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Biochemical Recurrence and Salvage Prostatectomy

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User
Posted 04 May 2021 at 18:41

This is from the Royal Marsden website about the surgeon I spoke to regarding salvage prostatectomy. He also practises at Imperial College.

" He regularly performs robotic prostatectomy at The Royal Marsden and is developing a new pathway of care for patients who are eligible for salvage prostatectomy surgery for recurrent disease after other treatments."

I am still holding on without treatment but I'm having a re-staging CT/PET scan on Thursday because my PSA has risen above 5ng/ml. This will be followed-up with a telephone consultation with my oncologist to discuss my options.

I think salvage prostatectomy is still at the bottom of my list.

Tom

 

User
Posted 01 Jun 2021 at 16:16

I now have the results of the PSMA PET/CT scan that I had on the 6th May. Unfortunately restaging of the disease has shown spread in the lymph nodes in my lumber region as well as a possible lesion on C£3 of my spinal column.

 Previously cancer was confined to my prostate and seminal vesicles.

I am now back on bicalutamide prior to restarting the Zoladex treatment I had 11 years ago. My memory is that I tolerated the Zoladex fairly well with hot flushes being the main problem. Other treatment options e.g. cryo-therapy, brachy-therapy are ruled out because of the location of the tumours

However, side effects of Zoladex are not my main concern. I realise that each individual is different but is there any information out there regarding average survival of people with my diagnosis?

User
Posted 02 Jun 2021 at 00:02
I believe a lot depends on how your PCA responds to the Zoladex ie the bigger the reduction the longer the treatment will work for.

Will they be treating you with ajuvant ABI or Enzo? These seem to be delivering major benefit if taken up front.

User
Posted 02 Jun 2021 at 11:24
My oncologist will decide whether or not to add enzolutamide at my next consultation in late July when he will have the results of my latest PSA as well as the results from a number of other blood tests.

Tom

User
Posted 13 Nov 2021 at 19:23

Hi Rob - what did you go for eventually?

Quote:

Hi Tom, 

Thank you so much for sharing your story with me.  Although my PSA is much lower at 2.5, the scans are very much pointing my oncologist towards pressing on with surgery soon. I too feel very well now but I don't want this thing spreading further. 

I wish you the smoothest possible journey on your chosen path. 

Best wishes, 

Rob

User
Posted 13 Nov 2021 at 22:32

Hi Tom 

Eventually it was concluded my cancer was inoperable. I am therefore now on a mix of Zoladex and Enzalutamide.  Fortunately I am responding well and my PSA is virtually undetectable. Of course I get all the side effects of no testosterone but hey, I am alive. I just have to live a little differently and hope that I can continue to respond to the treatment for as long as possible but I am very aware that nothing lasts forever. 

I hope you find the best way forward for your situation. 

 

Take care. 

Rob

User
Posted 14 Nov 2021 at 21:53

Glad you have responded well to the treatment. Why was the cancer inoperable - had it spread and, if so, where to?

Thanks

 

Originally Posted by: Online Community Member

Hi Tom 

Eventually it was concluded my cancer was inoperable. I am therefore now on a mix of Zoladex and Enzalutamide.  Fortunately I am responding well and my PSA is virtually undetectable. Of course I get all the side effects of no testosterone but hey, I am alive. I just have to live a little differently and hope that I can continue to respond to the treatment for as long as possible but I am very aware that nothing lasts forever. 

I hope you find the best way forward for your situation. 

 

Take care. 

Rob

User
Posted 14 Nov 2021 at 22:04

Zumerset, if you read RCMJ's profile you will see that his original diagnosis some years ago was T3b so surgery was ruled out and he had brachytherapy instead. When he had a recent recurrence, there was talk of salvage surgery but this did not go ahead, probably because the previous brachy would have made it too difficult.

Edited by member 14 Nov 2021 at 22:06  | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 15 Nov 2021 at 12:36

Hi Lyn. Yes - but I'm even more confused now. Why was surgery originally ruled out with T3b as I understand that this means the cancer has spread to the seminal vesicles. Don't they usually remove the seminal vesicles when they remove the prostate? I also didn't think that brachy could be used  to cure cancer in the seminal vesicles?

quote=LynEyre;261582]

Quote:

Zumerset, if you read RCMJ's profile you will see that his original diagnosis some years ago was T3b so surgery was ruled out and he had brachytherapy instead. When he had a recent recurrence, there was talk of salvage surgery but this did not go ahead, probably because the previous brachy would have made it too difficult.

User
Posted 16 Nov 2021 at 06:25
Once a T3 is diagnosed it is considered high risk and unlikely to be cured by surgery alone which tips the balance towards radiotherapy. A T3B pushes this even further.

User
Posted 16 Nov 2021 at 18:54

Originally Posted by: Online Community Member
Once a T3 is diagnosed it is considered high risk and unlikely to be cured by surgery alone which tips the balance towards radiotherapy. A T3B pushes this even further.

 

Thanks francij

I am T3b and they intend to remove my prostate and seminal vesicles as salvage therapy and they believe this will cure my cancer (although cure is never guaranteed of course!). However, I'm guessing that this is possibly only done at certain hospitals. It's also possible that they wouldn't do it years ago but surgery has improved.

User
Posted 17 Nov 2021 at 23:45
A bit of good news. After 6 months of being back on zoladex with virtually no side effects my psa has gone from 12 ng/ml to 0.12 ng/ml. Enzalutamide being kept in reserve.

Tom

User
Posted 18 Nov 2021 at 00:29

Good result, may it last a long time.

Dave

User
Posted 04 Jan 2022 at 15:24

Great news rank_bajin.

 

There's some stuff on SRP that I'd like to add to for future googlers. It is an op with a horrible SE profile. I get the general idea of avoiding it but it is not experimental. For those who cannot, there is a Recurrent Cancer team at Guy's that has (IMO) the two guys who will give you the best odds if you go that route. At least one (possibly two) actively takes on these guys despite the hits to his stats on SEs (and Guy's, BTW, tops the country*) because he wants to help the men whom other surgeons cannot or will not. The stats are not great, but they are as good as you are going to get. 

 

* https://www.npca.org.uk/provider-results/trust/guys-and-st-thomas-nhs-foundation-trust/plot/

 
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