New to forum, looking for advice

Welcome to the forum and the club. There are many here that can help guide your decision process. Try to stay positive and keep getting educated. Imaging the prostate has been a challenge and we are only recently getting capability such as PET scans with newer contrasting agents but this area is not fully developed yet. In light of that and because of your Gleason score, they removed your lymph nodes. I had evidence of advanced disease on the newest MRI even though no lymph nodes were highlighted, and they removed roughly the same number as your surgeon did. Even though both our situations are serious, we should both be grateful that we did not have lymph node involvement. Seminal vescicle involvement puts us both in a higher risk catagory that does not have as much study data and there are many different opinions on how to proceed, so you may want to seek more opinions from high end institution(s). That said, congratulations on your undetectable post operative PSA. I did not do as well as you in this category. There is hope for us though and new developments every year.

Before we can start, pleaes clarify - did the surgeon remove your seminal vescicles?

What was the final gleason score on the post surgery pathology report. Did they confirm Gleason 9?

What was your pre-surgery PSA?

George

Were there confirmed positive margins in the surgery sample?

If you don't already have it you should get a copy of the surgeons report and pathology report.

George

GeorgeG said:

On the assumption that

On the assumption that Gleason 9 was confirmed along with positive margins in your RP pathology same then many doctors would recommend adjuvant radiation meaning radiation just in case even though you had an undetectable PSA post op. Although the addition of hormone therapy (adjuvant if starting with radiation, neo adjuvant if starting before) is now fairly standard for primary radiation, it is not as universally accepted post RP. I am doing neo adjuvant hormone therapy along with salvage radiation because my PSA never became undetectable after RP and the latest studies seem to support HT in my case. In the case of adjuvant RT most of what I have seen leans toward no HT with ART. I have no idea how leaving the SV intact impacts all of this. I also have no insight on the choice of additional pharmaceuticals beyond HT at this stage. A few of the other guys know more than me like Max.

 

george

 

Good speaking to you George.

The relevance of the surgeon having left in the seminal vesicles is that they are where the surgeon said his cancer was present (other than the gland itself).  It is insane, knowingly leaving in active tumors, if indeed that is what happened.

In almost all prostectomies, the seminal vesicles are removed with the gland, just for a more thorough removal of potential sites for PCa. The glands serve no purpose after prostectomy, so there is no advantage to leaving them in. The most common areas for metastasis after escape from the gland are the vesicles or the lymph nodes, probably followed by escape along the nerves running through the gland (what is known as "preineural involvement"), so removing them is just common sense.

Redbelly:  I do not know a lot about HT, but many guys here are expert in it, and could better advise you.  I do agree with the one comment above that RT is what you need, and adding HT at all is questionable but pretty common. HT has lots of ugly side-effects, although most go away when HT ends.  Be sure that you are seeing a medical oncologist; most urologists are NOT medical oncologists. They are able to perscribe the same drugs, but most urologists do not have Board Certification in medical oncology.

max

George - I too am on HT as my PSA was never fully undetectale post-op, nadir at "<.02" and my RO is an advocate of concurrent HT with A/SRT. Due to several delays my RT (at this point I believe it is refered to as "early SRT") for my SVI is already six months behind, hoping to begin next month once my AUS is activated.

Max - Assuming the SV's were indeed left intact the only reason I can possibly conceive of would be that perhaps they were infected and the surgeon felt it was better to zap them with RT rather than risk cutting them open. Something about mucosal or vascular SVI... I've never been able to find much definitive info on the various SV pathologies.

redbelly,

your story is very similar to mine but you have a more aggressive form of prostate Ca. 

I had a Turp on June 1, 2016 and was incidentally diagnosed with prostate Ca Gleason 6.

Had TRAUS biopsy on August 11 which confirmed cancer but higher Gleson 7 (4+3) with 1 of 12 cores positive - 10%. I had RARP on November 2, 2016. Surgeon removed prostate, seminal vesicles an 8 limph nodes.

Luckily, my Gleson was downgraded to 3+4, multifocal lesions in both lobes, negative margins, organ contained So no need for additional treatment pT2c.

I would like to stay in touch with you to compare our recoveries to see if recovery of our elementary functions was impaired by TURP, if you don't mind.

My 8 months post op PSA just a week ago was <0.1.

BTW, at time of diagnosis and surgery,  I was 51.

Good luck with your recovery.

MK

redbelly7 said:

MK1965

Mk, yes, let's stay in touch.  I wish that I had a biopsy a lot sooner after the TURP.  I'm not sure how to private message or anything yet, but if you send me one, let me know here and I will find it.

Max, George and Roblee, thanks for all the info.  I will be finding out about the SV on Friday.  I had a lady at Emory do the TURP and a specialist at Emory do the RALP.  So I'm guessing it is possible that the TURP may have caused an issure w/ SV, but hopefully they took them out and being aggressive to start radiation.

Thanks again, I feel much better about my situation after talking w/ you fellows!

 

redbelly,

I sent you private message and explained you can do it to.

MK

This is all out of my wheelhouse, but maybe urologists should schedule biopsies before TURP procedures as a precaution???