bob33462 Member Posts: 76

Not a great day - results are in --
Post OP Pathology:
Non-Focal EPE, 2 positive margins, Gleason 4+3=7, involving 50% of gland, prostate weight 31.5 g, Stage pT3a N1 Lymph node involvement: 2/10, right side positive, Diameter of largest N Metastisis 2 mm

Surgeon, at U of Miami, says PSA in 3 months - then Lupron and radiation -

Not sure what options I have, if any?

Although I was hoping for a good report, I had expected a bad one!


  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,342 Member


    I am sorry for the bad news. ...I wish the best for you.



  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,814 Member
    Easy for me to say....


    I have never, to date, needed second-line or "salvage" therapy for PCa.  But from what I have been reading here for a few years now, you have a lot of options.  Certainly your situation is not dire or necessiarily even life threatening.  Radiation (it will almost certainly be IMRT or some form of IGRT) is still potentially curative for specifics like yours.

    I know you hoped to have this problem eliminated and over with; it has to be a tremendous letdown. But there is still much cause for hope, and even hope for total elimination of the disease.


  • VascodaGama
    VascodaGama Member Posts: 3,677 Member
    edited May 2016 #4
    Another chapter of the Treatment


    The best salvage treatment is radiation. It is the only way to provide a chance at cure. You will find many sites in the net with details on the methodology.
    The concern goes to the positive lymph nodes (N1) which “red flags” possibilities for far metastases (M1). This is usually treated with a chemo protocol added to the radiation. The combo treatment (HT plus RT) suggested by your doctor (urologist ?) is used in recurrence cases with localized metastases (NX). Probably he believes that the cancer can still be “stopped” at the localized lymph nodes. I would suggest you to discuss with him about his theory. What makes him to think that those lymph nodes are the only ones affected?

    The theoretical “travelling route” used by the cancer is via the blood stream, being caught along the lymph nodes where it sets “home” (iliac, chest, arm pits, etc). From there it goes to the bone and other organs (bladder, lungs and liver).

    The hormonal portion in the treatment you indicate is palliative. It will only improve the action of the radiation that kills the cancer. This is the typical treatment in recurrences. Chemo is avoided because it leads to nasty side effects but it also kills cancer, were ever the bandit is located. It is therefore a more appropriate way for patients with confirmed metastases in the lymph nodes (in the travelling route). In any case, chemo cannot be administered to its full strength (healthy tissues would be damaged too) so that one needs to balance opinions.

    The radiation is also effective if directional to targets. Tissues away from its rays are not affected. In other words the radiation will not be applied as a “brush” wiping the whole area but to defined spots in a field where most probable cancer is located. This is hard to know in advance and physicians chose protocols based on past experiences with successful outcomes. Typically in localized treatment they radiate the prostate bed and the nearby lymph nodes including those at the iliac. I hope you get second opinions from a radiologist-oncologist.

    I cannot understand why they did not provide you with a PSA test, typically done three weeks post op. This is an important item to judge cancer aggressivity and progress. The radiation should also only be started after proper healing (typically 4 to 6 months later), in particular in regards to the bladder sphincter that controls incontinence. Radiation can affect the already “fragile” tiny muscles. Moreover, there is no evidence that combination treatment of HT plus RT is more effective if done the earliest, in a similar case to that of yours.

    I would suggest you to get a testosterone test and bone densitometry scan now before starting HT to serve as base information when judging the progress of your future treatment and status.

    Thanks for sharing your story. It will help the many visiting this forum in similar “shoes”. I hope you continue updating your progress. Here are the links to your full story to date;


    Be positive. You will manage to knock down the bandit. How about planning a trip to visit that place you wanted so much.

    Best wishes and luck in this new chapter of your therapy.