New member

bestbob

Hello everyone, glad to be able to join the group. Brief history, 70 year old, just had robotic RP, biopsy of 12 cores showed 5 have gleason score of 6, and 3 with score of 7. Today is my 4th day after RP, and pathology reported I have Extraprostatic extension of neoplasm is present. Which I understand that the cance has spread to soft tissue outside of prostate. Will be discussing with Dr on next steps.

For know I will just be monitoring board, and welcome any comments.

Bob

Wheel

Bob,

Happy 4th day. I am now 30 days post RP. I turned 71 today. I too had focal extraprostatic extension. Initially I had positive margin reported by pathology during surgery, and the Surgeon went back in and subsequent pathology after surgery said no positive margin. It was a surprise that it had left the Capsule since PET did not show that and Surgeon said the tissue did not appear to reflect it either in his experience. Now I still wait for my first PSA Oct 16, two months post surgery. I know I went with Surgery as I still could, and it appeared localized and I did not want Radiation and ADT. I was gleason 8, one core, however after surgery it was downgraded to Gleason 7. I have learned that it is common for Salvage Radiation Treatment (SRT) with 40% of patients after a RP. The difficulty with SRT is now your bladder and rectum are more susceptible to side effects with the prostate gone. One main reason I did not want RT was because of those potential side effects even with like space oar, and some could effects could come years later.

Wheel

Bob,

One more comment as I wait for future PSA’s, if you google treatment’s after a RP if the cancer according to PSA and/or Gleason 8 or greater at diagnosis and the cancer is still there or possibly is, they discuss adjuvant RT and ADT right away and if your PSA rises more later, SRT. However a new school of thought appears to be being discussed. Their is PSA driven treatment and their is an image driven treatment. The image driven is more of a watchful waiting with more accurate PSMA Pet scans can show it when it first begins to metastasize to lymph nodes and treatment can be more focused at that time. An argument against waiting is certainly how aggressive a person’s cancer is. Also there is now appears a school of thought going to intermittent ADT without RT. The ADT drugs are changing rapidly too with new ones being brought in with less side effects. Their is a lot of promising new treatments also coming on board for newly diagnosed patients whose cancer is more focal. I had cribriform pattern, which I did not know nor was it shown in original biopsy. I could have opted for RT then found out RT failed, as Cribriform is less susceptible to RT. Then I would have been looking at a salvage RP which is more difficult. I think each year that passes brings us more options.

bestbob

https://csn.cancer.org/discussion/comment/1717937#Comment_1717937

Hi Wheel, appreciate the info. I’m still not sure what all this means, but researching and learning. The surgeon dis remove my lymph nodes, and don’t know if I’m positive or negative like in your comments. Sounds like you had 2 operations, what a pain in the a&$ I bet. It sounds like you have a good handle on things, and I agree, new options and treatments always .

Please keep me/group informed.

bob

Clevelandguy

Hi Bob,

With the cancer outside the Prostate I would think some forum of radiation would be the next step. Also a PMSA PET and bone scan could also be in order to locate where the cancer has escaped to. ADT will weaken the cancer but not kill it, it’s often used with radiation to give the cancer a 1-2 punch. Report back when you get a little more info after Urology and Oncology consultations.

Dave 3+4

bestbob

https://csn.cancer.org/discussion/comment/1717977#Comment_1717977

hi Dave, appreciate the input. Just had catheter removed today, and the next step is Psa every 3 months, with a dr consult after the first Psa. I am going to call tomorrow and ask about ART prior to 3 months? Everything I’ve read stated ART would be beneficial for high risk people, which I am not (negative margins and Gleason 3+4). Also, I’ve read an ART or SRT should not be performed until 4 months after RP.

bestbob

https://csn.cancer.org/discussion/comment/1717981#Comment_1717981

Dave, I am in lake county Ohio. I read some of your post, sounds like your doing great. Just to add one more item, 25% 3+4 and 45% 3+3, pre RP my Psa was 9.21 vs 4.1 the year earlier.

bestbob

Hi Wheel, it seems my Dr wants Psa every 3 months, just had catheter removed and this was while discussing with nurse. I am going to call back and ask about ART prior to 3 months? I’ve posted some add info about me as it looks like we are following the same process. Please keep us updated.

Clevelandguy

https://csn.cancer.org/discussion/comment/1717982#Comment_1717982

Hi,

Great resources at the Cleveland Clinic and University Hospital. I had my robotic surgery at the Siedman Cancer center. I live down by Kent.

Dave 3+4

Old Salt

It's likely that the extraprostatic extension will need to be treated with radiation, but I will leave the details to the radiation oncologists. The suggestion to consult with the Cleveland Clinic is one I would follow up on.