Post RALP path report

[runtrails]

Just got my pathology report back. Don't think my Urologist has even see it. Seems mixed in the positive and not so positive news. EPE and lymph are negative. Bladder neck, surgical margins and SV positive. What questions should I start with when he calls? For example, would I Start adjuvant therapies sooner than later?

FINAL DIAGNOSIS:

A: Fat of prostate:

Adipose tissue negative for carcinoma.

B: Prostate, prostatectomy (39 g):

ADENOCARCINOMA, Gleason score 4 + 3 = 7 (Grade Group 3), with bladder

neck invasion and bilateral seminal vesicle involvement; see staging

summary below.

Tumor

Histologic Type: Acinar adenocarcinoma

Histologic Grade

Grade: Grade group 3 (Gleason Score 4 + 3 = 7)

Minor Tertiary Pattern 5 (less than 5%): Not applicable

Percentage of Pattern 4: 61 - 70%

Intraductal Carcinoma (IDC): Not identified

Cribriform Glands: Present

Treatment Effect: No known presurgical therapy

Tumor Quantitation

Estimated Percentage of Prostate Involved by Tumor: 11 - 20%

Extraprostatic Extension (EPE): Not identified

Urinary Bladder Neck Invasion: Present

Seminal Vesicle Invasion: Present, bilateral

Lymphovascular Invasion: Not Identified

Perineural Invasion: Present

Margins

Margin Status: Invasive carcinoma present at margin

Margin(s) Involved by Invasive Carcinoma: Right bladder neck; Left

bladder neck; Posterior

[Tall_Allen]

No reason to get a therapy you may never need. You can safely wait 3 months for your PSA:

prostatecancer.news/2019/09...

Some details you may want:

• How long was your positive surgical margin?

• What was the Gleason score at the margin?

[runtrails in reply to Tall_Allen]

Thanks. Ill check that. My prostate was small and surgery report said seminal vessicals notably small. Not sure of that indicating anything. His report said prostate looked " normal" at removal. I guess indicating no visible tumors?

[Tall_Allen in reply to runtrails]

Ask those questions. You can decide after you have a PSA test in 3 months.

[Justfor_]

"A test is worth the opinions of 10 specialists". If you are eager to learn the RP outcome have a PSA test 5-6 weeks post RP.

[Hidden]

Always ask about the likelihood of micro-metastasis and hecpropses dealing with. Best wishes.

Gourd Dancer

[HopingForTheBest1]

Consider adding a genitourinary medical oncologist to your team.

[MateoBeach]

The positive margin with bladder neck invasion tell you that “the horse (cancer) is likely already out of the barn”. SV invasion also indicates it is aggressive.I would consult a radiation oncologist and begin planning for salvage radiation to the prostate bed, pelvic node fields. Bladder neck will be tricky and needs to be discussed with the surgeon regarding possible completeness of resection. Only PSA going to zero and staying there without any medication would be reassuring..

[runtrails]

yes, my urologist says RT (and possible adjuvant ADT?) is a given. Need to get that in the plan but also let things heal first. said possibly 6 months from surgery depending on all the data and what RO says. Hoping to find an RO and MO soon. Providence Regional Cancer system is in my insurance network, a block from my wife's work, and closest for RT at the radiant care facility, but I need to research and interview.

[Mark89]

i just wondering if you did PSMA Scan intially Before surgery , and what was the SUV Max on bilateral seminal vesicles before surgery ?

[runtrails]

No PSMA before..just the 2 PSA and biopsy.