Starting treatment

[skiddles]

Hi there,

I am a 75 yo white male. PSA 4.8 rose from 3.2 14 mos. previously. Sept. 28/24 I was diagnosed post biopsy of GL 4+4 , left sphere prostate cancer. Dec. 01/24, after a whole body bone scan which showed a suspicious lumbar flare and then a PSMA scan (neg. mets) I had a robot assisted laparascopic prostatectomy. {RALP} (my choice over radiation)

Post rp pathology as follows

Andenocarcinoma Gleason score 4+5 (Grade group 5),

Positive for tumor extension beyond the prostate gland at left apical and left posterior aspects. (also revealed on MRI)

Negative for bladder neck invasion

Negative for Seminal vesicle invasion (SVI)

Presence of perineural invasion. (PNI)

Presence of lymphovascular invasion (LVI)

Presence of intraductal carcinoma of the prostate (IDCP) p.s. I will ask if it is pattern 1 or 2.

Free all resection margins

Remaining prostate: nodular hyperplasia and atrophic change with patchy acute and chronic inflammation.

Lymph nodes left pelvic area ,dissection, negative for metatastic carcinoma in 4 nodes ( 0/4) {inguinal netting in the way}

Lymph nodes right pelvic area, dissection, neg. carcinoma in 10 nodes (0/10)

prostate wt. 64 gms.

Attached bladder neck muscle shows no gross tumor involvment.

Dec. 28/24 psa at <0.025 ng/ml by CMIA method. (at treatment center)

Jan. 27/25 psa at <0.003 ng/ml (at private lab)

Continence at 80% and improving each week. Have Urol. appt. c/w blood tests on Feb. 27/25.

On last appt. (Jan. 27) Urol. was more concerned re. presence of LVI than the other items on patho. report. My main concern was IDP.

Thanks for reading. Any thoughts on this?

[Tall_Allen]

Consider whole pelvic radiation. You can start on ADT now and do the salvage radiation after you regain full continence.

[skiddles in reply to Tall_Allen]

Thank you T_A. That is what my Dr. said Jan. 04/25. Adt 1st and then RT for the lymph nodes. Can always change direction to whole pelvic since I will be doing the drug regimen first. I would like your thoughts on which brand/type of ADT. I remember my Dr. mentioning Lupron (old school) but on researching this past week, there are some with less/different side effects. Appreciate your thoughts, again.

[Tall_Allen in reply to skiddles]

It has to be whole pelvic - individual lymph nodes don't work. You have to treat what you can't see, although you can get a boost to the individual nodes you can see, but they may be too small to see after ADT.

Most side effects from ADT are from castration-level testosterone -- all ADT meds do that.

[skiddles in reply to Tall_Allen]

Thanks. Urol. may well have said just that re whole pelvic. I just remember Adt/radiation/lymph nodes. That was two months ago (1 mo. post rp) and I was stoked about the good blood test results, psa <0.025 and being able to stay dry all night albeit having to void every 2.5 hrs. Next appt. Feb. 27/25.

Cheers.

[j-o-h-n]

Greetings skiddles,

How about updating your bio. All info is voluntary but it helps you and helps us too. Thank you and keep posting.

Good Luck, Good Health and Good Humor.

j-o-h-n

[gardian_galaxie]

As for your concern with IDP, you could ask for a test confirmation with an Immunohistochemistry (IHC) test. They can use the existing bio specimen. I've had a wide spectrum of pathology reports from simple Grade II to Grade III with cribriform and IDP. The IDP concerned me also with my own biopsy because of the aggressive characteristics. It sounds like your Dr is looking in the right direction with concern of LVI presence.

Best of luck to you.

[skiddles in reply to gardian_galaxie]

Thank you gardian_galaxie.

I will ask re IHC test. I am" getting my ducks in line" for the Feb. 27 appt.

Holiday is over after a succesful RALP. (Dec. 1/24)

All the best.

[Tall_Allen in reply to gardian_galaxie]

How does IHC help with IDP? I never heard that before.

[PKLA]

I agree with the other comments here. My surgery was in 2019 with no apparent spread of the cancer outside of the prostate, so I have no experience with these post op treatments. Good luck...this is a great site with great contributors.

[skiddles in reply to PKLA]

That's good! Yes, an excellent site and made that way by contributers taking time to assist.

[elwoodpdowd]

congrats on your successful RALP. It appears you are an intelligent and resourceful person. I seem to have won my battle against prostate cancer and would enjoy sharing my story with you offline. I invite you to visit my page on Facebook (Carl Gay in Port Angeles, Washington) in order to contact me and perhaps we can chat by phone.

[pirate21]

Agreeing with comments above and emphasizing the benefits of early radiation following RALP for complex cases, ie high Gleason scores. In this regard publications by Dr Anthony D’Amico of Dana Farber may be helpful and reinforcing. I had similar pathology to yours and am same age and had RALP followed by full pelvic radiation in 20/21. Fortunately so far no recurrence. I had Lupron annd Casodex and side effects lifted six months following last treatment. Good luck with the journey. Sounds like you are in a good track.

[skiddles in reply to pirate21]

Thank you for replying. Your positive treatment results are very reassuring. Any chance of you sharing the specifics of your treatment course.? Lupron/Casodex concurrent or consecutive? Also knowing the radiation regime would be helpful. I have started reading your publication referrals.

Cheers, pirate.

[NanoMRI]

Any thoughts? I would be very pleased with the "Jan. 27/25 psa at <0.003 ng/ml (at private lab)". A benefit with RP is we can, if we choose, utilize uPSA testing and get an earlier look at remaining cancer and spread, well ahead of general guidelines for biochemical and clinical recurrence. Nine years ago I chose to rely on <0.010 as best indicator post RP and to this day I am strong advocate for ultrasensitive testing and this threshold.

With the concern for spread I would be testing monthly to see if your uPSA rises. Based on my experiences with liquid blood biopsy testing I would add this to your investigations - especially with the identified LVI and clear lymph nodes. Before I did any treatments I would have multiple imaging methods for comparison. Hope this helps. All the best!

[skiddles in reply to NanoMRI]

Yes, totally agree. I was happy with the <0.025 ng/ml result, sensitivety 0.025 by CMIA method. I was curious about "how much less than?" so waited 1 month and had a u/sPSA test resulting in <0.003 ref. range 0.000-4.000 ng/ml. I will do another same private lab test just before my Feb. 27 Urol. appt. at which time blood tests inc. PSA will be done.

That said, my psa was (only?) 4.8 ng/ml at diagnosis (5 months ago) and 3.2 ng/ml 15 mos. before that. That has taught me to be a lot more pro-active.

Cheers and much obliged for your input.