Radiation after surgery. Was: Men's Health Network ...

[Guest guest]

Suzi Knowles wrote:

> I just want to say that I am very thankful for a doctor that

> ordered PSA testing for my husband as part of his regular 50

> year old testing.  My husband was asymptomatic.

>

> The path report following surgery said that my husband has

> Gleason 4+3 stage 3 cancer with the cancer spreading just

> outside the prostate (they think they got everything in

> surgery).  

>

> I think he would have died for sure if he didn't have that

> test.

>

> As it is, his 3 month post surgery PSA was undetectable, and

> he'll get his next test done in a few weeks.  We're still

> debating whether or not he should have radiation.

Hello Suzi,

I'm not a doctor or expert of any kind and I'm not qualified to

give you any advice.  What I say is purely the thought of a

layman.  However, I think if it were me I'd seriously investigate

radiation.

The doctors apparently know that the cancer had spread just

outside the prostate.  I can see how they can determine that.

But I'm not sure how they can determine that they " got it all " .

A pathologist examines the prostate after it is removed, but he

doesn't examine every square millimeter of it.  That would take

days of difficult examination with a microscope and, even if they

did it, individual tumor cells are much smaller than can be seen

with the naked eye and even in a microscope it can be hard spot

every one.  I believe that a pathologist can get a pretty good

idea of what's going on, but I don't think he can be certain and,

if cancer is found outside the prostate in some places, it's very

hard to be sure there aren't tiny spots of cancer elsewhere

around the prostate.

Whether or not you decide to get radiation, I think it's a good

idea to consult with a radiation oncologist.  Find the very best

one that you can since radiation can only be done once and it is

essential to get a doctor who is smart, experienced with prostate

cancer, and committed to his patients the first time.

Show him the pathology report from the surgery and all other

records that you can.  Ask him if he thinks radiation is

advisable now.  He may think it's a good idea only if the PSA

begins to rise again, or he may think it's a good idea to do it

without waiting.  Get his opinion on how often your husband

should have his PSA checked.  Get his opinion on what PSA should

trigger radiation if he doesn't think it should be done now.

The reasons I'm recommending this are:

 1. Age 50 is young to be diagnosed with prostate cancer.

    PCa often takes 15 or more years to kill a man, but at age 50

    15 years comes around at age 65 (being 66 myself, age 65

    doesn't seem as old to me as it used to seem.)

 2. Stage 3, Gleason 4+3, especially at age 50, is an aggressive

    disease.

 3. Killing the cancer before it spreads is tremendously easier

    than after it spreads.

    Current medical practice has no way to kill all of the cancer

    once it has left the vicinity of the prostate.

 4. There may be very little warning that the disease is

    spreading.

I don't like to be an alarmist, and I don't want to offer my

ideas as if they were expert opinion.  I think you need to find

the very best radiation oncologist in your area and get an expert

opinion from him or her.  The urologist you have is probably very

knowledgeable but, at this point, I'd want to get a radiation

expert's opinion on whether radiation is warranted at this time.

Best of luck to you.

    Alan