Help - changing PATHOLOGY on 2nd opinion - do we get a third?

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FairRider
Regular Member


Date Joined Jan 2008
Total Posts : 32
   Posted 3/28/2008 12:59 PM (GMT -6)   
Hello -

Had Robot assisted Laparoscopic Radical Prostatectomy on March 17. The 1st post-op Pathology is quite different from pre-op stats, so unclear if we should be doing anything - more tests, Bone scan, etc? You can read stats in profile, but basically this is the change:

PSA was 4.7, Biopsy Gleason 3+4=7 in one of 4 positive cores (10 total)
Pre-op DRE under anesthesia was given as TC1 - tissue soft, just as at Biopsy
Both Nerves spared, but took wider margins because of the Gleason 7, CLEAR margins, plus the 4 Lymph glands taken were clear, and Seminal Vesicles clear.
Difficult part is now a T3a because of 2 small 'foci of Extra-prostatic extensions' and Gleason now a 4+3=7 and Tumor was 20-30% of Prostate.

2ND Opinion from Johns Hopkins now says the Extra-prostatic extension is 'established' (not focal) and that there is also a positive margin there. They said is was questionable because it was 'crushed', but that the extension went to the ink.

How much do we worry about this new information? We were told pre-surgery, that we were in the 'possible cure group' and now unsure if that is even possible any longer.

Any input appreciated.
Thanks

FairRider
Age 54; (Father, paternal uncle and 1 brother so far with Pca)
1999 PSA 2.8; 2004 PSA 2.88; 1/2008 PSA 5.6 & repeat 4.37
DRE - "Unremarkable, L side slightly larger"
Free PSA 0.46 and ratio 0.11
Biopsy 1/25/2008 - 10 Cores - 4 with adenocarcinoma
3 cores Gleason 3+3=6 and 1 core 3+4=7
No Stage given on report, maybe T1c or T2c ?

Robotic Surgery March 17, 2008
Both Nerves Spared - Pre-surgery DRE - TC1
Post Op Pathology - T3a Extra-prostatic Extension,
CLEAR margins, 4 Lymph Nodes Clear, Seminal Vesicles clear.
Gleason now 4+3+7, Tumor 20-30% of gland
Dry immediately! - no pads by day 9 Post-op
No response with Viagra, minimal with Bimix

Post Edited (FairRider) : 4/7/2008 9:17:34 AM (GMT-6)


Magaboo
Veteran Member


Date Joined Oct 2006
Total Posts : 1210
   Posted 3/28/2008 3:08 PM (GMT -6)   
 
My stats are very similar to your husbands, except my pre op PSA was a bit higher. After my surgeon examined the pathologists report he stated, " I see nothing here that indicates the necessity for radiation at this time". So, no further action was suggested or done to date. I have sometimes wondered if I should have been more insistent on further treatment (Radiation). Only time will tell whether my surgeon was right.
All the best to you guys in the years to come.
 
Magaboo


Born Sept., 1936
PSA 7.9
Stage T1C
-ve DRE
Gleason's Score 3+4=7
2 of 8 positive
Open RP 28 Nov 06
Post op staging T3
Gleasons still 3+4=7
Seminal vesicles and lymph nodes clear
Catheter out 15 Dec 06
Dry since 11 Feb 07
All PSA tests in 2007 (4) <.04
PSA test Mar., 08 =.04 
 
 

Post Edited (Magaboo) : 3/28/2008 5:47:11 PM (GMT-6)


FairRider
Regular Member


Date Joined Jan 2008
Total Posts : 32
   Posted 4/7/2008 9:22 AM (GMT -6)   
Thanks for the reply Magaboo and good luck on your psa tracking.

I think I just ask too many questions - its seems the more I ask, the worse our case gets. Now we are told there is a positive margin at the extension. I edited original post to reflect.

Does this mean we now need to consider radiation? This journey is exhausting - I can't believe men have been so quiet so long - its great this forum exists.

FairRider
Age 54; (Father, paternal uncle and 1 brother so far with Pca)
1999 PSA 2.8; 2004 PSA 2.88; 1/2008 PSA 5.6 & repeat 4.37
DRE - "Unremarkable, L side slightly larger"
Free PSA 0.46 and ratio 0.11
Biopsy 1/25/2008 - 10 Cores - 4 with adenocarcinoma
3 cores Gleason 3+3=6 and 1 core 3+4=7
No Stage given on report, maybe T1c or T2c ?

Robotic Surgery March 17, 2008
Both Nerves Spared - Pre-surgery DRE - TC1
Post Op Pathology - T3a Extra-prostatic Extension,
CLEAR margins, 4 Lymph Nodes Clear, Seminal Vesicles clear.
Gleason now 4+3+7, Tumor 20-30% of gland
Dry immediately! - no pads by day 9 Post-op
No response with Viagra, minimal with Bimix


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 4/7/2008 9:42 AM (GMT -6)   
Hi FairRider,
There is always Hope. A positive margin does not mean no cure. Radiation and Hormone Therapy are options. But the first option is waiting until that first PSA is completed. You are looking to go to an undetectable PSA. That would be very good news. You will likely be told that radiation is an option, but do understand that any treatments at this point are contraversial as to what to do next. You mentioned worry, and I can advise that too much of it is not productive. I've been through the gambit of treatment for stage III cancer. I am doing well after one year in remission. My motto is stay positive and please do that. Get that PSA to zeroes.

Tony
Age 45 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007
Post-Op Pathology: Gleason 4+3=7, positive margins, Stage pT3b (Stage III)
HT began in May, '07 with Lupron and Casodex 50mg
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (1/08): <0.1
I will continue HT until May '09. 
Years in Remission (3/23/07): 1
Visit my Journey at:
 
STAY POSITIVE!
 
Prostate Cancer Forum Moderator


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 4/7/2008 9:59 AM (GMT -6)   
I agree with Tony 100%! Cure is an option! Stay positive and wait for that PSA to come back. We will pray that it will be undetectable.
Father's Information
DX July 15, 2007
Age 62 (now 63)
PSA 5.5
Original Gleason 3+4=7 
Post Surgery Gleason- 4+3=7
DaVinci Surgery Aug 31, 2007
Focally Positive Right Margin
One positive node
Bone Scan/CT Negative (Sept. 10, 2007)
T3a N1 M0
Oct. 17 PSA 0.07
Nov. 13 PSA 0.05
Casodex adm. Nov 07
Lupron beg. Dec 03, 2007 2 yr
Radiation started March 03, 2008 7 weeks 5x a week
2 weeks of radiation down!!!
 
 


FairRider
Regular Member


Date Joined Jan 2008
Total Posts : 32
   Posted 4/7/2008 10:20 AM (GMT -6)   
Thank you for the positive reminders. We know to wait for the first PSA, but wonder about further testing and consulting with others. We did not have the PAP test prior to surgery, or an MRI, or any other testing.

Another question for anyone...so we had nerve-sparing surgery....if we have to radiate, will the nerves then be fried?

FairRider
Age 54; (Father, paternal uncle and 1 brother so far with Pca)
1999 PSA 2.8; 2004 PSA 2.88; 1/2008 PSA 5.6 & repeat 4.37
DRE - "Unremarkable, L side slightly larger"
Free PSA 0.46 and ratio 0.11
Biopsy 1/25/2008 - 10 Cores - 4 with adenocarcinoma
3 cores Gleason 3+3=6 and 1 core 3+4=7
No Stage given on report, maybe T1c or T2c ?

Robotic Surgery March 17, 2008
Both Nerves Spared - Pre-surgery DRE - TC1
Post Op Pathology - T3a Extra-prostatic Extension,
CLEAR margins, 4 Lymph Nodes Clear, Seminal Vesicles clear.
Gleason now 4+3+7, Tumor 20-30% of gland
Dry immediately! - no pads by day 9 Post-op
No response with Viagra, minimal with Bimix


hawkfan75
Regular Member


Date Joined Jan 2007
Total Posts : 165
   Posted 4/7/2008 11:22 AM (GMT -6)   

FairRider

As you can see by my signature line, my stats are similar.  My 3 month PSA was fine, but then a bit higher at 6 months.  This is when I decided to undergo additional therapy, and thankfully, things are going well now.  You need to relax now and just get stronger.  The PSA tests later will help you make decisions later.

As far as your question, my surgeon did say that the radiation would probably zap the nerves he saved, but that was never a reason for me not to have the additional therapy.  I'm also on hormones for a couple of years, so that lessens the "libido".  I've always put LIFE in front of some of those other things, and I'm thankful that I had a second option following surgery.

You seem to be recovering well, so just keep that up and the rest will work its way out later.


Age 57 at diagnosis,  PSA 4.7 (up from 3.2 one year ago)
Biopsy November 8, 2006 1 of 10 cores positive 5% LEFT Side Gleason 3+3
Robotic surgery January 19, 2007
Post Surgery Pathology Stage T3a, Gleason 3+4, positive margins and capsular penetration RIGHT Side
Post Surgery PSA:  March 5:  0.01
5 month PSA, June 13, 2007:  0.08
Adjuvant therapy began June 26 with Zoladex injection
Radiation began August 23, ended October 8
First post radiation PSA, December 18, 2007:  0
 
 

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