Prognosis question

Lm, your husband's data is almost identical to mine. I also was a stage 3 , Gleason 8 , lympho & perineural invasion and a positive margin. I also had surgery. This was in Jan 2013.

As old Salt points out you must find out your husband's  psa post surgery ( I think it was after 3 months but I don't exactly recall ). If it is below .1 ng/ml your under control at this point and you should have your husband do the psa test every 3 months.  No fasting is required so it's a simple blood test. If his psa post surgery is at or  higher than .1 ng/ml then he may need more treatment and you should definitely  encourage him to seek that out. The type of post treatment suggested if needed will depend on where the cancer is located.

Hopefully he will take the next step and get his psa checked . In my opinion his life depends on it. Please encourage him... Good Luck - contento

Lm, that's excellent news !!  Let's hope it just keeps going like that.

Lmrunner

At this moment nobody knows if the surgery has fixed the problem. Surely this is a worrisome period because we are dependent on the PSA values. Constant increases may signify recurrence and it is only at that time that doctors recommend additional action, as commented by above survivors. However, some surgeons got their "predictive tools table" (own list of thresholds based on their experiences) to judge/predict surgery failure or success. My surgeon used a PSA threshold of >0.06 ng/ml at the first PSA post op to indicate failure of the surgery. When positive margins are present and are located closed to the tumor detected in image exams or by the biopsy, some doctors may recommend adjuvant radiation earlier at the pelvis, disregarding the PSA marker.
I wonder if his doctor has suggested already adjuvant radiation due to the pathologist report, but your husband has refused which made you to worry. I also wonder if the original treatment protocol was for a combination therapy of surgery plus radiation which decision your husband is now retreating.

In my lay opinion, the worse in the status you describe above are the grade of the cancer "Gleason 9" and the "positive margin". Grade 5 is the highest for aggressivity and these type of cells (poorly differentiated) are much linked to progressive cases of PCa. The location of the "posterior left positive margin" is the area in contact with the colon. In surgery typically there are two places of positive margins caused during dissection of the gland. One is at the base of the prostate (close to the bladder) and the other at the apex (close to the colon). When dissecting the walnut like gland its shell's skin retreats exposing the inner tissue. This exposure is reported by pathologists as "positive margin". At other places it could mean that the cancer has perforated the shell and spread out side.
Surely you do understand that if this area of the gland had cancer then probabilities of spread would exist. You can verify the location of the cancer in the gland from retrieved data; the biopsy report, CT or MRI or PET exams, and DRE results. Do you have any of these reports?
Other relevant data which physicians use to predict recurrence are the PSA histology (before and after surgery) and symptoms. Can you provide us with such details?

The pathological stage of pT3a pN0 (pM-na means no information) is a classification done to evaluate risks, however, surgery could have cured your husband. The percentage of cancer (volume) identified by the pathologist is useful to compare against the estimated PSA produced by cancerous cells or to predict the type of cancer. 25% may indicate that his cancer forms into individual tumors, therefore ruling out micrometastases.

You comment above that his PSA is 0 but there should be a number. Can you tell us the real value? Do you have copies of the results and reports?

Best wishes for continued low levels of PSA meaning complete remission.

VGama

Lm, Vasco's analysis is spot on. Your doctors will most likely use your psa values as their marker going forward ( I'm making the assumption that his scans were ok ).

It seems different institutions use different psa values as their trigger points. Mine used less than .1 ng/ml to determine surgery success and greater than .2 ng/ml to determine reoccurance.

as Max pointed out some institutions will recommend adjuvant radiation to those patients who had successful surgery ( less than .1 ng/ml ) but was determined pathologically to be at a very high risk for reoccurance. Other institutions however will wait to see if in fact that patient's psa will rise over time beyond their specific thershold. Then will recommend a treatment protocol. Since your husband's data is very similar to mine I know that the risk of reoccurance is very high but not definite. Like you and most all of us we worry about our survival statistics . After my surgery in early 2013 my pathology was a lot worse than the scans and biopsy indicated. I had asked my doctor, which I was scared to death to ask,  to run the numbers on the survival probabilities givin my situation. He said the 15 year survival rate ( prostate cancer specific ) was better than 90 %.I was happy with that number and I definitely didn't want to ask anything further.

At this point my best advice is to stay on top of your psa. I would think you would want to check this every 3 months faithfully.

Good Luck --  contento

I'm new to this forum, but in our battle (Stage 4, bone metastases only, recently castration resistant, but healthy, active, 60-year old diagnosed 2 years), we've found that for otherwise healthy individuals who demand to maintain their quality of life (and don't be shy about demanding it!) you need to do your own research and be very forthcoming about your expectations to your oncologist.  My guy was basically handed a grave prognosis, but has had no disease progression in the two years at all, so the one-size-fits-all standard of care wasn't acceptable (chemical castration and wait a few years to die).  Explore proton therapy, and radiation is not as debilitating as your initial indications.  It is well-targeted.  The standard-of-care treatment that would be next if he has a recurrence is far more life-altering than even a colostomy bag would be.  Best wishes to you!  The best gift a patient can have is a reasonable, but assertive advocate.