4+3 with possible Seminal Vesicle Involvement

Tim4plus3

Hi - 55you with Gleason 4+3 with a primary lesion on the left, and other positives on the right.

MRI indicates abutting the capsule, but clear Seminal Vesicles.

Pet CT shows "No other abnormal uptake to suggest tracer avid metastatic disease" BUT "Suggestion of bilateral foci of uptake in proximal seminal vesicles not well separated from prostate gland with SUV max 11.8 on the right and 10.3 on the left (CT image 294). "

The surgeon interprets my reports as "intermediate risk" and says I am ideal candidate for RP. He judges the SV suggestion on the PET CT as a false positive based on his view of the MRI

Radiation oncologist is much more concerned with the SV suggestion and thinks I am at higher risk of recurrance from microscopic spread after RP. He advised 6 weeks of hormone therapy (Orgovyx), followed by 5 weeks of daily external beam radiation and then seed implant. Believes I will end up there anyways so should get straight to it.

I am more confused than ever but will meet with my independent Urologist this week to try and make sense of it all. Appreciate any thoughts from others that have faced similar decision, and will update as I go.

Old Salt

Ideal candidate for surgery? Your surgeon must be a comedian at night.

I favor the radiological approach! Your radiation oncologist is likely correct in stating that surgery would not get rid of ALL cancer and that follow-up radiation would be needed.

lighterwood67

Seems to me if the seminal vesicles are involved, it would appear that the cancer has left the prostate. If true, it is my understanding that if the cancer has left the prostate you would probably be better off going with the radiation oncologist. I had a RP back in 2018. My surgeon had concerns about a certain areas around the prostate. He told me he would check it and margins during the surgery before removing the prostate. He said there would be no need to remove the prostate if the cancer had left the barn so to speak. Good luck on your journey.

Clevelandguy

Hi,

From what you stated it sounds like the cancer is on the inside wall of the Prostate but has not yet spread outside of the Prostate(abutting the capsule)? Don’t know if your PET CT is the same as a PMSA PET but the PSMA seems like its becoming the new standard for micro metastasis. If the cancer is “at the wall” and has not spread outside the Prostate, surgery or radiation could work. If the cancer has escaped, radiation would be a better alternative in my non medical humble opinion. Just need to make sure the exact location of the cancer before you decide. Good luck….

Dave 3+4

Tim4plus3

https://csn.cancer.org/discussion/comment/1708096#Comment_1708096

Thank for your thoughts. The uncertainty of whether it has left the barn is the problem. The RO puts a lot of weight in the PMSA PET suggestion of seminal vesicle involvement while acknowledging the surgeon's analysis that the Svs are clear on the MRI. Hoping my non-surgeon urologist can break the tie.

Tim4plus3

https://csn.cancer.org/discussion/comment/1708098#Comment_1708098

Thank you for your reply - yes it is the PMSA PET that shows the suggestion of SV involvement. Very frustrating that there is disagreement of the diagnosis between two 30+ year practitioners.

Tim4plus3

https://csn.cancer.org/discussion/comment/1708088#Comment_1708088

Thank you for the reply - is it the SV involvement that makes you suspicious of the surgeon's analysis?

Clevelandguy

Yep unfortunately it looks like your cancer might have spread outside of your Prostate, some form of radiation might be a better solution.

Dave 3+4

Steve1961

What is your psa levels

Tim4plus3

5.5 PSA. 7 out of 13 core samples on biopsy were positive (1 3+3, 3 3+4 and 3 4+3)

I was able to send all of my imaging to an independent radiologist for review, and he concluded that the SV's were not involved. Based on that, and careful consideration of all the probabilities and side effects, I decided to go through with the RP surgery on 8/31. Appreciate everyone that replied with advice, and will update on my progress. Good health to all!

https://csn.cancer.org/discussion/comment/1708262#Comment_1708262

Old Salt

Hope that the surgery will go well and that your recovery will be uneventful.

Steve1961

Glad you got a second opinion go for it dont look back you will cancer free in no time

Steve1961

Wow you are fortunate they scheduled you in soooooo fast fir surgery I have to wait nine weeks just for a damn MRI