Pathology report in - should we commend with HT?

Pathfinder,

Glad your father-in-law's surgery is completed.  I had an adhesion (prostate to bladder), when they did my surgery.  However, it wasn't from the HT.  I never had HT until  post surgery.  My adhesion was a birth defect.  It did slow down the robotic assisted surgery quite a bit, plus some other complications from a double abdominal hernia repair, and extreme leg muscle development from road cycling..  The surgery was supposed to take 2 1/2 hours and ended up taking 5 1/2 hours.  I also had no metastases in seminal vesicles but did have a small spot in one lymph node.  Thus I was treated as  Stage 4.  I am , as of this past week a three year survivor, from the time of diagnosis. At my last appointment with my surgeon/urologist he is talking 10 years from now. I will see him in four weeks for my next checkup and will know more at that time.    I would suspect your Father-in-Law will have radiation after some recovery time, as a "clean up".  That's what they did with me, and it worked out well, so far.    So keep the faith.  The wait for all the reports seems to take forever, I know.  But hang in there.

As Max & Vasco said, The HT will keep the PSA at "0".  the complete resulte won't be know until the Ht wears off.  I had two years of HT, post surgery, and that has been finished for 6 months at this point.  At my last check up I was still a PSA of <0.010.  My next checkup in a months time will tell us even more.  Your F-i-L's PSA should go down quickly, post surgery.  Mine went from pre surgery  69  down to .6 in two months before I started HT and Radiation.  Then went to "0" and has stayed there for three years.  It's amazing what they accomplish with us.

Know that you all are in my thoughs and prayers.

Peace and God Bless

Will

I wonder if the details you posted above is the total information provided in the pathologist's report. Do you have a copy?

My opinion is that the neural invasion finding is the worse in the report. Cancer spreads out via this route which could lead his surgeon to think that there are extra capsular extensions, therefore recommending  continued HT. Gleason score 8 (4+4) has been confirmed. This is an aggressive type of cancerous cells, but they indicate it to be positive to AR (+++), PSA (+) and PSMA (+), which makes them prune to an attack with hormonal weaponry, and control via PSA tests. Surely these missiles wouldn't kill the bandit but it would knock it down to the canvas. The indication on the PSMA (+) also provides possibilities for "guided" radiation missiles with a PSMA isotope (newer techniques in the fight against PCa).

Your comment on "...no break through..." may refer to negative margins. This is a particular in RP pathology when the outer skin of the gland retreats due to cutting. There is no information on the Lymph nodes which is strange because they dissected some, as indicated in your previous post. This LN data is very important and you should check with your family in China to inquire on the results.

For the moment your father in law needs to recover. When recurrence becomes apparent then he can pursue a salvage therapy with intent at cure, instead of a palliative treatment. That can be done once he ends the period on HT and gets a clean PSA result.

Best wishes for complete recovery.

VG

I agree with Old Salt's opinion. I think his doctor is not totally confident that the cancer was in fact contained so that he lean through ward prevention, recommending to continue HT. The initial diagnosis data and the findings from surgery may have lead him to believe in HT, in spite of telling you that "... the cancer was contained within the gland...".

HT after RP would not harm the outcome of surgery, it is palliative and could be started at any occasion without loosing its benefits. Radiation also can be done at any time (after RP recovery) but one should consider the possibility of an eminent spread to areas difficult to be treated later with RT, which information may be at the hands of the doctor, suggesting that such also do not exist.
Unfortunately you never shared the whole information  with us [image studies, prostate size, volume of cancer found within the gland, existing typologies other than cancer (calculi, BPH, etc), number of dissected lymph nodes, etc] found so that we cannot over opinion on the decisions (yours or of the doctor) to help in your thinking.

Overall the doctor you are referring to (maybe his surgeon urologist) seems more reliable than the previous one so that I would recommend you to trust his suggestions and follow the recommendations till apparent recurrence is set in, if ever.

It is a fact that, if surgery has solved the problem in getting rid of the cancer totally then additional treatment is not necessary. Instead of benefits the patient would suffer with added risks and side effects. But this is also the reason why doctors never mention the word "cure" to those diagnosed with PCa and then treated. The outcome is ambiguous, loads of guessing and we do not know which side to follow, but in the end that's what cancer is all about.

At the end of the adjuvant HT, if any, your next step is to wait for a surge in a clean PSA (not under the influence of HT) above a nadir to evaluate any development.

Best,

VG 

I speculate that the Chinese doctor who recommended HT initially (prior to the surgery) did so on the basis of the high PSA (24). He may have thought that such a high level could mean that cancer had escaped the prostate. Now that we have seen the pathology report, this hypothesis appears reasonable. Cancer cells may (!) have escaped, especially since neuronal invasion was present.

I see three approaches.

1. No HT and wait until the PSA starts to rise (there are thresholds for taking action).

2. Starting HT (after recovery from the surgery) right away, with the intent of killing (currently tiny) metastases. As mentioned, the latter could have been the source of the high PSA (24).

3. Irradiating the surrounding tissue to kill any cancer cells that might have settled there (after recovery from the surgery); perhaps in combination with HT

No an easy decision to make, but perhaps other forum members will present their recommendation(s).

I sincerely recommend you to inquire on the above and follow his doctor's advices.

HT drugs are palliative, cause side effects and work better on low aggressive hormone dependent type of cells. This action can be verified via testosterone and PSA tests. The PSA test should be done at two weeks post surgery (even under the effects of HT) to serve as an initial reference mark (this cannot be used to judge surgery outcomes or progression of the disease but it is helpful in checking drug's action). The test, then, should be done every two to three months during the first two years (most recommended). The testosterone can be done together with the PSA but it requires only one time per year, if he gets Zoladex (or similar). Both tests can be obtained at a local reliable laboratory.

Other recommended tests for those under hormonal therapies are a bone density test (DEXA scan not the scintigraphy bone scan) for screening bone health (HT deteriorates bone and cancer spreads to weaken bone), Heart health and the lipids should also be checked annually.

Best,

VG

I can't comment in detail (traveling), but I think that getting off HT is the best course to follow for now.

Of course, it will be awhile before the effects of the Zoladex are worn off.