New here, upgraded following RP to pT3a Nx R1 Gleeson 3+4=7 Tertiary pattern 5
Hello all, I would love some advice feedback, advice, suggestions for my husband. We are seeing his consultant on Tuesday February 1st next.
This site has been a wonderful find for us. I signed up last night. I do the research.
Background clinical details:
My husband is 53 years. Healthy. Never smoked. Harldy ever takes a drink. Vegetarian. His father had Brachytherapy aged 73 (9 years ago) for a Gleeson 3+3 = 6. Successful. No recurrence.
November 2020 my husband referred to the Rapid Access clinic following a PSA of 4.1
MRI scheduled. MRI results: MRI P4 left T2 NO Gleason 3+4 = 7 cores positive left lobe only.
January 2021 saw a consultant Urological and Robotic Surgeon
February 2021 Biopsies taken.
March 11th 2021 Urologist cancer confirmed on biopsies
May 20th 2021 had a Radical Prostatectomy
July 2021 first review following RP with Urological Surgeon. My husbands Cancer was upgraded.
RP PATHOLOGY REPORT May 2021
Specimen A: Adenocarcinoma
Histologic type: Acinar
Grade Group 2. Gleason Score 3+4 +7 with Tertiary Pattern 5 (<5%)
Percentage of Pattern 4: 20%
Cribriform Pattern: Present. Present
Percentage of Prostate involved by tumor: 40%
Lymphovascular Invasion: Suspicious Images Observed.
Intraductual Carcinoma (IDC) Not Identified.
Perineural Invasion: Present. Extensive.
Extra Prostatic Extension: Present Focally in Anterior Zone and Bladder neck.
Urinary Bladder Neck Invasion: Present
Surgical Margins: Extensively Involved by Carcinoma in Bladder Neck and Base (Pattern 3 extension:20mm)
Seminal Vesicle Invasion: Not identified.
Extensive amyloid deposits are Present. Confirmed by Congo Red. Consistent with Senile amyloid deposit. Correlate clinically.
Acinar Adenocarcinoma; Stage pT3a; Gleason 3+4 =7 (+5); PNI+++; Margin Positive; Bladder neck +
PSA since RP
My husband has had 3 PSA tests done since the RP in May 2021
PSA#1 July 2021 0.03
PSA#2 Oct 2021 0.06 (3 months later)
PSA #3 Jan 2022 0.11 (3 months later)
Bladder control is excellent. No incontinence. Zero Erectile function and is on Sildenafil twice weekly.
Since the RP we have had two meetings with the Consultant. Our third is on Tuesday next (Feb 1st)
At the first meeting post RP the consultant said that my husband’s final results do place him at an increased risk of recurrence down the road. That in a worse case scenario if his PSA goes up, he will need Radiotherapy down the road.
At the second he said that several of the features (above) are high risk. He said that with these aggressive features he will need radiotherapy but wants to wait until 0.02. He said that that is the trigger. He said we need one or 2 more PSA’s. He said he would like to schedule a bone scan and a Cat scan if the PSA goes up.
So, we will be meeting him on Tuesday next and the PSA has gone up again.
Please, any advice, comments, anything we should ask, anything that your experience has taught you ….anything at all would be so welcome. Anything.
My sincerest thanks.
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