Ending Active Surveillance Having Da Vinci 29th

Cpmont

After almost two (2) years of AS, due to a rising PSA I have decided to have surgery on 29 May. At 52 my doctor has given me a pretty good chance for full recovery. I will keep you guys posted as to how it goes, if you are keeping score.

hopeful and optimistic

Cpmont

I wonder, can you post the details of what is happening with you, or refer to the thread that discusses your situation...thanks

At any rate I wish you the best of luck.

yankeefan

hope it all goes well....

wishing you the best....

jerseyguy891

Active Surveillance

 

Cpmont,
I also being 52 and on AS would be curious to what your original biopsy results were and your PSA history.  There's a lot of controversy about younger guys being on AS. You don't read to much about others being on AS on these forums. 

littlemontana

also had Da Vinci

I had my prostrate removed on Dec 9 2011 thru Da vinci . I was 67 in good health . I had Psi checked for the last 10 years ,my reading wasn't high at the time and I didn't have any problems. In fact I didn't know I had cancer. The doctor found it after 3 biopsies .

 

After the operation the only thing I had was ed no incontience. In fact I was joging a mile about 2 months later. The ed I'm still working on it is coming back slowly. I figure at your age there will be no problem .

I look foward to your progress.

Cpmont

Out of Surgery

Had procedure at 7:00am. So far so good will feel better when full path report is recived (the still under Dr. talk was good as far as I can remember). Will get a copy of all medical records when I am discharged so I can chronical my journey to this point for you guys. ( and I will have keyboard, one handing this iPad is for the birds) p.s. nobody mentioned the catheter is as big as a pencil.

 

yankeefan

Cpmont said:

Out of Surgery

Had procedure at 7:00am. So far so good will feel better when full path report is recived (the still under Dr. talk was good as far as I can remember). Will get a copy of all medical records when I am discharged so I can chronical my journey to this point for you guys. ( and I will have keyboard, one handing this iPad is for the birds) p.s. nobody mentioned the catheter is as big as a pencil.

 

get well soon...

try to walk as much as you can...that will help you avoid blood clots and will keep your strength up.....

for the time being, always sit with your legs up...i.e. not in a regular chair, but on a couch, etc. where you can raise you legs.

your path report should be ready in about 4 days......

stay ahead of the pain....

all the best....

 

Cpmont

yankeefan said:

get well soon...

try to walk as much as you can...that will help you avoid blood clots and will keep your strength up.....

for the time being, always sit with your legs up...i.e. not in a regular chair, but on a couch, etc. where you can raise you legs.

your path report should be ready in about 4 days......

stay ahead of the pain....

all the best....

 

Thanks for the advise

Walking a pretty good bit. Found if I take the meds it really helps. I've never had surgery or any other issues so not familiar with pain management. I wasn’t using the medications at first. The way the surgery is described by the doctor I didn’t realize the full extent. I was thinking in and out but it looks like recovery will take a little time. By the way the Dr. is happy with the results and said the margins are clear.

For the first installment of why I left AS and had surgery. Initially my PSA was going down after diet and exercise changes but recently started rising again hit 13.85. About this same time I had some liver enzymes that came back elevated so my GP was concerned the cancer could have spread. I went through the whole battery of test again and bones/organs were fine. Enzymes also went back down. During this time I had an acquaintance pass away from PC (found too late, agent orange, don't count on the VA) and a friend who had successful surgery with my same doctor so I decided to move forward with the surgery. Saving radiation for salvage if necessary.

yankeefan

Cpmont said:

Thanks for the advise

Walking a pretty good bit. Found if I take the meds it really helps. I've never had surgery or any other issues so not familiar with pain management. I wasn’t using the medications at first. The way the surgery is described by the doctor I didn’t realize the full extent. I was thinking in and out but it looks like recovery will take a little time. By the way the Dr. is happy with the results and said the margins are clear.

For the first installment of why I left AS and had surgery. Initially my PSA was going down after diet and exercise changes but recently started rising again hit 13.85. About this same time I had some liver enzymes that came back elevated so my GP was concerned the cancer could have spread. I went through the whole battery of test again and bones/organs were fine. Enzymes also went back down. During this time I had an acquaintance pass away from PC (found too late, agent orange, don't count on the VA) and a friend who had successful surgery with my same doctor so I decided to move forward with the surgery. Saving radiation for salvage if necessary.

sounds good...

hope it keeps going well....remember..it will take a while, so stay patient....

VascodaGama

yankeefan said:

sounds good...

hope it keeps going well....remember..it will take a while, so stay patient....

Sounds good

So far you are standing and "kicking". This is a good start after a major operation. I hope to hear more about the good news when you receive your pathologist report and the first post-op PSA.

Best wishes for full recovery.

VG 

Cpmont

VascodaGama said:

Sounds good

So far you are standing and "kicking". This is a good start after a major operation. I hope to hear more about the good news when you receive your pathologist report and the first post-op PSA.

Best wishes for full recovery.

VG 

Update

Received first PSA results, blood taken 3 weeks after surgery: .0458 not sure if this is good or not, Dr. is recommending I start researching radiation. Will have updated PSA in a few days.

Here is the Pathology Report:

Anterior bladder Neck, Excision - no Evidence of Malignancy, - No evidence of glandular prostate tissue

Posterior Blader Neck, Excision- no Evidence of Malignancy, - No evidence of glandular prostate tissue

Right Pedicle, Excision - no Evidence of Malignancy, - No evidence of glandular prostate tissue

Left Vascular Pedical, Excision - Benign vascular, adipose and neural tissue with no evidence of malignancy.

Posterior Apex Prostate, Biopsy - no Evidence of Malignancy, - No evidence of glandular prostate tissue

Anterior Fat, Excision - no Evidence of Malignancy,

Prostate, Prostatectomy: Tumor Type: Invasive Prostatitic Adenocarcinoma, Acinar Type

Gleason Grade and Score: 3+4=7

Amount of Tumor: Tumor Location - Right Side 10% to 20%; - Left Side 40%

Extraprostatic Extension: Present, Multifocal

Prenieural Invasion: Present, Multifocal

Angiolymphatic invasion: Definitive Invasion not Identified

Surgical Margins of Resection: - Apex Noevidence of Malignancy - bladder Neck: No Evidence of Malignancy - peripheral: Positive see comment (There are multiple small foci of tumor that are cut across)

Microscopic invasion of bladder Neck: Absent

Semilan Vesicle Invasion: Absent

Treatment Effect on Carcinoma: Absent

AJCC Pathologic Stage: pT3a pNX pMX

What do you guys think?

 

Kongo

Cpmont said:

Update

Received first PSA results, blood taken 3 weeks after surgery: .0458 not sure if this is good or not, Dr. is recommending I start researching radiation. Will have updated PSA in a few days.

Here is the Pathology Report:

Anterior bladder Neck, Excision - no Evidence of Malignancy, - No evidence of glandular prostate tissue

Posterior Blader Neck, Excision- no Evidence of Malignancy, - No evidence of glandular prostate tissue

Right Pedicle, Excision - no Evidence of Malignancy, - No evidence of glandular prostate tissue

Left Vascular Pedical, Excision - Benign vascular, adipose and neural tissue with no evidence of malignancy.

Posterior Apex Prostate, Biopsy - no Evidence of Malignancy, - No evidence of glandular prostate tissue

Anterior Fat, Excision - no Evidence of Malignancy,

Prostate, Prostatectomy: Tumor Type: Invasive Prostatitic Adenocarcinoma, Acinar Type

Gleason Grade and Score: 3+4=7

Amount of Tumor: Tumor Location - Right Side 10% to 20%; - Left Side 40%

Extraprostatic Extension: Present, Multifocal

Prenieural Invasion: Present, Multifocal

Angiolymphatic invasion: Definitive Invasion not Identified

Surgical Margins of Resection: - Apex Noevidence of Malignancy - bladder Neck: No Evidence of Malignancy - peripheral: Positive see comment (There are multiple small foci of tumor that are cut across)

Microscopic invasion of bladder Neck: Absent

Semilan Vesicle Invasion: Absent

Treatment Effect on Carcinoma: Absent

AJCC Pathologic Stage: pT3a pNX pMX

What do you guys think?

 

I think your doctor gave you sound advice about starting to research radiation.  Despite what he told you after surgery about margins being clear, this patholgy report (if I am reading it correctly) suggests that there were multiple small foci of tumor that were cut across during the procedure.  Although the rest of your pathology report looks good, it seems the surgeon did not get all the cancer that he thought he would.  

I would hope the you consult with a radiologist that specializes in cases like yours that can address the pros and cons of early intervention with radiation.

Best of luck to you.

 

K

Cpmont

Kongo said:

I think your doctor gave you sound advice about starting to research radiation.  Despite what he told you after surgery about margins being clear, this patholgy report (if I am reading it correctly) suggests that there were multiple small foci of tumor that were cut across during the procedure.  Although the rest of your pathology report looks good, it seems the surgeon did not get all the cancer that he thought he would.  

I would hope the you consult with a radiologist that specializes in cases like yours that can address the pros and cons of early intervention with radiation.

Best of luck to you.

 

K

Update on PSA

Dr. called tonight with updated PSA of .004. I have an appointment scheduled with a radiologist for later in the month. Not sure how to proceed at this point.  I have another PSA scheduled in 3 months.

My Dr. gave me a copy of Dr. Patrick Walsh's Guide to Surviving Prostate Cancer and Dr. Walsh seems to indicate any number lower than 0.2 ng/ml indicates a successful operation. He also states ultra-sensitive PSA test should be avoided to prevent PSA Anxiety. He further indicates cancer in the margins could result from the prostate being stretched during surgery while being manipulated. Because my Dr. indicated the radiation would freeze my recovery at my current state, not needing pads but having problems with ED I am leaning toward putting off the radiation for a while. Anyone else have thoughts in this area?

VascodaGama

CPMONT

In reading the pathologist details, I think that the need for a salvage treatment (radiation) may be relative and become required if in fact your present status deteriorates. In any case they found multifocal extraprostatic extension (pT3a ) with none microscopic invasion of bladder neck but to which considerations should be taken because EPE is an adverse prognostic factor in prostatectomies. Your doctor is giving you the correct recommendation.
However, I think your judgement is right in “..putting off the radiation for a while…” 

I also agree with Walsh suggestion in waiting for a higher PSA to declare recurrence. The last PSA level of 0.004 ng/ml is considered by the many as a remission stage (lower than 0.06) and success of surgery. To add to the facts you got control on matters of continence and one should avoid “spoiling” the benefits of the treatment recovery. Urologists recommend salvage therapies in unstable PSA readings reaching the 0.4 threshold.

Earlier intervention on EPE cases has been controversial since the 1990st. Studies point out to better outcomes in terms of long biochemical free periods but not to higher number of survivals. Many suggest that SRT (salvage radiotherapy) is done guessing that the target is where the EPE was located but it gives no assurances of success. Such may be behind the failure of producing better long term survivals in cases of earlier intervention.

On the other hand, if recurrence is apparent at very low levels of PSA, found through constant increases of ultra-sensitive PSA test (0.XXX ng/ml), then there would be no justifiable reason to delay a treatment till a higher PSA is reached, because the threshold (0.4) recommended to trigger a treatment is also relatively low to identify any apparent metastases to serve as a target.

Your personal feeling is the best in the decision process to handle your case. For me I prefer better quality living than cured but handicapped forever. I treat my case of 13 years living with the bandit as a chronic affair. He never bother me and never shown its face. The treatments (RP +RT+HT), though mild, have leaved scars on me. 

Wishing you luck in your journey.

VGama 

Cpmont

VascodaGama said:

CPMONT

In reading the pathologist details, I think that the need for a salvage treatment (radiation) may be relative and become required if in fact your present status deteriorates. In any case they found multifocal extraprostatic extension (pT3a ) with none microscopic invasion of bladder neck but to which considerations should be taken because EPE is an adverse prognostic factor in prostatectomies. Your doctor is giving you the correct recommendation.
However, I think your judgement is right in “..putting off the radiation for a while…” 

I also agree with Walsh suggestion in waiting for a higher PSA to declare recurrence. The last PSA level of 0.004 ng/ml is considered by the many as a remission stage (lower than 0.06) and success of surgery. To add to the facts you got control on matters of continence and one should avoid “spoiling” the benefits of the treatment recovery. Urologists recommend salvage therapies in unstable PSA readings reaching the 0.4 threshold.

Earlier intervention on EPE cases has been controversial since the 1990st. Studies point out to better outcomes in terms of long biochemical free periods but not to higher number of survivals. Many suggest that SRT (salvage radiotherapy) is done guessing that the target is where the EPE was located but it gives no assurances of success. Such may be behind the failure of producing better long term survivals in cases of earlier intervention.

On the other hand, if recurrence is apparent at very low levels of PSA, found through constant increases of ultra-sensitive PSA test (0.XXX ng/ml), then there would be no justifiable reason to delay a treatment till a higher PSA is reached, because the threshold (0.4) recommended to trigger a treatment is also relatively low to identify any apparent metastases to serve as a target.

Your personal feeling is the best in the decision process to handle your case. For me I prefer better quality living than cured but handicapped forever. I treat my case of 13 years living with the bandit as a chronic affair. He never bother me and never shown its face. The treatments (RP +RT+HT), though mild, have leaved scars on me. 

Wishing you luck in your journey.

VGama 

Last update for 3 Months

Radiologist says my psa and recovery look good so check back in 3 months to see where we stand. No radiation unless psa starts to rise or he determines I have recovered from the side effects of the surgery as much as possible. So I'm hopeful and don't plan to worry about this thing for a while. You guys will likely hear from me again near the end of football season. By the way radiologist was wearing a polo shirt with the University of Alabama logo so I know I'm in good hands. Roll Tide

yankeefan

Cpmont said:

Update on PSA

Dr. called tonight with updated PSA of .004. I have an appointment scheduled with a radiologist for later in the month. Not sure how to proceed at this point.  I have another PSA scheduled in 3 months.

My Dr. gave me a copy of Dr. Patrick Walsh's Guide to Surviving Prostate Cancer and Dr. Walsh seems to indicate any number lower than 0.2 ng/ml indicates a successful operation. He also states ultra-sensitive PSA test should be avoided to prevent PSA Anxiety. He further indicates cancer in the margins could result from the prostate being stretched during surgery while being manipulated. Because my Dr. indicated the radiation would freeze my recovery at my current state, not needing pads but having problems with ED I am leaning toward putting off the radiation for a while. Anyone else have thoughts in this area?

as long as your psa stays at or less than 0.004, I'd do nothing

continued good luck...