pT3b just diagnosed

[bargerat]

on 9/18/2023 had prostatectomy. Resection margins clear but right seminal vesicles invasion identified along with lymphovascular and perineural invasion present. Any ideas on next step thanks Ed

[Justfor_]

Read my bio for a mirror image case (left seminal vesicle invaded). Jokeing-mode aside, in another 4-5 weeks you may have your first PSA count. It's value will tell you more than 100 experts' opinions you can consult now.

[Tall_Allen]

There are some men who have certain risk characteristics that immediate (adjuvant) radiation gives better outcomes than waiting for a PSA test (salvage radiation or SRT). She found that you would fall into that category. Read this:

prostatecancer.news/2021/10...

You can start on ADT immediately to give time for tissues to heal from the surgery you just had.

[thansen535]

hello. It’s been 2 years from my prostatectomy. Had margins similar to yours. See my bio. Had a 6 month shot of lupron because I was flying to FL shortly after. Although I was advised to have radiation to the general removal area I decided to do nothing. My psa continues to be non-detectable. Have the test every 3 months. So far so good. Good luck.

[Ramp7]

I was 53 when report came back very similar t3b, but margins were not clear. 69 years old now, and still dancing with the beast.

[bargerat in reply to Ramp7]

What therapy did you do thanks

[Ramp7 in reply to bargerat]

I did the robotic surgery. A year latter radiation to the prostate bed. PSA 0.1. That lasted about 10 years. PSA going up, Lupron, Zytiga with prednisone. That lasted about 18 months. Did a Novartis PSMA LU177 trial at Dana Farber. That worked for about a year, 6 infusions. Now onto self administered BAT.

[gsun in reply to Ramp7]

How is the BAT going? How long have you been doing it?

[Bowmaster]

2002 I had my prostate removed. Five years later my PSA came back . It was -0 after surgery and now it is 85 and going up . After many scanners and hospital trying to find where is the problem NOTHING . Next week I am going for PET scanner testing .

[j-o-h-n]

My suggestion........... Listen to Tall_Allen..... (and laugh at my humor btw)..... he knows this stuff like the back of his hand.

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 09/24/2023 3:21 PM DST

[TJGuy]

Very Similar for me, pT3Bn0m0 clear margins, extension and SV invasion, six weeks psa 2.3, 4 months Lupron, over seven months to recover urinary control, let PSA rise until PSMA found 5 spots in pelvis PSA 3.9, whole pelvis, pelvic bed radiation, 2 years Lupron, successful killed those mets, let rise for two years until now 1 lymph node, to be reconfirmed next week with another PSMA and MRI. PSA 1.5Expect 5 sessions of Stereotactic radiation to right common illiac met. Which has not been radiated as of yet.

The reason for the second PSMA scan in 3 months was denial by BCBS of PSMA at Mayo.

Got PSMA approved at different hospital, had them and Mayo both review, scan showed ureter as positive confusing results as to one or two lymph nodes.

Will go to Mayo now with BCBS approval for new PSMA scan and MRI due to supposedly superior equipment and software at Mayo to hopefully produce clearer definitive results.

If BCBS hadn't interfered to begin with this would all have been completed by now

This all happens next week.

You may choose as Tall Allen suggests to go ahead with whole pelvic and prostate bed radiation as soon as your urinary control recovers. And begin ADT which now may be using Lupron and second level ADT such as Zytiga.