Post-op pathology

[mike__c]

Hello. I am 53. Looking for any positive thoughts following my robotic prostatectomy. My pre-op stats were: PSA 26 Gleason 8 Bone scan- negative MRI negative for spread outside of the capsule. However, my post op pathology shows 3 of 10 lymph nodes were positive. Positive margins in the seminal vesicles and in the left and right apex of the capsule. Obviously, this is not great news. I've yet to talk to my surgical oncologist. I see him on Thursday. What might my likely path of treatment be from here?

[Justfor_]

First things first. 5 to 6 weeks after RP you shall have a PSA test. This will be your first guidance for the timeframe and possible types of further treatment.

[Tall_Allen]

I suggest you talk to a radiation oncologist instead. There is no question in your case that you require follow-up whole pelvic radiation. In one study, men with positive lymph nodes who had radiation and long-term adjuvant ADT did MUCH better than men who only had ADT:

prostatecancer.news/2017/12...

The sooner you start moving on this, the better. You can start ADT immediately - that will hold your cancer in check for a while, allowing your tissues to heal (for about 7 months) before irradiating them.

[mike__c in reply to Tall_Allen]

Thanks Allen. I will follow up after I see my surgeon to discuss pathology on Thursday.

[mike__c]

Two questions. How long after your surgery was your first PSA? What is your current treatment plan now that you are effectively PSA 0? (ie- will you be continuing Zytiga indefinitely?)

[TJS-1]

My history is also similar to yours (see my profile for Tx regimen to date). I agree you should be assembling your team of RO and MO at this point. My Uro Surgeon didn’t offer much after RRP, and I rely on the others for all treatment plans and decisions now. First PSA was at 8 weeks post surgery.

[Shorter]

Hi Mike, I don't think you can go wrong with Tall_Allen's advice. ADT will slow it down and give you a little time to heal and then do pelvic radiation.

I did not have the positive lymph nodes and did not get ADT after my prostatectomy. My PSA started rising quickly just before the 2 year mark. I originally had Gleason 9. I am now 65. I started ADT early this year followed 1 month later with radiation. I will be on ADT for 2 years+

[Bachisgreat]

I had negative nodes, but positive extension into the seminal vesicle on one side. My oncologist at the James in Columbus, OH (a great place) recommended oral Casodex for a month, followed by Eligard and Casodex for 18 months, with radiation starting about a month after the hormonal therapy. I followed his treatment plan, and now am about a year after the end of the hormonal treatment. My PSA now is undetectable. I had no trouble with the treatment except for significant hot flashes. I wish you well.. Feel free to ask me more questions.

[Downhill_Skier]

This is more of an opinion than a statement based on hard facts. If your doctor suggests radiation, I would do it. I am also 53 with a wife and 2 kids. My post-op PSA was 11, 3+4 Gleason, negative margins, no lymph node involvement, but extra prostatic extension. My PSA doubled twice within 12 months of surgery, although it never reached .2 to be considered a bio-chemical recurrence. Two radiation oncologists at a university medical center told me I needed radiation and my local radiation oncologist told me I needed radiation, not necessarily immediately, but within a matter of months. My local urologist told me to come back in 6 months for another PSA. My university medical center urologist said to take another PSA in 30 days. Screw it I told myself. I am going for the most aggressive approach. I started a 35 treatment regiment 4 weeks later and will finish in 3 days. I am glad I did it. There was no way I was going to wait to reach some official bcr. Good luck man.

[gamma909]

Sorry to hear about your experience-good luck. If you don't already have one, you should add a medical oncologist to your team, especially if you can find one who specialized in PCa. If I was in your situation, I would first meet with them and agree on a treatment plan.

[westernmass]

Hey Mike,

I am in similar situation with 2 kids. Waiting for first psa. I highly recommend 2 books. How not to die, and anti cancer. Both have sound advice around diet and lifestyle.

For the record, there is a lot to be hopeful for. First of all, you still have treatment options as others have indicated. 2nd of all, there are great advances being made in PCA. 3rd, the more proactive you can be on every front, as cancer is a multidimensional disease, the better your odds of long term survival. You are not helpless.

Be well and enjoy every moment with your kids, laugh, and play. Cuz that helps too!

[Hidden]

Given that I was the same age as you and a similar pathology I can only advise the following treatment:

1. ADT with Zytiga/Prednisone

2. Radiation with whole pelvic region

3. Plant based diet

4. Workout like you're a plow horse.

See my bio for specifics.

Good luck with whichever treatments your choose.