Treatment Question

Serg3839
Serg3839 Member Posts: 3 Member
edited May 2022 in Prostate Cancer #1

Hello all,

I’m on here today seeking information for my dad. He isn’t all that open with info so I may have some missing parts.

Back in January he had an elevated PSA score that triggered a biopsy (not sure what the number was, he never said). Anyways, the biopsy led to a gleason score of 3+4=7 (I understand this to mean moderate risk). He had an MRI and bone scans that didnt reveal anything. He had his prostate removed along with 14 nodes. The surgery went fine but there was cancer discovered in one of the 14 removed nodes. His Dr has told him this is not “great” but recommended nothing more than taking a wait and see approach. Basically, the Dr wants to do PSA checks every 6 weeks but nothing else for now.

That doesn’t sound quite right to me… am I off on this? Is that all that should be done right now? I dont know a lot and feel out of the loop on most of this. Does cancer found in a node mean a more advanced cancer? I would appreciate any feedback, thank you.

Comments

  • J69
    J69 Member Posts: 35 Member
    edited May 2022 #2

    Serg, sorry you have to be here. With the MRI and bone scans both negative, I am surprised the doc took out any nodes. However finding cancer in one, does suggest that the cancer has left the prostate. The 7 GL score put him at intermediate risk, but the positive node, I would think, puts him at a higher risk. That would mean that there may be salvage radiation and hormone treatment in his future. There must have been more to the story, like positive margins, for the doc to go for the nodes. In any case there are more here that have had surgery that can help you better going forward. They may suggest that his slides be sent for a second opinion and to get in touch with a radiation oncologist.

  • Serg3839
    Serg3839 Member Posts: 3 Member
    #3
    https://csn.cancer.org/discussion/comment/1696846#Comment_1696846

    J69,

    I agree with you, I feel like I’m missing parts of the story. I wish my dad would open up more but it seems like he’s trying to downplay the seriousness of it. From your statement, sounds like node removal isnt standard unless required. Is that correct? When you say positive margins, what does that mean? I’ll talk with my dad and see if he will give me access to his records for a second opinion. Thank you for the response.

  • J69
    J69 Member Posts: 35 Member
    #4

    Serg, if the MRI shows hotspots in the nodes the doc will take some during the prostate removal. When the doc is taking out the prostate a positive margin would be cancer was seen in the margin on the perimeter of the prostate. Docs like to see negative margins to show the cancer is contained within the prostate. I am not that knowledgeable about the removal of the prostate, as I had radiation only for my treatment. I am trying to remember what my URO told me of what could happen if I picked surgery. I hope you and your father get more answers sooner than later

  • Clevelandguy
    Clevelandguy Member Posts: 1,206 Member
    #5

    Hi,

    Its not uncommon during surgery that the doctor will take some of the nodes and evaluate them for cancer. Sometimes the cancer will spread to the nodes first but in my humble non medical opinion it does not mean the cancer is elsewhere in the body. The optimal scheme would be that the cancer was contained totally inside the gland itself but should there be further treatment? If you want you could have your Dad get a second opinion from another doctor/hospital network. Certainly with the cancer in the lymph nodes it will require further followup with MRI, bone,PET scans plus PSA tests. I had plural neural invasion with positive margins and I am still cancer free after almost eight years after my surgery. Another thing is you Dad’s age, if he is in his 70s or 80s and has other medical problems the treatment for quality of life could be different than if he was in his 50s and was in great health. Your father will have to keep a close eye along with his doctors for any future outbreaks of cancer.

    Dave 3+4

  • Serg3839
    Serg3839 Member Posts: 3 Member
    #6
    https://csn.cancer.org/discussion/comment/1696856#Comment_1696856

    Thanks for the info. After his prostate was removed, sounds like the cancer was found in his seminal vesicles, 1/14 nodes and he also had plural neural invasion. My dads nearly 70 as well. I think at a minimum we’ll get a second opinion.

  • VascodaGama
    VascodaGama Member Posts: 3,707 Member
    #7

    Hi Serg,

    I think the info you share above comes from the pathological stage report. This is what the pathologist found when analyzing the prostate specimen together with the 14 lymph nodes. Your dad is pT3b pN1 Mx

    The results confirm extraprostatic extensions with two not so favorable items that will require added intervention. These are the seminal vesicles involvement and the positive lymph node. Salvage radiation (SRT) with or without hormonal treatment (ADT).

    Some doctors perfer earlier intervention starting SRT two to three months post surgery after full recovery from surgery. In such regard, I think your dad's doctor is doing it right. Checking the PSA periodically while subjecting to additional image studies, like bone scan and PET.

    Dave above gave you a concise advice. I would suggest that you continue researching educating on the mater but without precipitating into the unreasonable. Cancer doesn't spread overnight. Do things coordinatly.

    Second opinions always help in formulating decisions.

    Best wishes and luck in this journey.

    VGama

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