10 days after surgery - margins involved by tumor

DougP · July 2009

I had laparoscopic sugery for pc 10 days ago and was hoping to come away with a clean final pathology report. I'm 56 years old and frightened for my future. I've been healthy my entire life with the only surgery being at age 18 for an appendectomy. About 6 months ago, during a routine blood test, my PSA was 4.2. My family doctor suggested that I see an urologist which I did. My urologist suggested a bioposy which detected cancer. My final PSA was 5.2 and my pre-op Gleason was 6. My bone scan and CAT scan were negative. I opted for surgery, however it was 2 months until I could schedule my surgery .... my surgeon is that busy!

Here's my final pathology report:
Gleason score: Primary 3 - Secondary 4 - Total 7
5 percent of prostate involved by tumor
Stage T2c

NO INVASION of:
regional lymph nodes
extraprostatic extension
seminal vesicle
venous (large vessel)
lymphatic (small vessel)

INVASION of:
Multifocal
Bilateral urethral margins
Perineural

I have not yet reviewed the final pathology report with my urologist. My wife has worked in the cancer/radiological field for over 35 years said that I will most likely have to undergo radiation in a few months. While I know that I could walk out and hit by a car tomorrow, I still would like to get a sense of what my life expectancy is given the above information .... it's all that I've been thinking about since receiving my final path report.

Thanks.

Thanks.

lewvino · July 2009

Doug,
Sorry to hear of your
Doug,
Sorry to hear of your news after having your surgery. I'm 54 and scheduled to have the DaVinci on August 12th.

I can relate to your fears since I'm concerned on my pre surgery numbers and what my path report will also be following surgery.

I'm curious where you had your surgery at if you don't mind sharing. Hang in there and know that myself and others care and will be praying for you and your wife.

Larry

lshick · July 2009

lewvino said:
Doug,
Sorry to hear of your
Doug,
Sorry to hear of your news after having your surgery. I'm 54 and scheduled to have the DaVinci on August 12th.

I can relate to your fears since I'm concerned on my pre surgery numbers and what my path report will also be following surgery.

I'm curious where you had your surgery at if you don't mind sharing. Hang in there and know that myself and others care and will be praying for you and your wife.

Larry

Positive margins
You might have a look at the following resources:

http://www.nomogram.org/ and click "Prostate Cancer" > "After Surgery"

http://www.mskcc.org/applications/nomograms/Prostate/PostRadicalProstatectomy.aspx

http://urology.jhu.edu/prostate/hanTables.php

http://www.cpdr.org/programs/database/postop.html

The other Larry

DougP · July 2009

lewvino said:
Doug,
Sorry to hear of your
Doug,
Sorry to hear of your news after having your surgery. I'm 54 and scheduled to have the DaVinci on August 12th.

I can relate to your fears since I'm concerned on my pre surgery numbers and what my path report will also be following surgery.

I'm curious where you had your surgery at if you don't mind sharing. Hang in there and know that myself and others care and will be praying for you and your wife.

Larry

Hi Larry,
I had my surgery
Hi Larry,

I had my surgery performed at Hershey Cancer Institute in Hershey, Pa. It's a Pennsyslvania State University Medical College. I looked at having DaVinci but the closest surgeon that my urologist felt had enough experience and success was located at the Pennsylvania College of Medicine in Philadelphia which my insurance would not cover.

Right now, I just want to have this catheter removed. I had to be re-catherized on Tuesday after not being able to pass urine. I actually would be feeling pretty good if were not for this catheter.

Good Luck with your surgery on the 12th. Please post so that we know how you made out.

Prayers and blessings to you,
Doug

DougP · July 2009

lshick said:
Positive margins
You might have a look at the following resources:

http://www.nomogram.org/ and click "Prostate Cancer" > "After Surgery"

http://www.mskcc.org/applications/nomograms/Prostate/PostRadicalProstatectomy.aspx

http://urology.jhu.edu/prostate/hanTables.php

http://www.cpdr.org/programs/database/postop.html

The other Larry

I'll give them a look,
I'll give them a look, Thanks Larry.

lewvino · July 2009

DougP said:
Hi Larry,
I had my surgery
Hi Larry,

I had my surgery performed at Hershey Cancer Institute in Hershey, Pa. It's a Pennsyslvania State University Medical College. I looked at having DaVinci but the closest surgeon that my urologist felt had enough experience and success was located at the Pennsylvania College of Medicine in Philadelphia which my insurance would not cover.

Right now, I just want to have this catheter removed. I had to be re-catherized on Tuesday after not being able to pass urine. I actually would be feeling pretty good if were not for this catheter.

Good Luck with your surgery on the 12th. Please post so that we know how you made out.

Prayers and blessings to you,
Doug

I plan on keeping active on
I plan on keeping active on this forum and will keep posting updates as I progress. I find the support very helpful from others that have been down the path before me.

NM · July 2009

DougP said:
Hi Larry,
I had my surgery
Hi Larry,

I had my surgery performed at Hershey Cancer Institute in Hershey, Pa. It's a Pennsyslvania State University Medical College. I looked at having DaVinci but the closest surgeon that my urologist felt had enough experience and success was located at the Pennsylvania College of Medicine in Philadelphia which my insurance would not cover.

Right now, I just want to have this catheter removed. I had to be re-catherized on Tuesday after not being able to pass urine. I actually would be feeling pretty good if were not for this catheter.

Good Luck with your surgery on the 12th. Please post so that we know how you made out.

Prayers and blessings to you,
Doug

Surgery
Hi Doug My name is Nick and i live in NE pa. I have not gotten as far as picking a doctor but am CURIOUS (IF YOU DONT MIND) WHAT KIND OF INSURANCE YOU HAVE ( I have blue cross blue shield and am hoping to go to John Hopkins(Baltimore Maryland) (if i can get a referral and ins co says yes)If not I am wondering how Hershey cancer institute treated you. Thanks Nick

DougP · July 2009

NM said:
Surgery
Hi Doug My name is Nick and i live in NE pa. I have not gotten as far as picking a doctor but am CURIOUS (IF YOU DONT MIND) WHAT KIND OF INSURANCE YOU HAVE ( I have blue cross blue shield and am hoping to go to John Hopkins(Baltimore Maryland) (if i can get a referral and ins co says yes)If not I am wondering how Hershey cancer institute treated you. Thanks Nick

Hi Nick,My insurance is
Hi Nick,

My insurance is Preferred Health Care of Pa. and typically it's pretty good. In fact, my wife works at Lancaster Heath Campus in Lancaster and her insurance would not have covered my surgery at Hershey.

If you don't mind the fact that Hershey Cancer Institute is a medical school and that there will be resident doctors on the surgical team, then I would highly recommend it. I had a wonderful surgeon by the name of Dr. Lewis Harpster who performed my surgery. Assisting him were two very competent 5th year resident doctors by the names of Dr. Trisha Krueger and Dr. Hall. I can't say enough good about the surgery and the nursing staff at Hershey. I was in a total of two days and three nights and could have cut it by a day if I didn't have bladder spasms. Any post-op questions were answered very quickly (usually within 30 minutes of my telephone call) by the doctors themselves, not a nurse. I would highly recommmend Hershey and Dr.Harpster's team.

Good luck with your surgery!

Mark58 · July 2009

Life Expectancy??
Doug:
Good luck on getting a Doctor to talk about that subject. They usually will not unless all treatment has been exhausted! Most people will not discuss this subject as you can see by your replies so far to your question. I saw this discussion on another forum several years ago. In reading all the different opinions which ranged from 10 to 20 years I came to the conclusion that there is no good answer to that question for any particular person. We are all different (this includes age, general health, body mass etc...)and therefore we all respond to treatment differently. Our cancers were also diagnosed at many different levels of development. I chose surgery which was in March of 2004. My prostate cancer was not contained. I have since gone through 39 radiation treatments (August and September of 2005). My PSA is rising again so I will soon start with intermittant harmone (Lupron) treatment. I am 63 now and live my life to the fullest. I will retire in a couple of years, but I will not put off anything. My wife and I travel, we enjoy our children and grandchildren, camping and fishing. As one reply put it, we could very likely die with Prostate Cancer but not from Prostate Cancer. I just take my treatment as it comes. Make your decisions with as much research as you can stand and don't second guess yourself. I'm starting to ramble, so I'll close. Best of luck to you!!!!

tarhoosier · July 2009

Life expectancy
The longest and most complete follow up of patients is from the Mayo Center. They followed hundreds of their patients who were diagnosed with cT3 prostate cancer. That means that the spread was identified before surgery but the surgeons operated anyway. These men were treated in the late 1980's to mid 1990's. They did not have follow up radiation because it was not recommended at the time and also the radiation available at that period was more toxic than the supremely precise methods now available. Also many of the men had orchiectomy rather than medical castration and also Bicalutimide and Avodart and other drugs were unavailable at the time of treatment. Even with all of these liabilities to their treatment, after 15 years 79% of the men were alive, or had succumbed to some other cause. Men today in such situations can expect more than an 80% chance to survive 15 years.
Your margins issues are the key to your treatment plan. I think it is quite likely that we will have you around for a very long time.

segersales · August 2009

Mark58 said:
Life Expectancy??
Doug:
Good luck on getting a Doctor to talk about that subject. They usually will not unless all treatment has been exhausted! Most people will not discuss this subject as you can see by your replies so far to your question. I saw this discussion on another forum several years ago. In reading all the different opinions which ranged from 10 to 20 years I came to the conclusion that there is no good answer to that question for any particular person. We are all different (this includes age, general health, body mass etc...)and therefore we all respond to treatment differently. Our cancers were also diagnosed at many different levels of development. I chose surgery which was in March of 2004. My prostate cancer was not contained. I have since gone through 39 radiation treatments (August and September of 2005). My PSA is rising again so I will soon start with intermittant harmone (Lupron) treatment. I am 63 now and live my life to the fullest. I will retire in a couple of years, but I will not put off anything. My wife and I travel, we enjoy our children and grandchildren, camping and fishing. As one reply put it, we could very likely die with Prostate Cancer but not from Prostate Cancer. I just take my treatment as it comes. Make your decisions with as much research as you can stand and don't second guess yourself. I'm starting to ramble, so I'll close. Best of luck to you!!!!

adjunct radiation
hi Doug, I was reading your history and I had a question for you. I had Robotic Surgery 2 years ago and the margins were suppose to be clear. however my PSA began to rise and i had 38 radiation treatments. My last PSA was <.01. How fast did your PSA rise after your radiation treatments. my friend glen, who is on the cancer survivor board had sone the intermittant Lupron treatment and would be a good source of info.

gjegan · August 2009

Same conditions
Doug - I am also 56. I have just been diagnosed with pc and have the same psa and Gleason values as you. I would appreicate how you decided to go with surgery, and how you have come out of it with side effects, mostly incontinence.

I'm trying to understand your results. I worry too about my future life. Do doctors really say that folks with pc only have 10-20 year life expectancy?

I've read some folks talk about proton radiation, but I hav enot found much about it. Is it an alternative to surgery? Does it have much history?

Does anyone have diabetes in addition to pc? Does the diabetes complicate the treatment for pc?

Thanks

gjegan · August 2009

Same conditions
Doug - I am also 56. I have just been diagnosed with pc and have the same psa and Gleason values as you. I would appreicate how you decided to go with surgery, and how you have come out of it with side effects, mostly incontinence.

I'm trying to understand your results. I worry too about my future life. Do doctors really say that folks with pc only have 10-20 year life expectancy?

I've read some folks talk about proton radiation, but I hav enot found much about it. Is it an alternative to surgery? Does it have much history?

Does anyone have diabetes in addition to pc? Does the diabetes complicate the treatment for pc?

Thanks

gjegan · August 2009

Same conditions
Doug - I am also 56. I have just been diagnosed with pc and have the same psa and Gleason values as you. I would appreicate how you decided to go with surgery, and how you have come out of it with side effects, mostly incontinence.

I'm trying to understand your results. I worry too about my future life. Do doctors really say that folks with pc only have 10-20 year life expectancy?

I've read some folks talk about proton radiation, but I hav enot found much about it. Is it an alternative to surgery? Does it have much history?

Does anyone have diabetes in addition to pc? Does the diabetes complicate the treatment for pc?

Thanks

gjegan · August 2009

Same conditions
Doug - I am also 56. I have just been diagnosed with pc and have the same psa and Gleason values as you. I would appreicate how you decided to go with surgery, and how you have come out of it with side effects, mostly incontinence.

I'm trying to understand your results. I worry too about my future life. Do doctors really say that folks with pc only have 10-20 year life expectancy?

I've read some folks talk about proton radiation, but I hav enot found much about it. Is it an alternative to surgery? Does it have much history?

Does anyone have diabetes in addition to pc? Does the diabetes complicate the treatment for pc?

Thanks

lewvino · August 2009

gjegan said:
Same conditions
Doug - I am also 56. I have just been diagnosed with pc and have the same psa and Gleason values as you. I would appreicate how you decided to go with surgery, and how you have come out of it with side effects, mostly incontinence.

I'm trying to understand your results. I worry too about my future life. Do doctors really say that folks with pc only have 10-20 year life expectancy?

I've read some folks talk about proton radiation, but I hav enot found much about it. Is it an alternative to surgery? Does it have much history?

Does anyone have diabetes in addition to pc? Does the diabetes complicate the treatment for pc?

Thanks

I can answer some of your
I can answer some of your questions on Proton Radiation. My father was treated with Proton Beam for his Prostate cancer back in 1997 and is doing fine today. There are I believe only five centers in the USA that offer Protons. The first and the leader is Loma Linda University in Southern California. This is where my dad was treated. They now have centers in Jacksonville Florida, Central Indiana, Massachussets and I forget where the 5th one is located. Proton is a type of Radiation. You could Google Proton or google Proton Bob. He is a gentlemen that was treated with Protons wrote a book about it and has a huge support group of men that were treated with Protons. Its history goes back to the early 1990's.

I looked at Proton Treatment but my insurance denied coverage since it is more costly So I am having Robotic surgery Aug. 12th.

I am Type II Diabetic and have PC. In preperation for my surgery I knew I was overweight so I have lost 38 pounds since being diagnosed with PC and since one year ago 52 pounds! Two weeks ago my Family Doc actually cut my Diabetic meds in half for their strength since my Blood sugar was running way to low.

My Surgeon for DaVinci told me he was more concerned about my Diabeties impacting my full recovery then any other thing but he gave me a very good prognosis.

I'm 54, 5 cores found positive 3 at Gleason 7 (4+3) and 2 at Gleason 7 (3+4). My PSA was 5.1.

If you want shoot me an email offline at lewvino@yahoo.com and I'll be glad to answer any other questions on PROTONS or how I came to the decision to have Robotic Surgery.

Larry

shubbysr · August 2009

Final Report Yet?
Hey Doug,
Sorry to hear of the path report. Was it final? Goood news is there was no lymph node
I had some similar verbage but, told "nothing bad".
Keep in touch as good thoughts & prayers to you.

Jim (shubbysr)

ZetB1 · December 2016

tarhoosier said:
Life expectancy
The longest and most complete follow up of patients is from the Mayo Center. They followed hundreds of their patients who were diagnosed with cT3 prostate cancer. That means that the spread was identified before surgery but the surgeons operated anyway. These men were treated in the late 1980's to mid 1990's. They did not have follow up radiation because it was not recommended at the time and also the radiation available at that period was more toxic than the supremely precise methods now available. Also many of the men had orchiectomy rather than medical castration and also Bicalutimide and Avodart and other drugs were unavailable at the time of treatment. Even with all of these liabilities to their treatment, after 15 years 79% of the men were alive, or had succumbed to some other cause. Men today in such situations can expect more than an 80% chance to survive 15 years.
Your margins issues are the key to your treatment plan. I think it is quite likely that we will have you around for a very long time.

EXPECTANCY OF LIVE

I am diagnosed as T4N0M0 and I asked my doctor how patients with a like diagnosis fared. He said 70% of men live five years, 50% live ten years.

10 days after surgery - margins involved by tumor

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