Can a month make a difference?

Ellesmere,

I am sorry for your diagnosis. The survivors above gave you excellent advice. I also think that one month wouldn’t alter the outcome result. I would use this “extra-time” in researching about pre op preparations and post op care. You also should consider on the possibility/need of adjuvant treatment because of your pathological findings.
By the info you shared, in particular the high risk Gleason pattern (ISUP Grade 5) and score (4+5;9) and the positive extra capsular extensions (EPE), it sets the option for surgery more as an intent for debulking. Adjuvant radiation (RT) may become necessary, which treatment you could also add in your investigations while waiting. Many similar Gs9 cases have included RT in the total protocol even if one opts in doing it as a sequential (at recurrence timing).
I wonder on the items described in the biopsy report and details of the PET image study. Have you obtained second opinions on these data?
How old are you?
Do you have any other illness?
How about symptoms?

Regarding the side effects; one may expect them to be different depending on the type of the surgery. Robotic cases have more chances for incontinence. It also prohibits dissecting lymph nodes at the iliac, which in a case of positive extra capsular extensions, it becomes essential to judge better the real status of the patient (post op clinical stage).
Positive lymph nodes (pelvic nearer to the prostate or at the iliac) would lead the patient to earlier intervention with chemo or hormonal therapy. In any case, your doctor’s comment “…the cancer did not appear to have spread beyond the prostate…” because of the negative PSMA PET scan, leads us to think that cancer is localized but not contained. The positive EPE could refer to extensions out of the inner capsule tissue but localized at the false external capsule tissue. This could also justify the “Perineural invasion present” finding. Those may have been identified by the PET and judged by the doctor as contained.

PSMA PET is the modern and best way at present times to diagnose metastases, and far away better than the traditional CT or MRI or C11, that are subjected to the size of the tumor. However, this newer technique is also subjected to limits in machine’s SUV. The good thing is that it did not identify far metastases (in bone, lymph nodes or other organs) classifying your stage M0.

Cancer treatments got risks and side effects one cannot avoid. The facilities (hospital, clinic, etc) and expertise of the physicians become important aspects to consider where and who is going to operate on us. I hope you have chosen the best. (How many cases handled by your surgeon in one year)

Best wishes and luck in your journey.

Please note that we are not doctors. We base our comments on own experiences and acquainted information along our journeys.

Welcome to the board.

VGama

I am sorry for your diagnosis

As others have posted it is highly likely that the cancer has escaped your prostate. Your diagnosis of aggressive and extensive Cancer and a high PSA indicate this.

There can be major side effects from each treatment modality that are cumulative. If you have surgery you can suffer severe side effects and still need to undergo hormone and radiation treatment for cure

You can obtain cure for cancer by having hormone and radiation treatment only and not have to have to undergo surgery that can have major side effects to include but not limited to incontinance and erectile dysfunction.

I strongly recommend that you consult with a radiation oncologist and a medical oncologist.

The medical oncologist is very important and your case and I suggest that you find the very very best

We may not always agree on this forum, but one thing we agree on, generally speaking, is the statement that urologists specialize in surgery. Australia may be different, but in the USA most urologists are not (very) knowledgeable about radiation therapies for prostate cancer. Or they may not be up-to-date, because the field has changed significantly over the last decade.

Radiation oncology really is different and one needs to talk with a specialist in that field to see if he/she can provide another approach to your case. Then you decide, after reviewing as much as you can handle. Easier said than done!

PS: We are just amateurs, with non-medical educations!

When initially treated with radiation especially SBRT aka as Cyberknife, Novalis, etc. the radiation oncologist has the ability to extend the perimeter of treatment beyond the prostate. This is routinely done for men with more aggressive cases. 

In your case the radiologist was uncertain of whether the cancer has escaped your prostate that's why he recommendated a bone scan.

The MRI does not pick up microscopic cancers, so there may still be cancer outside the prostate, which in your case likely.

Ellesmere,

Your additional information makes me think that your doctor’s diagnosis of a contained case comes from the MRI results. He may have disregarded the PET data (and I would understand it) because of this being done two weeks after the biopsy. Messy traces of blood would be detected in the perforated zones of the prostate by the PET scan, and not considered for the localized assessment. The PET information may have been used in the assessment of far metastases.

In regards to the MRI results, it reveals a lesion (tumor) with 1.3 cm. This is the best a MRI can detect. Small sizes tumors were not identified but the biopsy found 14 spots out of 19 cores taken all over the gland. I would trust more the pathologist’s report than the image study. This is where the positive EPE weighs in.
The other comments in the MRI report are typical. The specialist only tells what is seen. He also identified hyperplasia which could justify/influence the existing higher PSA. Nearer lymph nodes looked “normal” in size but the location close to the pubic bone (inguinal) suggests suspicious. T2 and b value (AC 660) indicate the values used by the operator (radiologist) to turn the image into a readable status.

In this link you can see the anatomy and physiology of the prostate;
http://www.cancer.ca/en/cancer-information/cancer-type/prostate/anatomy-and-physiology/?region=qc

Here you can read about the MRI reading techniques;
http://mriquestions.com/what-is-the-b-value.html

Maybe you would like to have some comments on the biopsy and PET reports. Just paste them in this thread.

Regarding your other comments above, I image you being content with simple things. This is the way of living in the country side. You found a recommendable doctor and you trust him. However, you will be the one to confront the consequences from a treatment he is deciding (surely his specialty). There is nothing wrong with that but surgery or radiotherapy got risks that you should know in advance. You will be asked to sign an agreement before intervention saving the doctor and the hospital from any wrong doing. You will confirm that you are aware of the proceedings.

It is most advisable that you research and get second opinions as most of the guys above are recommending; once comfortable with things then advance with a choice (surgery or radiotherapy). I would consult other doctors even if I needed to travel far or even if I needed to post pone the scheduled surgery. The worries of spreading PCa are more a matter of gathered trustful information than the timing of the intervention. In fact the PET results (negative far metastases) provide a choice for intervention much later if you chose RT as prime. RT covers the whole gland and surrounding tissues.

Your yawning symptom may have been the “saving alarm”. The PSA was high the cancer was active and voluminous, and most probably would interfere with your country living standards. Your body fitness would never tell you such. B12 is not produced by our body. One must get it from animal sources or supplements. Fatigue is typical in B12 deficiency but so it is from a case of advanced prostate cancer.

Best wishes for peace of mind.

I wonder in which part of that continent you live. Ayers Roks?

VGama

This group is the BEST!!

Here for you,

Was, and still is, here for me.

Will be here for the next person who needs a sanity check and advice.

And, I'm sure that you will join this team, and be here to support the next person who comes into this forum looking for help.

I wish you the best of luck and success on your journey.