New PC diagnosis

Earls_dad

I was just diagnosed with PC- PSA 4.98, Gleason 3+4 with 11/15 cores positive on biopsy with maximal Gleason 3+4 in 4 cores (3 targeted), 5% overall pattern 4. MRI indicated DIL (dominant intraprostatic lesion) in left post lateral PZ with 1mm ECE (extracapsular extension). I’m just beginning my journey to get educated but interested in this forum’s take on my treatment options. Both the urologist (surgeon) and radiation oncologist say my case is right down the middle in terms of viability of those 2 options. TIA for your perspectives!

Old Salt

Yes, it will be a difficult decision. Without knowing more details it does seem like both options are reasonable. Why not consult with a highly rated prostate cancer center to get their insight on what is best for you?

In the meantime, keep studying. Among others, focus on what the ECE finding implies with respect to therapy.

Earls_dad

Thanks. I’m in Seattle so working with the best urology surgeon in the Seattle area- my brother had successful RP performed by him 2 years ago with clean bill of health and no side effects. Both he and the radiation oncologist said I would probably have a good outcome with either option but curious if anyone on this site has experience with very small ECE on MRI and how that played into their treatment decision.

Clevelandguy

Hi,

I had pleural neural invasion which means the cancer was starting into the nerve bundles on the outside/inside of the prostate. Similar to your ECE in that the cancer is getting ready to leave the barn so to speak. I chose surgery because my Urologist told me no cancer appeared to be outside the gland and post op found no cancer outside of the Prostate. That was almost ten years ago and so far I am still undetectable(.1). I thought the best shot was to remove the whole Prostate along with the cancer. From what I understand radiation does not kill the whole gland but just the cancer+the area around the radiated area. Both radiation and surgery will leave you with very minor to sometimes not so minor complications usually ED or urine leakage. I have a useable member plus a very mild dribble of urine if I lift awkwardly. If I was in your shoes I would get a PMSA PET scan to see if your cancer has spread outside of the Prostate. Get the best doctors and the best facilities to get the best results. The decision is up to you/doctor team/family. Good luck…..

Dave 3+4

Earls_dad

Thanks so much for responding. I’m leaning towards surgery also- there is no indication of spread into lymph system or nerve bundle from MRI so hoping everything is contained but won’t know for certain until pathology post-surgery. I’m 67 and in very good health otherwise so hopefully I fall into the minimal side effects category.

eonore

Hi Dad,

With the extension I would lean towards radiation. Modern day radiation tens to have less side effects than surgery, and the RO can make the field wide enough to deal with the extension. I had my prostate removed, and the post surgery pathology found an extra capsular extension. A year and a half later I was having salvage radiation. Initial radiation would theoretically saved me the double treatment.

Eric

Earls_dad

Just got my pathology report follow RARP- I’m a little confused about the discussion regarding margins and the comments at the end categorizing the tumor “Primary Tumor (pT): pT3a pN Category: pN0” and appreciate any insights from the group. Seems contradictory but I haven’t discussed with my Dr. yet who performed the surgery.

PROSTATE GLAND: Radical Prostatectomy PROSTATE GLAND: RADICAL PROSTATECTOMY - All Specimens 8th Edition - Protocol posted: 11/10/2021 SPECIMEN Procedure: Radical prostatectomy Prostate Size: Prostate Weight (Grams): 48 g TUMOR Histologic Type: Acinar adenocarcinoma Histologic Grade: Grade: Grade group 2 (Gleason Score 3 + 4 = 7) Minor Tertiary Pattern 5 (less than 5%): Not applicable Percentage of Pattern 4: 11 - 20% Intraductal Carcinoma (IDC): Not identified Cribriform Glands: Present Treatment Effect: No known presurgical therapy TUMOR QUANTITATION: Estimated Percentage of Prostate Involved by Tumor: 11 - 20% Extraprostatic Extension (EPE): Present, nonfocal Location of Extraprostatic Extension: Left postero-lateral (neurovascular bundle) Location of Extraprostatic Extension: Left posterior Urinary Bladder Neck Invasion: Not identified Seminal Vesicle Invasion: Not identified Lymphovascular Invasion: Not Identified MARGINS Margin Status: Invasive carcinoma present at margin Linear Length of Margin(s) Involved by Carcinoma: Greater than or equal to 3 mm (non-limited) Focality of Margin Involvement: Multifocal Margin(s) Involved by Invasive Carcinoma: Right posterior Margin Involvement by Invasive Carcinoma in Area of Extraprostatic Extension (EPE): Not identified Gleason Pattern at Margin(s) Involved by Carcinoma: Pattern 3 Gleason Pattern at Margin(s) Involved by Carcinoma: Pattern 4 REGIONAL LYMPH NODES Regional Lymph Node Status: : All regional lymph nodes negative for tumor Number of Lymph Nodes Examined: 2 PATHOLOGIC STAGE CLASSIFICATION (pTNM, AJCC 8th Edition) Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the time the report is issued. As per the AJCC (Chapter 1, 8th Ed.) it is the managing physician’s responsibility to establish the final pathologic stage based upon all pertinent information, including but potentially not limited to this pathology report. Primary Tumor (pT): pT3a pN Category: pN0 

eonore

Dear Dad,

The Pt3a in your final stage means that your cancer has escaped the capsule. This is reflected in the body of the report by references to positive margins and extra prostatic extension. The other two numbers mean that lymph nodes and bones and other organs are clear of involvement, as far as this report can show. At this point, it is probably likely that salvage radiation is in your future. It is vital that you monitor your Psa on a regular basis to monitor if and when you have a reoccurrence

Eric

Earls_dad

Thanks Eric- I did consult with both a surgeon who is chief of urologic oncology dept and radiation oncologist at the premier cancer research hospital in the area. They both concurred it was my choice and could opt for any of the treatment options and weren’t favoring one over the other even with EPE. Ultimately I went with surgery figuring that RT could be a follow-up option if needed. Have to admit this is not the report I was hoping for.

eonore

Hey Dad,

I had my prostate removed in October, 2017, recurred a year later, and had radiation and hormone therapy in 2019. My pathology was pretty similar to yours. Let me tell you that the radiation and hormone therapy is very tolerable. My mistake going in was not getting in better shape heading in. The better shape you are in, and the more you exercise during the therapy, the less it will impact you. Let’s hope you don’t recur, but if you do, you’ll still have a great chance at a cure.

Eric

Old Salt

I concur with Eric. Rather than looking at the not so good pathology findings, the finding of No lymph node invasion is a positive news. No use looking backwards, but it does seem that follow-up radiation therapy (+ hormone therapy?) may be in your future if your PSA starts to rise.