PSA 32 Gleason 3+4=7 Localized

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  • Josephg
    Josephg Member Posts: 383 Member
    #22
    IndyJoe said:

    Update

    Hey guys,

    Been awhile since I was out here and wanted to provide an update on my status.  The MRI results indicated heavy cancer in the prostrate (which we knew from the biopsy).  It found no indication of spreading beyond the gland or lymphnodes.  With that information and all of the info from previous scans / tests, I made the decision to have the Davinci RP which was executed this past Fri.  Home recovering now.  Catheter comes out this Fri at which time I will learn about the pathology reports which we all know from comments above will set the state for the next set of treatment decisions to be made.  Again, I can't tell you guys enough how much I appreciate you contributing above. Very much appreciated.  Will report back soon.

     

    Thanks again....Joe 

    We Are Here For You

    We will always be here for you, Indy, and I believe that you will always be here for folks who join this Forum after you.

    We are Brothers in PCa.

  • VascodaGama
    VascodaGama Member Posts: 3,641 Member
    #23
    After RP

    Indy,

    Thanks for updating your story. I am glad for the news and for knowing that you are well. It is better to concentrate now in recuperating fully instead of involving yourself in "... the next set of treatment decisions ". That may not even be necessary; however, recuperation obliges you to be active from the beginning. After RP, among several things, my doctor recommended me daily walks, and after removal of the catheter he suggested sex related activities to avoid atrophy of the penis, using a pump or masturbation (sort of massaging the penis extending it), and taking Viagra twice a week. The purpose is to oxygenate the cavernous areas of the penis filling it with blood. In regards to continence, kegels exercises are recommended but too much of it may lead to other complications. Good diets are also important, in particular if one requires any adjuvant treatment.

    Surely the pathological stage will dictate the next step but the PSA is the marker and I believe that your doctor will use it to judge anything for the future. Surgery success is taken when the PSA at one month post op gets into remission levels lower than 0.05 ng/ml. This is the number I expect to read in your next update.

    So far you are alive and kicking. Congratulations.

    Best wishes

    VGama

  • IndyJoe
    IndyJoe Member Posts: 15
    #24
    VascodaGama said:

    After RP

    Indy,

    Thanks for updating your story. I am glad for the news and for knowing that you are well. It is better to concentrate now in recuperating fully instead of involving yourself in "... the next set of treatment decisions ". That may not even be necessary; however, recuperation obliges you to be active from the beginning. After RP, among several things, my doctor recommended me daily walks, and after removal of the catheter he suggested sex related activities to avoid atrophy of the penis, using a pump or masturbation (sort of massaging the penis extending it), and taking Viagra twice a week. The purpose is to oxygenate the cavernous areas of the penis filling it with blood. In regards to continence, kegels exercises are recommended but too much of it may lead to other complications. Good diets are also important, in particular if one requires any adjuvant treatment.

    Surely the pathological stage will dictate the next step but the PSA is the marker and I believe that your doctor will use it to judge anything for the future. Surgery success is taken when the PSA at one month post op gets into remission levels lower than 0.05 ng/ml. This is the number I expect to read in your next update.

    So far you are alive and kicking. Congratulations.

    Best wishes

    VGama

    Thank You VG

    Thanks for the detailed post RP info VG.  Very helpful.  It will be interesting to see if my doc takes a similar approach.  Wasn't even thinking about some of this until I read your post.  Thanks again and will most definitely keep you and the gang here posted.    

  • Sctt_rbrtsn
    Sctt_rbrtsn Member Posts: 1
    edited December 2019 #25
    55y yr old biopsy report questions

    Hi everyone

     

    I am 55 and in march began medical weight loss program. It was a combo of precription app suppressant and TRT. In Sept I began having urinary difficulties, weak stream. Hard to start, etc.. wen to PCP he tested my PSA result was 4.2 from a 1.6 result in Mar when i began program. PCP referred me to urologist. PSA was 4.1 but t level was at 1200. I had stopped TRT month before urologist appt. Uro scheduled me for biopsy dec 9th . End of Nov went back to PCP retested PSA and it had dropped to 2.2. Biopsy results 12 cores positive 25% gleason was 3+4=7 . Digital test before biopsy no lumps found but one side felt hard. Dr ordered bone acan and ct scan as next step. Father was diagnosed at 78 with prostate cancer . 

    Im in uncharted water here. How serious does this sound? I was told i was not low or high but at intermediate risk.

    Can anyone advise me if next steps and scan tests are normal protocol.  I understand scans will allow uro to grade my tumor and guide him to recommended treatment advise. Otherwis very healthly 6,2" 220 lb man. 

     can anyone advise on questions to ask or next steps i should consider?

    what should i get prepared for?

     

    thank you!

     

     

  • IndyJoe
    IndyJoe Member Posts: 15
    #26
    Hi Scott

    To ensure your post get maximum coverage in this forumn, I would advise you re-post this as a new topic to this prostrate cancer page.  If you are unsure how to do this, just let me know as I am happy to get that started.  Right now, your post is only being seen by those looking at my specifc thread.  It will be best for you to start a new one.  The reason why I say this is because there are so many awesome guys out here with a load of experience that will definitly weigh in on your question.  Sorry to hear about your diagnosis.  My story is above, in this thread.  I just had my prostrate removed last week and the catheter pulled today :).  Anyway, just let me know if you'd like my help is getting your post into a new thread.....

     

    Joe

  • IndyJoe
    IndyJoe Member Posts: 15
    #27
    Pathology Report Came In

    Hi gang,

    To recap, I had a RP performed on 12/12.  PSA prior to the surgery was 32.  I got my hands on the pathology report and below are the highlights, a bit of a mixed bag.  First PSA test post RP is set for late Jan.  Will share more info when I have it.  As always, comments, questions etc are welcomed.

     

    Gleason 3+4=7

     

    Primary pattern 3 – 50%

     

    Secondary pattern 4 – 45%

     

    Tertiary pattern 5 – 5%

    ISUP/WHO Grade group 2/5

    Extraprostatic Extension – Present (Nonfocal)

     

    Urinary bladder next invasion – No

     

    Seminal Vesicle Invasion – Absent

     

    Surgical margin involvement – No

     

    Apex involvement – Positive

     

    Intraductal carcinoma – Not identified

     

    Perineural invasion – Present

     

    Lymphovascular invasion (20 Lymph nodes tested) – Absent

     

    Other significant findings – None

    Pathologic stage – pT3a pN0

     

  • VascodaGama
    VascodaGama Member Posts: 3,641 Member
    edited December 2019 #28
    pT3a pN0

    Indy,

    Some doctors would consider adjuvant RT in a case with the characteristics described in your pathological report. The data confirms localized extraprostatic extensions and an existing tertiary grade 5 (aggressive) but it doesn't inform its location. These two items are the baddies in the report, diagnosing a pathological stage of pT3a pN0. They write Gleason 3+4=7 but this would be up graded to Gleason score 8 (3+5) in spite of the low percentage of grade 5 cells.

    A considerable number of cases get such classification but there is a difference in the judgment done by the doctors between pT3a pN0 cases with a Gleason score 6 and those (similar to your case) with Gleason score 8 (3+5). I wonder what will be the opinion of your doctor. Some wait and follow the PSA marker, administering a salvage therapy when such becomes required (if ever), and some disregard the PSA marker prefering to administer adjuvant RT as soon as the patient has recuperated from the surgery (typically 1.5 to 2 months post op).

    Let's enjoy the festivities and wait for the PSA.

    Best wishes for the New Year.

    VG

  • IndyJoe
    IndyJoe Member Posts: 15
    #29
    VascodaGama said:

    pT3a pN0

    Indy,

    Some doctors would consider adjuvant RT in a case with the characteristics described in your pathological report. The data confirms localized extraprostatic extensions and an existing tertiary grade 5 (aggressive) but it doesn't inform its location. These two items are the baddies in the report, diagnosing a pathological stage of pT3a pN0. They write Gleason 3+4=7 but this would be up graded to Gleason score 8 (3+5) in spite of the low percentage of grade 5 cells.

    A considerable number of cases get such classification but there is a difference in the judgment done by the doctors between pT3a pN0 cases with a Gleason score 6 and those (similar to your case) with Gleason score 8 (3+5). I wonder what will be the opinion of your doctor. Some wait and follow the PSA marker, administering a salvage therapy when such becomes required (if ever), and some disregard the PSA marker prefering to administer adjuvant RT as soon as the patient has recuperated from the surgery (typically 1.5 to 2 months post op).

    Let's enjoy the festivities and wait for the PSA.

    Best wishes for the New Year.

    VG

    Thanks VG

    Thanks for your thoughts on the path report VG.  I was especially interested in your comments regarding the Gleason which confirms what I was thinking as I really didn't understand why they rated it as a 3+4=7 given the breakdown.  I see my doc on 1/22 and we will have the revised PSA results in hand when having that next step conversation.  My sense based on prior converstaions is that he will advise to go active surveillance via PSA marker.  We shall see.  Thanks again for your thoughts and Happy New Year my friend.      

  • IndyJoe
    IndyJoe Member Posts: 15
    #30
    First PSA Post RP

    Hi all,

    Quick update on my situation.  My first PSA test following my RP which was approx 6 weeks ago was 0.043 which was measured earlier this week.  I met with my doc who now has me on active surveillance with next test in 3 mos.  As I say most every time I'm out here, Ireally appreciate all the support all of you have given me throughout my journey.  You all are a true blessing to me....Thanks again.

  • VascodaGama
    VascodaGama Member Posts: 3,641 Member
    #31

    Congratulations for the low PSA. Let's hope for remission forever.

    I recall my moments after prostatectomy 20 years ago just two days after op. The surgeon visited the room telling me that he has vacuum well the whole area before stitching me up. It seems that the action was common in open surgeries. The intent was to be certain that no prostatic cells were left behind.
    The practice is still used today by some robotic operators in particular to those cases diagnosed with extraprostatic extensions like yours. One is not sure if the RP has cleaned all but one can hope for that.

    Best

    VG

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