 (He did have hernia sugery 3 months ago.)

> Anybody else with similar scenario? what options are next

I'm afraid that your husband's operation was unsuccessful. He

almost certainly still has cancer.

This is terribly unfortunate, but not uncommon with a Gleason

4+5. The surgeon tries to get all the cancer but with that high

a Gleason score it often happens that there is some cancer

outside the prostate and inaccessible to surgery.

At this point there are two common options:

1. " Salvage radiotherapy " .

X-rays are used to try to destroy the cancer. The X-rays can be

aimed not only at the " prostate bed " (the place where the

prostate used to be) but also at the area around the the bed,

typically for a centimeter or so.

This sometimes works and sometimes doesn't. If it is done soon,

before the cancer grows any more, it has a better chance than if

it is done later. However it is often the case that the cancer

has already spread to other areas in the body where it is not

accessible to radiation.

If the radiation is successful, then a complete cure is

possible. At this point, radiation is the only hope for a

complete cure, but it is far from certain.

2. " Androgen deprivation therapy " (ADT).

Drugs are administered that cause the body to stop producing all

but a trickle of testosterone. Most prostate cancers require

testosterone in order to grow. The drugs thus stifle the growth

of the cancer.

ADT can work very well, but only for a limited time. On

average, the time is said to be about 18 months. However it is

now thought that it can work longer if administered earlier

rather than later. Some men get very lucky (if anyone with

cancer can be called " lucky " ) and get many years of cancer

suppression from ADT. Francois Mitterand, the former President

of France, lived 15 years on ADT even though his cancer was

already metastatic when treatment began. Others are not so

lucky.

I'm not a doctor and not qualified to give advice, but if I were

in your shoes I might ask the doctors to first do the most

extensive testing they can to determine if the cancer has

spread, and then start ADT immediately. The ADT will stop the

growth of the cancer and give you more time to consider the

radiation option. If there are any tests that the doctors can

do that they haven't yet done, they will probably get more

information from them if they test before the ADT begins.

I presume that your husband is still seeing the urologist who

performed the surgery. At this point, a urologist can't do any

more for him. He needs to see a good medical oncologist

(preferably one who specializes in prostate cancer) who can do

any testing, administer ADT if he thinks it is warranted, and

give advice. If the medical oncologist thinks there is a chance

it will help, your husband would then try to find the best

radiation oncologist that he can in order to administer the

radiation.

If the urologist is the only doctor immediately available (i.e.,

if it takes a lot of time to get an appointment with a good

medical oncologist), then your husband should discuss matters

with the urologist. The urologist can start him on ADT.

Although the failure of surgery is bad, please do not lose hope.

Radiation may be possible and, even if it is not or if it fails,

with good medical help, your husband will certainly have quite a

few years ahead of him, and new treatments are in development

that might be able to extend his life further and further.

I wish the best of luck to both of you.

Alan

October 15, 2008

I was in this disapointing position 12 years ago, alright with a slightly lower Gleason.

Some have a view that debulking tumours can help reduce the speed of progression.

I hope that you find the hormone manipulation treatment works effectively for a good length of time.

October 15, 2008

I was in a similar situation with a slightly 3+3 Gleason and a PSA 7.4 before surgery. Post-surgery biopsy was T2c, NX MX Stage II, Grade G2. Post-surgery PSA went from 0.28 to 0.41 and then 0.54. My surgeon stated he wanted to start IMRT before my PSA reached 1.0 as that meant a better chance of getting more (hopefully all) that was left . I went through 31 IMRT treatments the beginning of this year and my PSA dropped to 0.21 three-months post and now 0.1 six-months post IMRT. It's time to take action.

Wishing the best for both of you.

Subject: psa up after radical prostectomyTo: ProstateCancerSupport Date: Tuesday, October 14, 2008, 9:56 PM

Hi, My husband had a radical prostectomy one year ago. last psa was .02 3 months then.04 at 6 months . This psa was .53 then with redo .44 (He did have hernia sugery 3 months ago.) Anybody else with similar scenario? what options are nextThanksHave a happy and healthy

October 15, 2008

I was in a similar situation with a slightly 3+3 Gleason and a PSA 7.4 before surgery. Post-surgery biopsy was T2c, NX MX Stage II, Grade G2. Post-surgery PSA went from 0.28 to 0.41 and then 0.54. My surgeon stated he wanted to start IMRT before my PSA reached 1.0 as that meant a better chance of getting more (hopefully all) that was left . I went through 31 IMRT treatments the beginning of this year and my PSA dropped to 0.21 three-months post and now 0.1 six-months post IMRT. It's time to take action.

Wishing the best for both of you.

Subject: psa up after radical prostectomyTo: ProstateCancerSupport Date: Tuesday, October 14, 2008, 9:56 PM

Hi, My husband had a radical prostectomy one year ago. last psa was .02 3 months then.04 at 6 months . This psa was .53 then with redo .44 (He did have hernia sugery 3 months ago.) Anybody else with similar scenario? what options are nextThanksHave a happy and healthy

October 15, 2008

I was in a similar situation with a slightly 3+3 Gleason and a PSA 7.4 before surgery. Post-surgery biopsy was T2c, NX MX Stage II, Grade G2. Post-surgery PSA went from 0.28 to 0.41 and then 0.54. My surgeon stated he wanted to start IMRT before my PSA reached 1.0 as that meant a better chance of getting more (hopefully all) that was left . I went through 31 IMRT treatments the beginning of this year and my PSA dropped to 0.21 three-months post and now 0.1 six-months post IMRT. It's time to take action.

Wishing the best for both of you.

Subject: psa up after radical prostectomyTo: ProstateCancerSupport Date: Tuesday, October 14, 2008, 9:56 PM

Hi, My husband had a radical prostectomy one year ago. last psa was .02 3 months then.04 at 6 months . This psa was .53 then with redo .44 (He did have hernia sugery 3 months ago.) Anybody else with similar scenario? what options are nextThanksHave a happy and healthy

October 15, 2008

Bechtold wrote:

> I was in a similar situation with a slightly 3+3 Gleason and a

> PSA 7.4 before surgery. Post-surgery biopsy was T2c, NX MX

> Stage II, Grade G2. Post-surgery PSA went from 0.28 to 0.41

> and then 0.54. My surgeon stated he wanted to start IMRT

> before my PSA reached 1.0 as that meant a better chance of

> getting more (hopefully all) that was left . I went through 31

> IMRT treatments the beginning of this year and my PSA dropped

> to 0.21 three-months post and now 0.1 six-months post IMRT.

> It's time to take action.

Salvage radiotherapy is such a crap shoot. There are a lot of

men for whom it didn't work. So I love to hear stories like

this one of a guy who rolled the dice and came up with sevens.

Thanks for letting us know.

Alan

October 15, 2008

On October 14, Alan Meyer wrote to " tennismema " :

> I'm afraid that your husband's operation was unsuccessful. He almost

> certainly still has cancer.

>

> This is terribly unfortunate, but not uncommon with a Gleason 4+5.

> The surgeon tries to get all the cancer but with that high a Gleason

> score it often happens that there is some cancer outside the prostate

> and inaccessible to surgery.

(snip)

If it helps, I too am a Gleason 4,5=9, plus a separate 4,4=-8 tumor.

Five years since dx, still here.

Alan has stated the case clearly and his suggestions have merit.

I have to say that the urologist doesn't impress me.

In any event, a list of some PCa specialists will be found via this

portal on the encyclopedic website of the Prostate Cancer Research

Institute: http://prostate-cancer.org/resource/find-a-physician.html

If needed, I'm sure that a referral would be gladly given.

Some of the tests that Alan refers to are these:

CGA: chromogranin A

NSE: neuron-specific enolase

CEA: carcino-embryonic antigen

They are explained on the PCRI site: http://prostate-cancer.org/index.html

And much essential information is included in _A Primer on Prostate

Cancer_ 2nd ed., subtitled " The Empowered Patient's Guide " by medical

oncologist and PCa specialist B. Strum, MD and PCa warrior Donna

Pogliano. It is available from the PCRI website and the like, as well as

Amazon (30+ five-star reviews), & Noble, and bookstores. A

lifesaver, as I very well know.

The disease may well be systemic, which is *not* the same as metastatic.

I recommend composing and posting a PCa Digest on the Physician to

Patient (P2P) site. At least one of the best and brightest will likely

respond with an assessment of the case within a few days. Here is the

starting point: http://www.prostatepointers.org/mlist/mlist.html

It often helps to meet others in a similar situation. I recommend

attending a local chapter of the PCa education and support organization

Us Too International. Information is available via the home page at:

http://www.prostatepointers.org/

NB: They are presently coping with a catastrophic hardware failure, but

the link to the support groups is operative.

Good luck. Please keep us informed.

Regards,

Steve J

" Empowerment: taking responsibility for and authority over one's own

outcomes based on education and knowledge of the consequences and

contingencies involved in one's own decisions. This focus provides the

uplifting energy that can sustain in the face of crisis. "

--Donna Pogliano, co-author of _A Primer on Prostate Cancer_, subtitled

" The Empowered Patient's Guide. "

October 16, 2008

Thank you Alan, Steve and . I so much appreciate your

replies. The doctor we used was Dr. Herbert Lepor. His specialty

is prostate cancer. It seems what you are saying that our next step

should be a medical oncologist. We are in Manalapan, New Jersey and

if there are any recommendations for an oncologist; I would

appreciate it. Thanks you all for the info I am going to read it

over to try to understand a little more. Any other words of wisdom

are greatly appreciated.

Thank you again!

>

> > Hi, My husband had a radical prostectomy one year ago. last

> > psa was .02 3 months then.04 at 6 months . This psa was .53

> > then with redo .44 (He did have hernia sugery 3 months ago.)

> > Anybody else with similar scenario? what options are next

>

> I'm afraid that your husband's operation was unsuccessful. He

> almost certainly still has cancer.

>

> This is terribly unfortunate, but not uncommon with a Gleason

> 4+5. The surgeon tries to get all the cancer but with that high

> a Gleason score it often happens that there is some cancer

> outside the prostate and inaccessible to surgery.

>

> At this point there are two common options:

>

> 1. " Salvage radiotherapy " .

>

> X-rays are used to try to destroy the cancer. The X-rays can be

> aimed not only at the " prostate bed " (the place where the

> prostate used to be) but also at the area around the the bed,

> typically for a centimeter or so.

>

> This sometimes works and sometimes doesn't. If it is done soon,

> before the cancer grows any more, it has a better chance than if

> it is done later. However it is often the case that the cancer

> has already spread to other areas in the body where it is not

> accessible to radiation.

>

> If the radiation is successful, then a complete cure is

> possible. At this point, radiation is the only hope for a

> complete cure, but it is far from certain.

>

> 2. " Androgen deprivation therapy " (ADT).

>

> Drugs are administered that cause the body to stop producing all

> but a trickle of testosterone. Most prostate cancers require

> testosterone in order to grow. The drugs thus stifle the growth

> of the cancer.

>

> ADT can work very well, but only for a limited time. On

> average, the time is said to be about 18 months. However it is

> now thought that it can work longer if administered earlier

> rather than later. Some men get very lucky (if anyone with

> cancer can be called " lucky " ) and get many years of cancer

> suppression from ADT. Francois Mitterand, the former President

> of France, lived 15 years on ADT even though his cancer was

> already metastatic when treatment began. Others are not so

> lucky.

>

> I'm not a doctor and not qualified to give advice, but if I were

> in your shoes I might ask the doctors to first do the most

> extensive testing they can to determine if the cancer has

> spread, and then start ADT immediately. The ADT will stop the

> growth of the cancer and give you more time to consider the

> radiation option. If there are any tests that the doctors can

> do that they haven't yet done, they will probably get more

> information from them if they test before the ADT begins.

>

> I presume that your husband is still seeing the urologist who

> performed the surgery. At this point, a urologist can't do any

> more for him. He needs to see a good medical oncologist

> (preferably one who specializes in prostate cancer) who can do

> any testing, administer ADT if he thinks it is warranted, and

> give advice. If the medical oncologist thinks there is a chance

> it will help, your husband would then try to find the best

> radiation oncologist that he can in order to administer the

> radiation.

>

> If the urologist is the only doctor immediately available (i.e.,

> if it takes a lot of time to get an appointment with a good

> medical oncologist), then your husband should discuss matters

> with the urologist. The urologist can start him on ADT.

>

> Although the failure of surgery is bad, please do not lose hope.

> Radiation may be possible and, even if it is not or if it fails,

> with good medical help, your husband will certainly have quite a

> few years ahead of him, and new treatments are in development

> that might be able to extend his life further and further.

>

> I wish the best of luck to both of you.

>

> Alan

>

October 16, 2008

Thank you Alan, Steve and . I so much appreciate your

replies. The doctor we used was Dr. Herbert Lepor. His specialty

is prostate cancer. It seems what you are saying that our next step

should be a medical oncologist. We are in Manalapan, New Jersey and

if there are any recommendations for an oncologist; I would

appreciate it. Thanks you all for the info I am going to read it

over to try to understand a little more. Any other words of wisdom

are greatly appreciated.

Thank you again!

>

> > Hi, My husband had a radical prostectomy one year ago. last

> > psa was .02 3 months then.04 at 6 months . This psa was .53

> > then with redo .44 (He did have hernia sugery 3 months ago.)

> > Anybody else with similar scenario? what options are next

>

> I'm afraid that your husband's operation was unsuccessful. He

> almost certainly still has cancer.

>

> This is terribly unfortunate, but not uncommon with a Gleason

> 4+5. The surgeon tries to get all the cancer but with that high

> a Gleason score it often happens that there is some cancer

> outside the prostate and inaccessible to surgery.

>

> At this point there are two common options:

>

> 1. " Salvage radiotherapy " .

>

> X-rays are used to try to destroy the cancer. The X-rays can be

> aimed not only at the " prostate bed " (the place where the

> prostate used to be) but also at the area around the the bed,

> typically for a centimeter or so.

>

> This sometimes works and sometimes doesn't. If it is done soon,

> before the cancer grows any more, it has a better chance than if

> it is done later. However it is often the case that the cancer

> has already spread to other areas in the body where it is not

> accessible to radiation.

>

> If the radiation is successful, then a complete cure is

> possible. At this point, radiation is the only hope for a

> complete cure, but it is far from certain.

>

> 2. " Androgen deprivation therapy " (ADT).

>

> Drugs are administered that cause the body to stop producing all

> but a trickle of testosterone. Most prostate cancers require

> testosterone in order to grow. The drugs thus stifle the growth

> of the cancer.

>

> ADT can work very well, but only for a limited time. On

> average, the time is said to be about 18 months. However it is

> now thought that it can work longer if administered earlier

> rather than later. Some men get very lucky (if anyone with

> cancer can be called " lucky " ) and get many years of cancer

> suppression from ADT. Francois Mitterand, the former President

> of France, lived 15 years on ADT even though his cancer was

> already metastatic when treatment began. Others are not so

> lucky.

>

> I'm not a doctor and not qualified to give advice, but if I were

> in your shoes I might ask the doctors to first do the most

> extensive testing they can to determine if the cancer has

> spread, and then start ADT immediately. The ADT will stop the

> growth of the cancer and give you more time to consider the

> radiation option. If there are any tests that the doctors can

> do that they haven't yet done, they will probably get more

> information from them if they test before the ADT begins.

>

> I presume that your husband is still seeing the urologist who

> performed the surgery. At this point, a urologist can't do any

> more for him. He needs to see a good medical oncologist

> (preferably one who specializes in prostate cancer) who can do

> any testing, administer ADT if he thinks it is warranted, and

> give advice. If the medical oncologist thinks there is a chance

> it will help, your husband would then try to find the best

> radiation oncologist that he can in order to administer the

> radiation.

>

> If the urologist is the only doctor immediately available (i.e.,

> if it takes a lot of time to get an appointment with a good

> medical oncologist), then your husband should discuss matters

> with the urologist. The urologist can start him on ADT.

>

> Although the failure of surgery is bad, please do not lose hope.

> Radiation may be possible and, even if it is not or if it fails,

> with good medical help, your husband will certainly have quite a

> few years ahead of him, and new treatments are in development

> that might be able to extend his life further and further.

>

> I wish the best of luck to both of you.

>

> Alan

>

October 16, 2008

I would try to get a cancer center that has ties with one of the major centers, like Fox Chase. My local cancer center in Bucks/Montgomery PA works hand-in-hand with Fox Chase and they review all treatment plans.

Ask questions, read as much as you can on the subject and travel if you must, to find someone you feel comfortable with and confident in their treatment.

Best of Luck

Subject: Re: psa up after radical prostectomyTo: ProstateCancerSupport Date: Thursday, October 16, 2008, 7:37 AM

Thank you Alan, Steve and . I so much appreciate your replies. The doctor we used was Dr. Herbert Lepor. His specialty is prostate cancer. It seems what you are saying that our next step should be a medical oncologist. We are in Manalapan, New Jersey and if there are any recommendations for an oncologist; I would appreciate it. Thanks you all for the info I am going to read it over to try to understand a little more. Any other words of wisdom are greatly appreciated.Thank you again!> > > Hi, My husband had a radical prostectomy one year ago. last> > psa was .02 3 months then.04 at 6 months . This psa was .53> > then with redo .44

(He did have hernia sugery 3 months ago.)> > Anybody else with similar scenario? what options are next> > I'm afraid that your husband's operation was unsuccessful. He> almost certainly still has cancer.> > This is terribly unfortunate, but not uncommon with a Gleason> 4+5. The surgeon tries to get all the cancer but with that high> a Gleason score it often happens that there is some cancer> outside the prostate and inaccessible to surgery.> > At this point there are two common options:> > 1. "Salvage radiotherapy" .> > X-rays are used to try to destroy the cancer. The X-rays can be> aimed not only at the "prostate bed" (the place where the> prostate used to be) but also at the area around the the bed,> typically for a centimeter or so.> > This sometimes works and sometimes doesn't. If it is done soon,>

before the cancer grows any more, it has a better chance than if> it is done later. However it is often the case that the cancer> has already spread to other areas in the body where it is not> accessible to radiation.> > If the radiation is successful, then a complete cure is> possible. At this point, radiation is the only hope for a> complete cure, but it is far from certain.> > 2. "Androgen deprivation therapy" (ADT).> > Drugs are administered that cause the body to stop producing all> but a trickle of testosterone. Most prostate cancers require> testosterone in order to grow. The drugs thus stifle the growth> of the cancer.> > ADT can work very well, but only for a limited time. On> average, the time is said to be about 18 months. However it is> now thought that it can work longer if administered earlier> rather than

later. Some men get very lucky (if anyone with> cancer can be called "lucky") and get many years of cancer> suppression from ADT. Francois Mitterand, the former President> of France, lived 15 years on ADT even though his cancer was> already metastatic when treatment began. Others are not so> lucky.> > I'm not a doctor and not qualified to give advice, but if I were> in your shoes I might ask the doctors to first do the most> extensive testing they can to determine if the cancer has> spread, and then start ADT immediately. The ADT will stop the> growth of the cancer and give you more time to consider the> radiation option. If there are any tests that the doctors can> do that they haven't yet done, they will probably get more> information from them if they test before the ADT begins.> > I presume that your husband is still seeing the urologist

who> performed the surgery. At this point, a urologist can't do any> more for him. He needs to see a good medical oncologist> (preferably one who specializes in prostate cancer) who can do> any testing, administer ADT if he thinks it is warranted, and> give advice. If the medical oncologist thinks there is a chance> it will help, your husband would then try to find the best> radiation oncologist that he can in order to administer the> radiation.> > If the urologist is the only doctor immediately available (i.e.,> if it takes a lot of time to get an appointment with a good> medical oncologist), then your husband should discuss matters> with the urologist. The urologist can start him on ADT.> > Although the failure of surgery is bad, please do not lose hope.> Radiation may be possible and, even if it is not or if it fails,> with good

medical help, your husband will certainly have quite a> few years ahead of him, and new treatments are in development> that might be able to extend his life further and further.> > I wish the best of luck to both of you.> > Alan>

October 16, 2008

I would try to get a cancer center that has ties with one of the major centers, like Fox Chase. My local cancer center in Bucks/Montgomery PA works hand-in-hand with Fox Chase and they review all treatment plans.

Ask questions, read as much as you can on the subject and travel if you must, to find someone you feel comfortable with and confident in their treatment.

Best of Luck

Subject: Re: psa up after radical prostectomyTo: ProstateCancerSupport Date: Thursday, October 16, 2008, 7:37 AM

Thank you Alan, Steve and . I so much appreciate your replies. The doctor we used was Dr. Herbert Lepor. His specialty is prostate cancer. It seems what you are saying that our next step should be a medical oncologist. We are in Manalapan, New Jersey and if there are any recommendations for an oncologist; I would appreciate it. Thanks you all for the info I am going to read it over to try to understand a little more. Any other words of wisdom are greatly appreciated.Thank you again!> > > Hi, My husband had a radical prostectomy one year ago. last> > psa was .02 3 months then.04 at 6 months . This psa was .53> > then with redo .44

(He did have hernia sugery 3 months ago.)> > Anybody else with similar scenario? what options are next> > I'm afraid that your husband's operation was unsuccessful. He> almost certainly still has cancer.> > This is terribly unfortunate, but not uncommon with a Gleason> 4+5. The surgeon tries to get all the cancer but with that high> a Gleason score it often happens that there is some cancer> outside the prostate and inaccessible to surgery.> > At this point there are two common options:> > 1. "Salvage radiotherapy" .> > X-rays are used to try to destroy the cancer. The X-rays can be> aimed not only at the "prostate bed" (the place where the> prostate used to be) but also at the area around the the bed,> typically for a centimeter or so.> > This sometimes works and sometimes doesn't. If it is done soon,>

before the cancer grows any more, it has a better chance than if> it is done later. However it is often the case that the cancer> has already spread to other areas in the body where it is not> accessible to radiation.> > If the radiation is successful, then a complete cure is> possible. At this point, radiation is the only hope for a> complete cure, but it is far from certain.> > 2. "Androgen deprivation therapy" (ADT).> > Drugs are administered that cause the body to stop producing all> but a trickle of testosterone. Most prostate cancers require> testosterone in order to grow. The drugs thus stifle the growth> of the cancer.> > ADT can work very well, but only for a limited time. On> average, the time is said to be about 18 months. However it is> now thought that it can work longer if administered earlier> rather than

later. Some men get very lucky (if anyone with> cancer can be called "lucky") and get many years of cancer> suppression from ADT. Francois Mitterand, the former President> of France, lived 15 years on ADT even though his cancer was> already metastatic when treatment began. Others are not so> lucky.> > I'm not a doctor and not qualified to give advice, but if I were> in your shoes I might ask the doctors to first do the most> extensive testing they can to determine if the cancer has> spread, and then start ADT immediately. The ADT will stop the> growth of the cancer and give you more time to consider the> radiation option. If there are any tests that the doctors can> do that they haven't yet done, they will probably get more> information from them if they test before the ADT begins.> > I presume that your husband is still seeing the urologist

who> performed the surgery. At this point, a urologist can't do any> more for him. He needs to see a good medical oncologist> (preferably one who specializes in prostate cancer) who can do> any testing, administer ADT if he thinks it is warranted, and> give advice. If the medical oncologist thinks there is a chance> it will help, your husband would then try to find the best> radiation oncologist that he can in order to administer the> radiation.> > If the urologist is the only doctor immediately available (i.e.,> if it takes a lot of time to get an appointment with a good> medical oncologist), then your husband should discuss matters> with the urologist. The urologist can start him on ADT.> > Although the failure of surgery is bad, please do not lose hope.> Radiation may be possible and, even if it is not or if it fails,> with good

medical help, your husband will certainly have quite a> few years ahead of him, and new treatments are in development> that might be able to extend his life further and further.> > I wish the best of luck to both of you.> > Alan>

October 16, 2008

I am sorry to hear that his prostate cancer has recurred. As I am sure

you are learning about 30% of all men treated do have a recurrence. As said since his PSA is still low you still have a good shot at " curing " the

cancer. Current thinking is that after surgery if treatment is

received while the recurrent PSA remains under 1.0 to 1.5 radiation to

the prostate bed can be curative. There is no guarantee, but you and

your husband should seek immediate advice about this treatment.

I too have a recurrence after surgery, but I did not catch it soon

enough so I have moved on to a systematic treatment, hormone blockade.

Many of us, even if the recurrence is not cured with radiation, go on

to live many happy years.

However, at this time you need to be aggressive and seek treatment immediately.

Since you live near New York City there are many excellent hospitals

available. Columbia Presby, NYU Comprehensive Cancer Center and

Sloanne are just a few. Personally, I am seeing an oncologist at

Columbia Presby who is top of the line, Petrylak. However,

there are many excellent oncologists in the New York Metro area.

I would suggest that your husband consider attending a support group.

There is a weekly group (just talking no lectures) with other men at

various stages of prostate cancer. The group is sponsored by Malecare

and meets every Wednesday evening at 6pm in Union Square (NYC). If he

is interested I can give him additional information or you can find the

information at the malecare web site (www.malecare.com).

We also have an internet support group for both men with advanced,

recurrent prostate cancer and their caregivers. You can sign on to the

group at: http://health.groups.yahoo.com/group/advancedprostatecancer/join

I write a blog which you might want to read specific to advanced

and recurrent prostate cancer at www.advancedprostatecancer.net This

is a noncommercial blog.

-- To learn about the Petition to Make Prostate Cancer a National Priority go to http://www.prostatecancerpetition.org

Thank you Alan, Steve and . I so much appreciate your

replies. The doctor we used was Dr. Herbert Lepor. His specialty

is prostate cancer. It seems what you are saying that our next step

should be a medical oncologist. We are in Manalapan, New Jersey and

if there are any recommendations for an oncologist; I would

appreciate it. Thanks you all for the info I am going to read it

over to try to understand a little more. Any other words of wisdom

are greatly appreciated.

Thank you again!

>

Recent Activity

6

New Members

Visit Your Group

Give Back

Yahoo! for Good

Get inspired

by a good cause.

Y! Toolbar

Get it Free!

easy 1-click access

to your groups.

Yahoo! Groups

Start a group

in 3 easy steps.

Connect with others.

.

-- T NowakTo learn about the Petition to Make Prostate Cancer a National Priority go to http://www.prostatecancerpetition.org

October 16, 2008

tennismema wrote:

> Thank you Alan, Steve and . I so much appreciate

> your replies. The doctor we used was Dr. Herbert Lepor. His

> specialty is prostate cancer. It seems what you are saying

> that our next step should be a medical oncologist.

If Dr. Lepor performed the prostatectomy operation, then he is a

urologist. A urologist can be a specialist in prostate cancer,

but his main subspecialty within that field is surgery for

prostate cancer.

A good urologist will know more than just surgery. He'll

certainly know the basics of hormone therapy and how to

administer it, but he may not be as up on the latest ideas in

testing, ADT, diet, chemotherapy, and the many other medical

treatments. He will also not be able to perform radiation

therapy.

I assume you like and trust Dr. Lepor. By all means, get his

opinion on what to do next. He certainly knows much more than I

do! Ask him if he had prostate cancer and failed surgery, who

would he want to be his medical oncologist and who would he pick

as a radiation oncologist. Hopefully he knows the other local

doctors in this field and can give some useful referrals

(assuming your insurance plan allows this.)

> We are in Manalapan, New Jersey and if there are any

> recommendations for an oncologist; I would appreciate it.

> Thanks you all for the info I am going to read it over to try

> to understand a little more. Any other words of wisdom are

> greatly appreciated.

The only words I can add at this point are: Don't despair.

You've heard from a number of people already who are members of

this group and were in your husband's position quite a few years

ago. They're still here, still posting messages, still leading

normal lives. It is possible to fight this disease.

So in addition to all of your reading about cancer and visits to

doctors, don't forget to plan some vacations, see some great

movies, go to some concerts, visit some friends and family, and

do all of the things you like to do. Life has gotten a little

tougher, as it always does when we grow older, but it's still

good.

Best of luck.

Alan

October 16, 2008

tennismema wrote:

> Thank you Alan, Steve and . I so much appreciate

> your replies. The doctor we used was Dr. Herbert Lepor. His

> specialty is prostate cancer. It seems what you are saying

> that our next step should be a medical oncologist.

If Dr. Lepor performed the prostatectomy operation, then he is a

urologist. A urologist can be a specialist in prostate cancer,

but his main subspecialty within that field is surgery for

prostate cancer.

A good urologist will know more than just surgery. He'll

certainly know the basics of hormone therapy and how to

administer it, but he may not be as up on the latest ideas in

testing, ADT, diet, chemotherapy, and the many other medical

treatments. He will also not be able to perform radiation

therapy.

I assume you like and trust Dr. Lepor. By all means, get his

opinion on what to do next. He certainly knows much more than I

do! Ask him if he had prostate cancer and failed surgery, who

would he want to be his medical oncologist and who would he pick

as a radiation oncologist. Hopefully he knows the other local

doctors in this field and can give some useful referrals

(assuming your insurance plan allows this.)

> We are in Manalapan, New Jersey and if there are any

> recommendations for an oncologist; I would appreciate it.

> Thanks you all for the info I am going to read it over to try

> to understand a little more. Any other words of wisdom are

> greatly appreciated.

The only words I can add at this point are: Don't despair.

You've heard from a number of people already who are members of

this group and were in your husband's position quite a few years

ago. They're still here, still posting messages, still leading

normal lives. It is possible to fight this disease.

So in addition to all of your reading about cancer and visits to

doctors, don't forget to plan some vacations, see some great

movies, go to some concerts, visit some friends and family, and

do all of the things you like to do. Life has gotten a little

tougher, as it always does when we grow older, but it's still

good.

Best of luck.

Alan

October 16, 2008

I was floored when I got the news that my Gleason 8 prostate cancer

came back after what seemed successful surgery and an undetectable

PSA for several months. The most important thing you can do right now

is find a good medical oncologist. You are beyond Urology now. You

will also need an opinion from a radiation oncologist.

I learned a lot of things the hard way. Take this for what it is

worth and see if it applies to you:

1. Choice of salvage radiation is to be weighed against possible

failure of salvage therapy. Salvage radiation therapy has side

effects that need to be considered. Things weighing against a local

recurrence and making salvage radiation more likely to fail include:

a) If the recurrence happened within months after surgery, that

supports spreading outside the area.

If the psa doubling time is short, that supports spreading outside

the area.

c) If gleason score is high

2. ADT approaches vary widely among oncologists. The good oncologists

try to alternate the meds to make treatment more effective and make

them work as long as possible. Intermittent treatment is another

choice among the better oncologists. For example, a good approach is

to use Lupron + low dose Casodex for a year, then stop everything for

a few months then switch for a while to an Estrogen + an immune

booster such as Leukine when PSA starts rising again. There are

numerous other variations that a good oncologist can plan out for

you. Some big names in the world of oncology and prostate cancer

treatments include Dr Small in San Francisco, Dr E Myers

in Virginia, and Dr Mark Scholz in Marina Del Rey. A good ADT plan in

most early stage cases can make prostate cancer a manageable nuisance

rather than a terminal disease.

3. It is very important to take advantage of the time you have now

while you still have testosterone in your system. Check your bone

density, check your heart, get the cholesterol down, go on a diet,

stop smoking, hire a personal trainer in the gym, check all your

problems and fix them. Get all dental work done now. See an

endocrinologist to check vitamin and hormone levels, and start

Vitamin D if needed, (found to be needed in most cases). Anything

else, get it done.

Here is a note I sent to my medical oncologist after successful

treatment that knocked my PSA down to zero again after my 2nd

recurrence:

" Meeting with you was like picking up a health pack in a video game

after almost running out of life. I added salsa and ballroom dancing

to my list of fun activities and to improve cardio fitness. I am

dancing my ass off on Monday nights at a salsa club, and I

participate in student teacher demos at open house parties at the

ballroom dance studio I now belong to. I plan to go skiing this

winter with some relatives who live in Telluride Colorado. I am

starting to think about that trip to South America that I always

wanted to take. You cannot imagine how happy I am about living. Life

is good. "

>

> > Thank you Alan, Steve and . I so much appreciate

> > your replies. The doctor we used was Dr. Herbert Lepor. His

> > specialty is prostate cancer. It seems what you are saying

> > that our next step should be a medical oncologist.

October 16, 2008