How would you interpret this?

Timlong

After reviewing the pathology report from December 2011 following Tim's RP I notice that during examination of 9 removed lymph nodes it was concluded "no tumor present". Further in the report there is mention of " no regional lymph node metastasis" Does this rule out micro-metastasis? Can Micromets been seen during node exam?
Tim's Stats: PSA 22,70 percent of prostate involved, Gleason 9 (4+5), 12/12 cores positive w/ 80-90 percent, EPE, SVI, PNI, pt3bno, non nerve sparing robotic RP . Just concluded IMRT to prostate bed. PSA now .035

Jeff

Kongo

Jeff
I think what the report is saying is that there was no involvement at all in the lymph nodes. That's a good thing as far as it goes but it does not rule out possible metatstasis (microscopic or otherwise) to other areas that were not examined surgically. I have read that lymph node metastasis is not that common with prostate cancer. Obviously it does occur and when it does I think it is a more serious indication.

Involvement in the seminal vesicles is more common and apparently your friend Tim did see some of that along with the extracapusular extension. All of those indicatiors point to doing the post-surgical IMRT to the prostate bed and his post radiation PSA of 0.035 is a very good first reading. Hopefully it stays down.

I hope your friend is recovering well from all the procedures he's had recently.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892838/

VascodaGama

Kongo said:

Jeff
I think what the report is saying is that there was no involvement at all in the lymph nodes. That's a good thing as far as it goes but it does not rule out possible metatstasis (microscopic or otherwise) to other areas that were not examined surgically. I have read that lymph node metastasis is not that common with prostate cancer. Obviously it does occur and when it does I think it is a more serious indication.

Involvement in the seminal vesicles is more common and apparently your friend Tim did see some of that along with the extracapusular extension. All of those indicatiors point to doing the post-surgical IMRT to the prostate bed and his post radiation PSA of 0.035 is a very good first reading. Hopefully it stays down.

I hope your friend is recovering well from all the procedures he's had recently.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892838/

Missing to find cancer in a positive speciment is possible
I think that the involvement of lymph nodes could occur independently of a diagnose for extra capsular extensions. As Kongo comments above some guys get a "clear bill" for lymph nodes metastases but they recurred later, and are considered as being positive for micrometastases.

However, Tim's PSA results indicates very low remission levels (close to the threshold 0.03 ng/ml) which rates his case in the 75% for long survival free over 5 years. This is a great status and I wish him a continuous success.

It is possible for a miss by the pathologist who examined the dissected lymph tissues. The work is done under the microscope and they do not check the whole areas but the ones where most of the positive cases occur. That is also true when analysing the dissected prostate gland.
http://www.harvardprostateknowledge.org/positive-surgical-margins-following-radical-prostatectomy
http://www.hindawi.com/journals/ijbc/2012/932784/

In any case one shouldn't be worried with such “missing” possibilities and should look forward to a complete recovery and return to a normal life. Enjoy and celebrate the low PSA.

Best to your friend.
VGama

Timlong

VascodaGama said:

Missing to find cancer in a positive speciment is possible
I think that the involvement of lymph nodes could occur independently of a diagnose for extra capsular extensions. As Kongo comments above some guys get a "clear bill" for lymph nodes metastases but they recurred later, and are considered as being positive for micrometastases.

However, Tim's PSA results indicates very low remission levels (close to the threshold 0.03 ng/ml) which rates his case in the 75% for long survival free over 5 years. This is a great status and I wish him a continuous success.

It is possible for a miss by the pathologist who examined the dissected lymph tissues. The work is done under the microscope and they do not check the whole areas but the ones where most of the positive cases occur. That is also true when analysing the dissected prostate gland.
http://www.harvardprostateknowledge.org/positive-surgical-margins-following-radical-prostatectomy
http://www.hindawi.com/journals/ijbc/2012/932784/

In any case one shouldn't be worried with such “missing” possibilities and should look forward to a complete recovery and return to a normal life. Enjoy and celebrate the low PSA.

Best to your friend.
VGama

Tim's PSA
Sorry guys What I meant was Tim's PSA pre IMRT was .035. He just got the post IMRT an hour ago which is .07. Now I must ask....when do they look for a doubling time? This has more than doubled but is it considered in these low ranges. His Onc simply said we will watch it....call me. What/////No battle plan...just " call me". What kind of BS is that?
According to a Doubling Time tool his velocity is .01 ng/ml/months which puts him at a psa of 3.0 come next August.
Jeff

VascodaGama

Timlong said:

Tim's PSA
Sorry guys What I meant was Tim's PSA pre IMRT was .035. He just got the post IMRT an hour ago which is .07. Now I must ask....when do they look for a doubling time? This has more than doubled but is it considered in these low ranges. His Onc simply said we will watch it....call me. What/////No battle plan...just " call me". What kind of BS is that?
According to a Doubling Time tool his velocity is .01 ng/ml/months which puts him at a psa of 3.0 come next August.
Jeff

Too early for judgements
It would help if you describe Tim’s treatment protocol. I think it was RP followed with RT. The PSA reading of 0.035 before RT was in fact very low, but I believe that previous confirmed progression lead to the decision of administering IMRT. Now Tim is confronted with the first PSA post RT of 0.07.
In any case, your above comment that Tim has finished radiation very recently (one month/two months/three months ago ???????) matters to any prognosis in his case. If the above is consistent with the events then it is too early to make any judgement on cancer progression.

After RT the PSA is erratic and you will need a period of waiting to check on the PSA-curve. In some the values go up before starting its decline and reach its nadir point. Tim’s doctor is doing it right by testing in 3-months. This is the way to “battle” cancer with “brains”.

PSA Anxiety is probably taking over your good judgement. The level of 0.07 seems to be OK to me and the value alone after RT cannot be used to define a PSADT (doubling time) or vPSA (velocity). Recurrence in a case similar to Tim is usually declared after three consecutive increases in the tests done at least 1.5 months intervals post treatment. He should wait for a confirmed nPSA (Nadir PSA) and start from there.

Be confident.

Good luck in his journey.

VGama