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.
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)