Pathology after 3/2/20 RP. Some questions.

Hi Jay, 

First of all congratulations on getting past your surgery.  I wish you a speedy and uneventful recovery.

While I am no expert, focal lymphovascular invasion means that cancer cells were detected in surrounding lymph and vascular tissue.  The major takeaway is that you are at increased risk of Bcr.  Your extracapular extension means the same thing.  You need to monitor your Psa frequently using the ultra sensitive test.  I suspect that given your relatively low Gleason score, adjuntive radiation will not be recommended, but this is a conversation you need to have, both with your surgeon, and also I would line up a consult with a top notch radiation oncologist.  I don't think that this is a catastrophe, but you need to be vigilant.

Eric

Hi Jay,

I also was 3+4 with perineural invasion and after after 5 yrs. my PSA is still undectable. If it was me and I am no doctor I would wait for a couple of PSA readings to see where you are at.  Radiation would probably be the next step if you still have a detectable PSA but why go that route unless needed.  Food for thought, good luck.

Dave 3+4

jayjelinek said:

My concern specifically is

My concern specifically is the EPE positive and the lymphovascular space positive pathology results. These seem to indicate higher risk of recurrence than just perineural invasion. You're right not to go down the radiation road unless needed, but there seems to be some research indicating early adjuvant radiation therapy may actually be beneficial in cases like mine, like Eric noted. But not conclusive. Continuing to look at this. Jay

I'm a new guy doing his research so take this with a huge boatload of salt, but I recall hearing that at the 2019 ESMO meeting, the question of adjuvant vs. salvage post-surgery radiation was discussed in the RADICALS-RT and ARTISTIC trials.  My layman's takeaway was that early salvage radation was just as good as adjuvant radiation -- meaning that post-RP radiation could wait until PSA began to rise (no higher than 0.2) before initiating radiotherapy treatment, rather than automatically turning to adjuvant radiation soon after surgery.  Again, this is just my impression as a non-medical guy.  Here are a few links I looked at:

https://www.urotoday.com/conference-highlights/esmo-2019/esmo-2019-prostate-cancer/115205-esmo-2019-adjuvant-or-salvage-radiotherapy-for-the-treatment-of-localized-prostate-cancer-a-prospectively-planned-aggregate-data-meta-analysis.html

https://www.ascopost.com/news/september-2019/men-with-prostate-cancer-can-be-spared-radiotherapy-after-surgery/

http://dailyreporter.esmo.org/prostate-cancer-what-is-the-optimal-timing-for-radiotherapy/

 https://ascopost.com/issues/october-25-2019/studies-suggest-early-salvage-radiotherapy-may-be-preferable-to-adjuvant-radiotherapy-after-prostatectomy/

Jay,

According to the information you share above, you are now three weeks post op. I would think that the surgery option was decided based on the information gathered initially and chosen as the best way leading to cure. Now you need to wait and give time to verify if surgery was successful in freeing you from the cancer. Surely the pathologist's report on the gland's specimen and dissected tissues (out of your body) is taken into consideration in any future decision for additional treatment but the contents by itself doesn't lead to a conclusion.
The report identifies cancer at gland's' shell (EPE) and at the outer tissues encompassing the lymph nodes but one doesn't know if malignant cells were left behind as they vacuum the area cleaning all debris and blood at the cavity.

You could be cured by now or you may need a salvage treatment, but such should follow reasonable principles not just based on what was found by the pathologist. Adjuvant treatment (radiation) is typically recommended when the conditions verified before surgery (RP) have suggested high probabilities for EPE. That means that such patient had conditions appropriated for a prime radiotherapy (RT) or a combination treatment with RP+RT. In your case, going adjuvant may not lead to a successful end. Apart from that, not all EPE cases recur and one may risk the side effects of two treatments unnecessarily.

Without knowing your previous diagnosis, clinical stage and data from initial tests and exams, I only can say that you better give time to verify if recurrence occurs, deciding on the matter then. You can test already the PSA as the body usually takes two weeks to clean up circulating serum. This should be closer to 0.05 ng/ml and stay there at three months post op.