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.
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.
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.
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!
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.
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.
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.
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Question about IMRT on multiple targets simultaneously
Opinions on my husband’s Pylarify scan results? Is additional radiation possible? 
The wait is over, surgery completed 12/18
Starting on Plan C ..... how did I get here?
