Post-RALP PSA 2.6

RandyCarrera

Pre-op PSA 15.8
Gleason 4+3=7 GG3
RALP 5/24/21 - Johns Hopkins
Eleven (11) lymph nodes and associated fibroadipose tissue, negative for tumor.

Pathology report of surgical margins.  Dismissed by my surgeon as no concern - "It's nothing, pathologists are always over-aggressive in finding positive margins"

Margins
Summary	Positive
Location	Left ; Posterolateral, Posterior ; Apex, Mid Apical margin
Nature of positive margins	Positive in an area of extraprostatic extension
Summed length of positive margin	4 mm
High Gleason grade at positive margin	3+4=7

Post-op PSA 2.6 9/27/21

So...  I assume I'm in for salvage RT and (possibly/definitely?) ADT.  Having just received my PSA results and not scheduled to for follow-up appointment until 10/28, I haven't consulted with a doctor and would like to prepare for that consultation as well as I can.  Here are some questions I have in the hopes of hearing some opinions from the knowlegable people of this forum.

1. My surgeon has left Hopkins and I'm now under the care of a urologist in the same practice.  I have not met with the new doctor.  I had a consult with a Radiation Oncologist before I made the RALP decision.  Should I go ahead and schedule an appointment with the Oncologist since I'll be switching my care to him?  Is there a reason to continue parallel care with the urologist?

2. Is there a chance I can escape ADT?  

3. What questions would you ask either doctor?

Thanks for reading,
Steve

 

Clevelandguy

More tests?

Hi Randy,

Since your PSA is still showing results after 4 months it looks like you still have some cancer in your body.  If it was me I would want to do more testing to try and determine where the cancer is located via Pet scan or MRI. I would not do ADT at this time until I knew where the cancer was located.  If they can't find any cancer via scans then do the ADT to try and knock the cancer back until it does rear it's ugly head. ADT will not kill your cancer but slow its growth, got to find it to kill it in my opinion.  Just advice, I'm not a doctor nor do I play one on TV.

Dave 3+4

Josephg

Engage a Medical Oncologist

I strongly recommend that you engage a Medical Oncologist to be the long term leader of your PCa medical treatment team.  A Medical Oncologist has no professional preference for potential treatment options, such as surgery or radiation, and the Medical Oncologist is the expert in hormone therapies, which may be used in conjunction with other treatments, such as radiation. Personally, I've had PCa for over a decade, and my Medical Oncologist has been at my side for my entire PCa journey.  Surgeons and Radiation Oncologists have come and gone with their treatments, at the direction of my Medical Oncologist, but my Medical Oncologist remains my sustaining medical professional and consultant.

RandyCarrera

Clevelandguy said:

More tests?

Hi Randy,

Since your PSA is still showing results after 4 months it looks like you still have some cancer in your body.  If it was me I would want to do more testing to try and determine where the cancer is located via Pet scan or MRI. I would not do ADT at this time until I knew where the cancer was located.  If they can't find any cancer via scans then do the ADT to try and knock the cancer back until it does rear it's ugly head. ADT will not kill your cancer but slow its growth, got to find it to kill it in my opinion.  Just advice, I'm not a doctor nor do I play one on TV.

Dave 3+4

Thank you. Added to my list

Thank you. Added to my list of Dr questions. 

RandyCarrera

Josephg said:

Engage a Medical Oncologist

I strongly recommend that you engage a Medical Oncologist to be the long term leader of your PCa medical treatment team.  A Medical Oncologist has no professional preference for potential treatment options, such as surgery or radiation, and the Medical Oncologist is the expert in hormone therapies, which may be used in conjunction with other treatments, such as radiation. Personally, I've had PCa for over a decade, and my Medical Oncologist has been at my side for my entire PCa journey.  Surgeons and Radiation Oncologists have come and gone with their treatments, at the direction of my Medical Oncologist, but my Medical Oncologist remains my sustaining medical professional and consultant.

Do you have any suggestions

Do you have any suggestions for how to find a medical oncologist with prostate cancer experience?  I tried before making the surgery decision and could find no one in the mid-atlantic. 

Josephg

RandyCarrera said:

Do you have any suggestions

Do you have any suggestions for how to find a medical oncologist with prostate cancer experience?  I tried before making the surgery decision and could find no one in the mid-atlantic. 

Medical Oncologist Search

I recommend that you start your search by engaging major hospitals and healthcare networks in your area.  Any major hospital and/or healthcare network with a Cancer Center, expecially if it is considered a Center of Excellence in treating cancer, will have a number Medical Oncologists on staff.  Look on their web sites in the Find a Doctor section, and you can find complete bios on these individuals.  You would be looking for individuals with a prostate cancer specialty, and that should not be difficult, given the number of prostate cancer patients everywhere.  Once you have some names, look for reviews on those individuals, as in today's world, reviews are easy to find.