Husbands post PR pathology

[Froody]

Hello! My 61 yr old husband recently (8/18) had RP for Gleason 9 (4+5)biopsy report. He had the biopsy because at his yearly physical our doctor didn't like the feel of his prostate, PSA was drawn and was 13.4. So urologist did RP hoping to get it all. Well, that didn't work out quite the way we had hoped. He has:

1. Positive apical and right base margins,

2. Extracapsular extension right posterior base,

3. Positive right and left seminal vesicals.

4. Removed 29 lymph nodes and they were all negative.

So now he will be having radiation once healed. He is taking it well, has a positive outlook, and trusts the doctor (and the second opinions we've gotten are in agreement). I try my best to keep my worries to my self, but as he is the most important person in the world to me, I want him to have the best care! Our doctor is still hoping for curative outcome with the additional radiation.

Does this sound reasonable? Could this still be curative (I don't want false hope). The things I've seen seem to indicate that it is most likely to come back, but I don't know how to tell what the strongest indicator of likely recurrence is, PSA or Gleason? Also he is very fatigued, which I am guessing is normal for 2 weeks out from surgery.

Sorry so long a post, I've appreciated the information I've gleaned from this site and you all!

Alicia

[Hidden]

I am in a very similar stage with your husband. Main differences: no margins, no extracaptular extensions, unilateral seminal vesicle involvement, 20 nodes dissected all negative, 15 months post RP, a decade older. I will have an early salvage RT, I have no doubt about it, but I am not in a haste. I monitor my PSA monthly and when it gets greater to 0.1 I will have a PSMA PET/CT in an effort to have a personalized sRT in contrast to the usual blind one that your husband will now get. My PSA at this time is 0.05 with a 6-7 months doubling time, consequently, the sRT will probably be early next year. Yet, I am already making my research for a best solution. Be advised that blind RT, in your husbands case aRT (a from adjuvant) has a success rate of 40-50%. They will probably prescribe hormonal therapy with it, which current trials have proved unnecessary to harmful. My advise is to check his PSA frequently -not every three months- and try to mount a personalized treatment plan because the SoC treats patients like in an automobile assembly line, far from optimal, that is.

Knowledge is aboundant here and you can profit from.

[Davick in reply to Hidden]

I’m following right behind you with this plan.

That’s how I’ve decided to go.

[Tall_Allen]

If you want to see the approximate odds of salvage radiation being curative, try this nomogram:

riskcalc.org/ProstateCancer...

But the probabilities don't predict for the individual case. For your husband, the results are binary - it works or it doesn't.

[HopingForTheBest1]

Make sure to get Prostate Cancer Foundation's prostate cancer patient guide at pcf.org . It will help you find answers.

Would also recommend pathology second opinion from Dr Johnathan Epstein at Johns Hopkins, the best in the business.

[Froody in reply to HopingForTheBest1]

Do they do virtual second opinions?

[HopingForTheBest1 in reply to Froody]

The second opinion is done by sending a tissue sample for their analysis. There is no need for virtual, as a written report is provided.

[fluffyfur]

My husband had very similar surgical outcome to yours. Main difference is his Gleason score was 7(3+4) but he also had positive margins and extra capsular extension. 37 nodes removed during RP all negative.

His PSA dropped to un-detectable but started to rise about 6 months after surgery. He consulted with two ROs and both recommended radiation. We started that when his PSA rose to .2.

Is it curative? I'm hopeful but I suspect his cancer will return at some point. Seems like the magic number is 5 yrs. I guess in some cases you can go into remission for a longer period. I don't like using the word cure for some reason.

Higher Gleason scores tend to act more aggressively.

[Froody in reply to fluffyfur]

Thank-you. How many sessions of radiation did he have? Hope all continues to go well for you all!

[fluffyfur in reply to Froody]

He had 35 sessions at 2 Gy each for a total of 70 Gy. From what I understand all the large cancer centers are using that dose. Some even up to 72 Gy. It's definitely something you should ask about. There is no definitive research on the magic radiation dose but lower doses seem to have a higher chance of re-occurrence.

Here's some info about radiation dose by TA from this group.

prostatecancerinfolink.net/...

Feel free to PM me as well. I am happy to answer any questions you may have or if you want to just chat about the situation.

All the best.

[cpcohen]

FWIW --

My understanding is that, for high-Gleason PCa (like your husband's), radiation plus ADT has a better cure rate than radiation alone. (This conflicts with a previous comment -- ask the docs, and do some research).

"Cure" does sometimes happen after surgery fails, _if_ the tumor is still localized (that is, no "micro-metastases"). I don't know what the odds are, of that.

Mostly, with recurrences, patients and docs play "whack-a-mole". As more anti-cancer drugs are developed, there are more chances to whack whatever cancerous cells remain alive, after the previous treatment. Prostate cancer is a constantly-mutating disease -- different drugs seem to work for different mutations, and we don't have really good data about that relationship. The researchers are hard at work.

As more drugs and "drug cocktails" are proven, and go into use, the rate of "cure" (either "no biochemical recurrence", or "the patient dies, but not of prostate cancer") goes up, and the overall survival rate goes up.

I'm not trying to raise false hope -- his situation is serious. But I suspect he'll survive well into the unforseeable future.

. charles

PS -- I don't have any experience, am reporting what I hear and read.

PPS -- if he _does_ go on ADT, a suggested book:

"Androgen Deprivation Therapy: An Essential Guide . . . (Second Edition)"

. . . by Richard Wassersug (and others)