Hello everyone. new to this. was wondering if anybody else had a peritoneum biopsy after radical proctectomy come back positive. Seems like there isn't much about peritoneum metastasis of prostate cancer (everywhere I've looked seems to say its rare and deadly - 3 to 6 mos to live, etc.) Anybody know different?
Peritoneum Metastasis (What's it mean... - Advanced Prostate...
Peritoneum Metastasis (What's it mean and how bad is that?)
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PghTopCat
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I do not understand how your doctors detected the peritoneum metastasis. You had a Robotic Assisted Radical Prostatectomy on May 25th of 2021. As usual they did remove lymph nodes to check for lymph node metastases. In your case they took out 11 nodes and three of these were positive. Now, how did they find a peritoneum metastasis during this procedure? No surgeon will check the peritoneum for metastases during prostate surgery. I think you misunderstood your doctors and they meant something different.
evidently, the surgeon saw something and sent it for biopsy while he was in there. I wish it were as you are saying. Not sure, but the pathology reads pretty clear to me...
Snippet from pathology. are you seeing this as anything less than peritoneum mets?
I assume they detected this lesion with a CT before surgery and therefore did this biopsy. I would get a PSMA PET/CT now to see if there are additional mets not found yet. This is likely. To avoid treatment of only part of the mets, i.e. the ones detected so far.
My initial CT showed no bone mets and the MRI showed no swollen lymphs or other tumors. I was only informed of this after the surgery. According to the surgeon, he spotted it during the surgery. I have first PSA test in 2 more weeks and multiple consults with surgeon and radiation oncologists coming up. hopefully more will be revealed and further, more accurate scans can be done. Thanks for your input!
Some parts are fuzzy to read in the image. What I can make out is no metastasis seen (Mx).There is extra-prostatic extension - that is local or adjacent to the prostate and prostate bed, so it is not metastasis but local invasion. It does identify perineural invasion, meaning layers surrounding nearby nerves, but not the nerves themselves. Perineural is not peritoneal. All organs in the abdominal and pelvic cavity are covered by a layer of membrane, including top of prostate, bladder, lymph nodes . Etc. But local extension does not equal remote on-contiguous metastasis. Unless there is something I am not able to read here. Should be thinking about a local and regional treatment such as prostate bed SRT with pelvic lymph node fields also well covered.
Meant “ non-contiguous”
I thought it was just me. I don’t know how you can confuse perineural invasion with peritoneal metastasis, but it looks like that may be what happened. It would be a shame if this guy thinks that he’s dying when his pathology report actually looks pretty good (to my untrained eye, at least).
I'm sorry you were unable to see it well. Thanks for the hopeful comment. It was a malignant biopsy of peritoneal tissue that tested positive for prostate cancer. I guess I should have realized that such an uncommon condition would have been met with skepticism about its accuracy first. I don't think I'm dying just yet. Got to hold out hope, but again, thanks for your input. Peace
My apologies. The snippet that I saw made no reference to the peritoneum. I thought that the visible information was the entirety of the snippet. It was only following your comment that I saw the magnifying glass that showed the additional report comment re the peritoneal biopsy. I’m truly sorry for the misunderstanding and I wish you the best.
Doc already confirmed it was M1. Too much confusion on this one. I'm going to leave it alone here unless anybody wants me to follow up with what happens in in case somebody else is hit with rarity. Thanks all for your input.
Here is a link to Dr. Beckert, Nalakrats was refering to:
There is never any substitute for experience.
I think you should promptly schedule a second opinion visit with the Becket in Germany.
While doing that, ask him if you should do a psma scan there while visiting him.
PSMA scan is not a guarantee of seeing anything!
My persistent PCa following RP in 18' and ADT & RT in 19' all PSMA clear, as was genetic testing. In 20' I became detectable once again, or persistent,
and developed some abdomen pain B's subsequently. While going through the SOC detection process of tests, the abdomen pain became a problem. Met with a urologist surgeon and he felt it was possibly Appendicitis, so removal was suggested. Complicated by what was it might be needed for the PCa. But the pain became so acute, it needed remedy. PCa aside, I scheduled the surgery for the Appendix removal. This is when the surgeon had seen the lesions in my Peritoneum and stopped the procedure, taking tissue samples for biopsy. Came back PCa. Tumor was observed at the Appendix but was unknown, not touched at that time. Genetic testing of that tissue also showed 11 somatic changes with a few notable as associated with PCa. Follow up surgery to remove tumor at Appendix was successful and also confirmed as PCa. I decided to use Chemo first as it can be used again later, plus my age (56) now probably more tolerable for the therapy.
Much much searching and very little to go by. Been looking at Ovarian and Colon cancers as they spread to this area for some comparison in regard to characteristics and prognosis, etc. But as a PCa patient with mets to the Peritoneum, we are a rare breed, no paths worn in front of us. We suffer the SOC as a buffer between detection and aggressive therapy, and those aggressive modalities reserved for later more advanced staging!
Although I'm not sure what's more advanced than a cancer presenting itself in a manner that is unusual and rare.
Not sure where you got that 3-6 months...? One rare and well documented case was a Japanese patient who lived 18 months but was detected with the disease well established and many, MANY mets in his Peritoneum. Hard to find any other information. I've been with it for almost a year now, obviously longer as PCa is slooooow, so who knows how long it's been there.
My fortune circumstance is that the tumor on the Appendix had looped around and reattached to the colon. This was in all probability causing the stitches/pain I was experiencing and absent that, it could have grown for a long time without detection because only slight inflammation was shown on scans with suspect "infection"... Lol, lucky right!?
The German link is specific to HIPEC which has shown promise, but not great results so far. And for some cancer, no better results than regular chemo. The idea behind it was the Peritoneum doesn't have main blood source and therefore limited delivery with regard to chemo. Ehhhhh... From the limited information I could find...
Anyways, Best Regards!
A peritoneum metastasis is not that rare. In the study below they compared a PSMA PET/CT versus CT/bone scan to see if non-metastatic castration-resistant patients had lesions which were not detected with CT/bone scan. In 55% of the patients this was the case and 6% of these had visceral mets. Four of these patients had lung mets, five had liver mets and four had mets in the peritoneum!
clincancerres.aacrjournals....
See the remark b of table 2.
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