Recent Radical Surgery

[wharr]

Hi All,

diagnosed after biopsy in December 2023 with 2 hits, one was a Gleason 4+3 and one was a Gleason 4+4.

Just had the Radical Davinci Robotic Prostatectomy in March and my pathology seemed all good.

Pre surgery PSMA scan and MRI contrast both showed all gland contained

5 lymph nodes were taken and all negative for cancer. .Margins were clear of all cancer, and seminal vesciles were also all negative. Report stated that all cancer confined to gland and was nerve sparing but, report did say "Perineural Invasion-Present" and I dont know what this really means for me... Due to hear from surgeon next week and wanted to be able to ask the right questions regarding the pathology report.

Any help appreciated...Thanks Pat

[Tall_Allen]

It's a perfect pathology report -congratulations! PNI is common and has no significance unless it's on biopsy.

[wharr in reply to Tall_Allen]

Thank You for the quick response!...That is great news to hear...Lab results were sent to "MyChart" so I peaked, and surgeon belongs to a different network so has not seen yet I am assuming. Thanks again for putting mind at ease....Pat

[cigafred in reply to Tall_Allen]

I do not know the science on this, but (1) my pathology was "perfect" except for PNI (Gleason 3+4) yet I had recurrence in para aortic and common iliac lymph nodes a couple of years later, and (2) if PNI is common and of no significance on pathology report why is it reported?

[Tall_Allen in reply to cigafred]

The pathologist is supposed to report what is there regardless of whether it has clinical significance, but they do not always report it.

Biopsy-detected PNI does have clinical significance, but post-RP doesn't.

prostatecancer.news/2018/03...

ncbi.nlm.nih.gov/pmc/articl...

ncbi.nlm.nih.gov/pmc/articl...

[cigafred in reply to Tall_Allen]

Thank you.

[allie2020]

Yes, it looks like a great pathology report to me. I had my RP in 2018, my pathology was similar to yours and I've been <.006 ever since. I did not have the perineural invasion but if TA says it has no significance, I believe it has no significance. My Uro. told me the most important thing is the negative margins.

Just a couple suggestions...take it really easy for a while, only exercise allowed is walking for six weeks from date of surgery. I think you want to start your penile rehab. with a vacuum erection device before long. You should be taking a PED5 (viagra, cialis, etc. ) now. I believe in monitoring with an ultrasensitive PSA test but many just go with the standard test. Congratulations and some celebrating is probably in order.

[wharr in reply to allie2020]

Thanks much for kind words and advice..

[Murk]

Copied from the web.... Perineural invasion means prostate cancer is present inside a nerve in the prostate. This may provide important information about a person’s outlook, but it is not the most important factor in determining how aggressive a cancer is. As many as 84% of prostate cancers feature perineural invasion.

[Justfor_]

Catheter removal ONLY after the anastomosis tightness is confirmed through cystography. You wouldn't like to find yourself in a similar situation as the US Secretary of Defence, last Cristmass.

[bcnulater]

Kegel exercise, my urologist gave me some simple Kegels to do after the catheter was removed and cleared to start. After about 4 weeks of doing the Kegels recommended, I was not happy with my incontinence. Did some research and found that there is such a thing as pelvic floor physical therapist. Made an appointment, after exam, was given +12 additional Kegels to do. Did these, within a week, my inconvenience was significantly better. By the end of the 3rd week of doing the Kegels was about 95%. Would say I am at 98%-99% now, will have an occasional oops, usually when turning quickly or something similar.

Check with your urologist and do some research about pelvic floor physical therapy after a RP. Most pelvic floor therapist work with women only, you may need to search of one that works with men.

I am a high school football referee, this last season did have a couple of times I was accidently hit during a play, one time was accidentally knock to the ground by a linebacker coming across the line, did not have any dribbles from this.

FYI - the pelvic floor therapy was not covered under my insurance. I could have appealed but only needed 2 sessions. Decided it was not worth the time or brain damage go through the appeal process.

Cheers!

[MarkS]

You can work out roughly the chances of cancer in the pelvic lymph nodes from the Roach score: LNI risk (%) = 2/3 × PSA + [(Gleason score − 6) × 10]. So in my case (PSA 12, Gleason 9), the score is 38%. I'm not sure what your PSA was, but assuming a PSA of 12, that would give you a risk of 2/3 x 12 + (8-6) x 10 = 28%. You have had some lymph nodes tested, so your actual risk might be lower. So it's worth asking this question of your surgeon.

The Roach score, although quite an old system, has been validated more recently and found to still be accurate: ncbi.nlm.nih.gov/pmc/articl...

There is another scoring system which my oncologist also uses, MSKCC, which is more complicated: evidencio.com/models/show/440, which gives me a score of 53%.

Nerves can be a route for cancer cells to spread, so it is worth asking your surgeon questions on that.

[wharr in reply to MarkS]

Thanks for response...my psa was only 4.92 but had doubled in 2 years and have history among brothers and dad.I'm glad Uro suggested biopsy and found the aggressive Gleason 8 early.

[HerbalGrower]

Similar post RP surgery mid March. Pathology report: No spread to lymph nodes. Perineural involvement. No further treatment recommended. Catheter out day 8. Significant incontinence. Pelvic floor exercises (Kegels). On to the next 20-30 years cancer free. Good luck with your recovery.

[Fairway]

Congrats on the clear and nerve sparing outcome. Sorry, no help on the question.

[wharr in reply to Fairway]

Thanks.