Final Path Report After RALP (Dad - 74, G7- 4+3) , what’s next ?

[EzioAudi7]

Hi All,

I had posted about a month ago about my dad with G7 - 4+ 3. We originally thought there were bone Mets but it just turned out to be another bone anomaly identified in the PSMA PET scan.

We went ahead with RALP and have shared the final path report here.

While the MRI showed no signs of seminal vesicles and PNI , the final report after the prostrate was removed did show that. However the margins were clear and no nodes were identified.

My questions are more around could it have spread to the seminal vesicles and PNI ? Could it have advanced that quickly or was it just not picked up during the MRI / Biopsy. With the above should we be considering waiting on the PSA results or proactively consider ADT + Radiation as an option. We are now meeting a medical oncologist next week to go over these reports to understand next steps.

Thank you again for your help.

Original post :

healthunlocked.com/advanced...

Final Pathologic Diagnosis

Prostate with bilateral pelvic lymph nodes and periprostatic fat :

Acinar adenocarcinoma, conventional involving the left lobe.

- Gleason grade group 3; (gleason score 4 + 3 =7).

- Intraductal carcinoma is present.

- Perineural invasion is noted.

- Extraprostatic extension is noted.

- Left seminal vesicle is involved by tumor.

- All margins are negative for invasice carcinoma.

- Eight lymph nodes noted are free of metastatic carcinoma (00/08).

Path stage: pT3N0.

[Tall_Allen]

You are safe waiting for PSA to go to 0.1 or 0.2.

[EzioAudi7 in reply to Tall_Allen]

Thank you again Tall_Allen

[Justfor_]

Similar case to mine, only higher GS. To answer your queries now: SVI was already there, undetected. Biopsy is prostate gland only and MRI can only judge from dimensional parameters. During the early stages, there is no dilatation detected, so it passes unnoticed.

A check list follows, so you will be informed/prepared:

1) Irradiation has its risks. Key words: Radiation colitis, radiation cystitis, second cancers.

2) The best prognostic tool for someone that has had RP as primary treatment, is the PSA doubling time (PSADT). For a no-nonsense PSADT, 5-6 readings are required. With monthly tests, this will take half a year. With quarterly tests, triple this.

[EzioAudi7 in reply to Justfor_]

Got it thank you for sharing. Did you consider Radiation or RP as your primary treatment ?

We will discuss a testing schedule with the medical oncologist and start charting it.

[Justfor_ in reply to EzioAudi7]

It was RP 4.5 years ago. BCR followed 2 years ago. Since then, N=1 experimentation with, up to now, good results. Documented here:

healthunlocked.com/prostate...

Trying to kick salvage RT as far down the road, as possible.

[Bethpage]

My husband's results post-prostatectomy were the same. Margins were clear. After a slowly rising PSA for 3 years, an MRI-guided biopsy was done. It was clear. However, a PSMA done in clinical trial at Stanford in late 2018 found the BCR in the tracks of the removed seminal vesicles, prostate bed. He did 2.5 years of ADT (bical because of cognitive impairment issues) and 39 RT.

[EzioAudi7 in reply to Bethpage]

Got it thank you for sharing.

The doctors have recommended Degarelix (once every 3 months ) as a precaution and then will evaluate if RT is required after 6-12 weeks.

[Bethpage]

That sound like a good plan. I'd rather my husband had been able to do Lupron or Firmagon, but he was teaching and afraid of progressing cognitive impairment. Wishing you very good luck!

[EzioAudi7]

We just got the first precautionary dose of Degarelix (Firmagon) yesterday and had a lot of side effects including low energy , nausea etc. This was recommended by his practioneer to be on the safe side.

Hoping for a better outcome next time since the dose will be 80mg or may shift to Orgovyx next time if it doesn't improve.

We can't take Lupron or others due to his pre existing comorbidities related to his heart.

First post op PSA is scheduled in Jan hoping for the best at this point.

[Melzer2169]

I come in every so often and always look for new info on intraductal, you father's pathology is nearly identical to my husbands, (57) however, my husbands margins were positive. I am somewhat surprised as they have done nothing since the RP (now 14 months post op). My husband doesn't even want to talk about it, but i am concerned they should be doing more...but his PSA is undetectable...but it was never high, not ever. Found during his colonoscopy. I guess worry just come with this PC.....anyway, hope your father is going great.

[EzioAudi7 in reply to Melzer2169]

Thank you , hope your husband is doing well.

My dad's PSA after Firmagon is around 0.04, not undetectable but pretty low. Hoping it stays that way but we are continuing with the Firmagon now , it's been better with the second dosage since that was just 80 vs the 240 initially.