Post Surgery Report :(

[gmj51207]

Well, I posted a couple ago a little stressed that I had not received my post robotic surgery pathology report. My initial biopsy revealed a Gleason of 6, however the after surgery report revealed a higher Gleason 4 + 3 = 7. I initially thought when I didn't hear back from the surgeon for about 1 1/2 weeks that I was all clear. However, today I got the call and told the cancer spread beyond my prostate. Therefore, I will be scheduled to return to the doctor in 2 -3 months for a PSA check and then discuss my options. They say possible radiation, so I started searching information and found out about Salvage Radiation Therapy (SRT). Can anyone provide any comfort as to the success on this treatment? I realize my Gleason number is still a little low (stage 3), but i am sure everyone can feel my anxiety. Thanks for help.

Gary

[Tall_Allen]

Here are some questions to ask:

pcnrv.blogspot.com/2017/12/...

How do they know it escaped the prostate? Were there positive surgical margins, and if so, how big were they, and what was the Gleason score at the margin. You might want to wait at least 6 weeks to have an ultrasensitive PSA test before deciding. You have to wait anyway to give the anastomosis time to heal.

[gmj51207 in reply to Tall_Allen]

MARGINS:

Positive

Location and nature of positive margins: Right posterior (base)

Positive where it is difficult to distinguish EPE vs intraprostatic

incision

Summed length of positive margin: 1 mm

Highest grade at margin: 4+3=7

[gmj51207 in reply to gmj51207]

The doctor indicated they want to wait 2-3 months to do another PSA test....she mentioned radiation, but want to wait to see me and get the results

[Tall_Allen in reply to gmj51207]

It was only focal (1 mm), so it may not have escaped. only way to know for sure is to wait for the PSA. I think it is prudent to get an ultrasensitive PSA test at 3 months.

[gmj51207 in reply to Tall_Allen]

Thanks

[charlesmeyers1964]

get a 2nd opinion its better if u attack this early. remember its your body not the docs

charlie

[Harley1948 in reply to charlesmeyers1964]

I have a positive margin (gleason 3) and an EPE with a negative margin. I have an undetectable PSA and will have ART. RP was Oct 23, 2018 and will start ART in a couple weeks. I am 59. This maybe over treatment, but was recommended based on my pathology report.

[gmj51207 in reply to Harley1948]

my report indicated that it was difficult to determine EPE intrusion or intr incision. The only invasion shows seminal vesicle invasion and a positive margin ,right posterior. Some of the researched uncovered mixed feelings of concern. One says not to be concern if cancer reach out in the seminal vesicles and another suggested that ART will probably be recommended.

[Harley1948 in reply to gmj51207]

I did not have lymph or seminal invasion. I have my pathology report in my first post. I decided to have ART because I do not want to think back in a couple years and wish I would have had ART due to a BCR. Kill it now if possible. It took me a month to agree after the Radiation Oncologist recommended it.

[gmj51207 in reply to Harley1948]

I had no lymph invasion, so i initially thought I would not need additional treatment. However, like yourself, I am thinking the same kill it now to avoid any future issues or concerns. I have my next appt with Dr. in March to retest my PSA and then discuss ART. I tell you this is challenging, but I guess my numbers could be worse.

[pjoshea13]

Gary,

Your biopsy GS was 3+3 although pathology reported 4+3 as the highest grade at the margin.

My biopsy showed 4+3. Surgery failed immediately. Salvage radiation was probably useful, but PSA continued to rise. & yet, that was 15 years ago. At a certain point, the anxiety subsides. But it does take time for the mind to adjust to the new reality.

Meanwhile, life continues to be good. Each day there are pleasures to be had.

-Patrick

[gmj51207 in reply to pjoshea13]

That's good to know that it will subside, but I am a blessed man. Thanks for sharing

[Break60]

My post RP pathology was quite similar to yours( read my profile) but Gleason score was 4+5 in the two cores also at base which is more amenable to leaving the prostate. But g score at positive margin was 7. So my stage was pt3b like yours. (SVI ). As has been said, You need to wait for healing and full continence before starting SRT .

[gmj51207 in reply to Break60]

that's my goal is to wait until the next PSA test in March. Fortunately, I have not had any issues with incontinence...My urine stream is not the strongest, but I am able to detect when I have to go and get up. The best thing is that I am only getting up 2 times at night which is much different before the surgery. Thanks for the advice. I think I am still going through the shock of the report considering initially my pre-surgery biopsy was a 3 + 3 / 6, now 4 + 3 / 7. However, I am very happy I chose to get the surgery and not have waited.

[Break60]

BTW, to answer your initial question, after SRT to prostate bed and subsequent radiation elsewhere , I've never had recurrence in any area treated with radiation. But when I stop ADT I've quickly suffered recurrence in a new spot. So radiation has worked well for me but I'm (unlike you) very high risk so I need to stay on systemic treatment .

[gmj51207 in reply to Break60]

that's very helpful information. Thank you.