6 week checkup wasn't good.

tkbbn

I would like to thank everyone for their time and all the information that they give here first of all. I have obtained a lot of information from reading this forum and it is greatly appreciated, This is my first time asking a question about my own prostate cancer adventure. In summary. Diagnosed with PC early summer, 12 samples taken and 4 were cancer, gleason scores of 6,6,6 and 8. Bone scan and cat scan were performed. Both were clear at this time. Radical prostectomy was performed on 8/28 after mri was performed. Initial psa was 5.7 at start of diagnosis to cancer also.  At 6 week checkup Psa was still 0 which was great news .  23 lymph nodes were removed and all were clear for cancer also. Pathology report was not good as it had 4 tumors of cancer. #1 is 3+4, #2 is 4+5, #3 is 3+4, #4 is 3+4.  # 1,3 and 4 are contained to the prostate. #2 exhibits extraprostatic extension of 4mm and extends to the margin of resection Extent of marginal involement is less than 1mm. Seminole vessels and segments of the vasa deferentia are grossly free of tumor. Pathoologic stage classification is (pTNM, AJCC 8th Edition) I am scheduled for a psa recheck in early Jan. Should i wait this long or start alternative treatment even though no cancer is showing on my PSA test? Not sure what my next step should be going forward. I do go to MD Anderson in Houston so I feel that mu care team is very good. I did not understand at the time what all this meant and am now starting to understand what it means and of course its concerning. Any input would be greatly appreciated. Thank You, Tony

eonore

6 week checkup

 

 

 

 

Hi Tony,

Contrary to the title of your post, your six week checkup was great, zero is the best possible result.  Whether it will stay there is another question.  Your post surgery pathology had some negative findings, specifically the EPE.  Have your doctors discussed with you the possibilities of adjudent or salvage radiation?  If not, you should sit down with a radiation oncologist at MD Anderson and discuss their thinking and how they want to proceed, and why they want to wait until January to retest.  In other words, what are the various options and the pros and cons of each.  In my case, I too had an EPE, and at approx. ten months my Psa began to rise, and I ultimately had salvage radiation.  Hopefully I am done but only time will tell.

In the meantime, try to enjoy life, and enjoy the zero result.  If something happens there will be plenty of time for worry later.

 

Eric

 

tkbbn

Thank you

You are correct it was good, but the EPE caught me off guard. He discussed the radiation treatment a little but I didn;t realize that the margin i guess wasn't there. I assumed that they had gotten all of it and after reading the report realized that wasn't the case. I think I will call and ask my doctor for a better explanation and guidance on this matter. If I should start chemo or another treatment? I am trying to enjoy life for sure but this has been a little difficult at times as I'm 54 and not what I had planned for sure. Thank You for reminding me that its still good though.

VascodaGama

Probably a pT3a pN0 MX

Tony,

In your shared info you do not describe the pathological stage indicated in the pathologist's report, but I think that due to existing EPE it may indicate pT2+. Such stage added to the negative seminal vesicles (N0) plus negative lymph nodes, together with the negative image studies and latest zero PSA (at 6 weeks post op), may have led your doctor in to deciding to wait for another PSA test to draw a final conclusion. This is common practice and the next PSA usually is scheduled for three months post op. Your doctor may be highly confident so that he has recommended to get it in January.
However, pT2+ signifies that there are probabilities for a classification of pT3a from the start which in your case would consist of Gleason grade 5 poorly differentiated cells (#2 exhibits extraprostatic extension). These are aggressive and lead many doctors to recommend adjuvant radiation treatment as Eric points out above. Adjuvant means to get treated before recurrence is declared.

In any case, several other doctors prefer to wait for a signal of recurrence before acting on an EPE positive case. This intervention is called Salvage Radio Therapy (SRT) also known by Early-Salvage Postprostatectomy Radiotherapy, which, apart from being done with at a much higher PSA (above 0.1to 0.5 ng/ml), it got a different protocol (wider approach) from the one used in adjuvant radiotherapy. For such a reason I also concur with Eric above that it may be wise to discuss again with your doctor and get the situation more clear. Surely both methods are valid and have high curative rates.

MD Anderson is considered as one of the best institutions for the care of prostate issues (cancer and other cases). It is a reliable place and I think that they want to have their patients well informed. In any case, you will be the responsible for all decisions in interventions (and the outcomes) so that you should get educated before deciding. You need to be attentive and inquire when ever in doubt. You can use the above comments to formulate your list of questions to the doctor.

Here are some materials for you to read;

https://www.auanet.org/guidelines/prostate-cancer-adjuvant-and-salvage-radiotherapy-guideline

https://jamanetwork.com/journals/jamaoncology/fullarticle/2670381

Best wishes and luck in this journey.

VGama

Steve1961

Discrepancy

Wow sorry to hear about this ..that was such a major discrepancy between biopsy report and final report ..maybe a second opinion is warranted .

 

Max Former Hodgkins Stage 3

Pathology

The data you have thus far does not prove any metastasis, but leaves open the possibility of such manifesting itself in the future.  In most cases, metastasis uses as its conduit the lymphatic system, and the fact that so many sentinent nodes tested negative suggests that such did not occur.  

Your present dilemma is as Vasco described:  some doctors would go with a preventative RT (IMRT/IGRT) to the gland bed now.  Others would wait for some evidence of recurrence via PSA results.   It is a matter for you to decide in consultation with your surgeon and the Radiation Oncologists.  I WOULD go ahead and get an RO's opinion now.  But insist on one who specializes in PCa, since ROs tend to be generalists, treating whatever cancer type an assigned patient may have.  I do not have a clear sense of what Best Practices are in your case, but I suspect that more men wait for further treatment.

 

Clevelandguy

Wait

Hi Tony,

If it was me I would wait until your PSA shows something.  Why do radiation if it is not warranted even though you showed EPE, there will be time for that in the future if it's needed.  It's sounds like even if a PSA does start to show a small amount, the cancer may not be found on scans until it grows in size.  Probably the next step could include some type of testosterone reducing drugs or radiation once the cancer is located. Why put yourself through that until it's necessary.  Just my two cents worth.

Dave 3+4

 

Georges Calvez

Wait and see or bang it on the head?

Hi there,

I might be tempted to wait and see if the PSA inches up a bit to say 0.2 ng/L before hitting the button marked 66 Gy of radiation plus six months on ADT which is the likely course of action.
Experiences do vary as they say but it is not a walk in the park and if you can give it a miss then I would.
It is impossible to see anything on scans unless the PSA is more than 2 and then it has to be concentrated into one spot if there is a scatter of tiny spots then they cannot see anything.
As Dr Tigger my urologist might say in one of his more lucid moments 'You may not be cured or on the other hand you may not be ill, we really do not know at this point.' :-)

Best wishes,

Georges

tkbbn

Thank you

I have talked with my surgical team about this and I feel the same way as some has mentioned in that I would like to wait and see if it does come back as well. The thing they pointed out was that if I do radiation at this point as a preventative my healing process will be what it is most likely and it would be best to get the incontinence under control first and then go from there if it does resurface in the future. You guys are great and I truly appreciate all the input as it can be very overwhelming. The ideas and suggestions puts it all into a lot better perspective for me Sincerley Tony