A New Member Thanks you

MTHome

I am 57 years old, and was diagnosed with a Gleason 7, and Gleason 6, prostate cancer in March 2016. I was seeing a Urologist locally first (Montana), until I asked for different options and was told he had already made up his mind, and no matter what other test I went through he was not going to be changing his mind about what I needed to do. Needless to say he was dropped immediately, and I went to the Mayo Clinic in Phoenix. As I see many of you on this board discuss, hearing cancer for the first time is devastating. That was the longest 2 1/2-hour flight back home I have ever taken.

Once home I started my research, and came across this message board. While I haven’t written before, everyone here was extremely helpful, and provided me a lot of information I found to be very useful in making my final decision for surgery. it is great to hear from people who have been through this process, not those who are guessing.

I had robot assisted surgery on May 10, 2016, and spent the next week in Phoenix recovering. I saw the doctor a week later, and the catheter was removed. I intially had some major issues with incontinence, but it seems to be clearing up. I started out using three, to four Depends a day. I am now using one pad a day, and have not had a sleeping accident in a few days.

The results of the pathology, which the doctor was very happy with, are listed below. I return to see the doctor on June 27^th, and will get my first post-surgery PSA test completed then. I am praying the results are good. I am very apprehensive about the follow-up PSA. It is hard to get the cancer diagnosis out of your head.

I do have a question though, if someone knows the answer to it. I was told along with the PSA’s, I will need to have DRE’s completed for the first two years. I am sure they are looking for bumps, or scar tissue, but wanted to see if anyone else has had this done, post-op, and exactly what it is for, if you know.

Again, I wanted to thank everyone here for all the information you provided my pre, and post-op. I am onboard now, and will continue to be an active member of this forum.

TEST RESULTS:

02/12/14 - PSA 3.57

10/08/15 - PSA 7.85

11/11/15 - PSA 4.16

11/19/15 - PCA3 44

DRE: Multiple and all Negative

03/04/16 - 12 Needle Biopsy - Right Base Gleason: 3+4=7, and Left Mid: Gleason 3+3=6

05/10/16 - RARP, nerve sparing, performed at Mayo Clinic - Phoenix

    Gleason scores remained the same following disection

    Margins - Negative

    Perineural invasion - Not identified

    Lymph-vascular invasion - Not Identified

    Seminal Vesicle Invasion - Not Identified

    Bladder Neck margin - Negative for Carcinoma

 

VascodaGama

Several doctors did DRE on me after surgery

Hi, Welcome to the board.

DRE is practical in finding disturbances at the prostate bed after surgery. In particular experienced doctors do it at consultation. This is not a bad practice but an easy way to touch localized tissues. In my case (open surgery in 2000), the first PSA (two weeks post surgery) was 0.11 well above the remission level of 0.06 used as reference of surgery success by my surgeon. One month later it was 0.18 indicating biochemical failure, and he did DRE. 6 months later I reached 0.26 and was declared with recurrence. I consulted then several doctors and many did DRE.

It never bother me, but I think that they would send me for a scan (CT, MRI, etc) if something abnormal was felt. Today there are better and more precise ways to identify those suspicious bumps, through PET exams. However, when tumors are tiny (PSA< 1.5) the image study results commonly become false negatives. These would not be felt also by DRE.

I hope you will not need such exams and that the PSA of June 27th indicates success. Free of cancer and free of worries.

Best wishes,

VGama

Max Former Hodgkins Stage 3

Good pathology

MT,

Your post-surgical pathology report sounds about ideal, and suggests that very likely all of your future PSAs will be "O".  But as I myself know, waiting on results remains stressful.

I had my prostectomy about 18 months ago, and the doctor has never mentioned, or done, a DRE on me since surgery. 

max

Josephg

Post Surgery, Post Radiation DRE

My Radiation Oncologist performs a DRE at each 6 month checkup to determine if any irregularities in the empty radiated prostate bed are noticed.  So far, nothing irregular has been noticed.

MTHome

VascodaGama said:

Several doctors did DRE on me after surgery

Hi, Welcome to the board.

DRE is practical in finding disturbances at the prostate bed after surgery. In particular experienced doctors do it at consultation. This is not a bad practice but an easy way to touch localized tissues. In my case (open surgery in 2000), the first PSA (two weeks post surgery) was 0.11 well above the remission level of 0.06 used as reference of surgery success by my surgeon. One month later it was 0.18 indicating biochemical failure, and he did DRE. 6 months later I reached 0.26 and was declared with recurrence. I consulted then several doctors and many did DRE.

It never bother me, but I think that they would send me for a scan (CT, MRI, etc) if something abnormal was felt. Today there are better and more precise ways to identify those suspicious bumps, through PET exams. However, when tumors are tiny (PSA< 1.5) the image study results commonly become false negatives. These would not be felt also by DRE.

I hope you will not need such exams and that the PSA of June 27th indicates success. Free of cancer and free of worries.

Best wishes,

VGama

DRE Post Surgery

Thank you for your response about the DRE's post surgery. Kind of figured they were looking for something. Doctor and I will have a discussion on the topic during my visit on Monday,

Thank you for your best wished, and the same to you.....

MTHome

Josephg said:

Post Surgery, Post Radiation DRE

My Radiation Oncologist performs a DRE at each 6 month checkup to determine if any irregularities in the empty radiated prostate bed are noticed.  So far, nothing irregular has been noticed.

DRE Post Surgery

Josephg,

Thanks for the information. Glad to hear nothing has shown on these test for you. Hoping for the same......

MTHome

Max Former Hodgkins Stage 3 said:

Good pathology

MT,

Your post-surgical pathology report sounds about ideal, and suggests that very likely all of your future PSAs will be "O".  But as I myself know, waiting on results remains stressful.

I had my prostectomy about 18 months ago, and the doctor has never mentioned, or done, a DRE on me since surgery. 

max

Post Surgery

Hey Max,

Thanks, and waiting for someone else to do their job has always been a hard thing for me, especially when it involves my health. Monday is the day, so I will know how my first post surgery visit goes. Thanks to everyone for all the incouragement. 

Max Former Hodgkins Stage 3

MTHome said:

Post Surgery

Hey Max,

Thanks, and waiting for someone else to do their job has always been a hard thing for me, especially when it involves my health. Monday is the day, so I will know how my first post surgery visit goes. Thanks to everyone for all the incouragement. 

PSA

Your appointment is right at six weeks following your RP, so a first PSA test at that time is reasonable.

The results should come back at what is called "undetectable."  This means that the result will be below a very low threshold value.  Depending on whether you get a more conventional test or a so-callled "ultrasensitive" one,  there WILL BE numbers on the result that are not zeros.  This is NOT a cause for concern, and nothing to pay any attention to. 

Most labs define "undetectable" as a PSA result below 0.1   Sloan-Kettering uses a stricter definition of < 0.05 .   (Source: Dr Peter Scardino's Prostate Book, p. 320, 2010)  All of my post-surgical PSA results have had some non-zero numbers on them, but they were all < 0.1, and my surgeon has said that they absolutely qualify as undetectable, and to be happy and forget about the second or third place decimal place values.  

Your pre-surgical numbers as well as your post-surgical numbers all suggest that you will be undetectable.....

You will most likely get another PSA test at six months from the test on the 27th, and then once a year for life.  You should not need to see the surgeon more often, unless it is to address urinary or potency issues.

Beginning my next visit, I don't see the doctor at all, but a N.P.

max

Will Doran

DRE Post Surgery

MT, 

I am almost three years post Robotic Surgey, two years of Lupron and 8 weeks of Radiation.  My PA does a DRE every time I come in for a check up at Radiation Oncology.  The first was 3 or  6 months and then , now It's been once a year, since.  I've had three DRE's since my surgery.  Angie (my PA) tells me she is checking for any signs of damage from the radiation.  They told me about that possibility before the radiation treatments even started.  I started with a PSA of 69 when diagnosed, and I've had a PSA of <0.010 since two months post surgery, and they said they will continue to do DRE's everytime I come in for my check up at Radiaiton Oncology..

Good Luck

Peace and God Bless

Will