Post surgery results: Upgraded

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Veteran Member

Date Joined Dec 2008
Total Posts : 673
   Posted 6/4/2009 7:20 PM (GMT -6)   
I had a retropubic RP in early May. Recovery is going well. Catheter removed and staples out 2 weeks later. I had pretty much full urinary control from the get-go except for a few stress squirts from a sneeze or cough. That is almost completely gone now at 4 weeks out. Nerves were spared but, at best 25-30% of presurgery erectile function. I am trying Levitra for the first time.
Pathology from surgery as follows:
1) Staging: pT3a N0 Mx...stage III prostate cancer, cancer has extended beyond prostate capsule, no lymph node involvement, metastasis (spread) cannot be determined 
2) Extraprostatic Extension (EPE): Unifocal, tumour abutting periprostatic fat, distinct bulging tumour nodule...the cancer is not confined to the prostate
3) EPE within surgical margins
4) Seminal vesicles: Clear
5) Lymph nodes: No malignancy in regional lymph nodes
6) Gleason score: Upgraded from 6 (3+3) to 7 (3+4), both lobes affected with tumours
7) Perineural invasion: Present (seen on biopsy, also)
8) Resection margins: Apical, bladder neck, radial...uninvolved with cancer
9) Additional: High grade PIN, glandular and stromal hyperplasia
Not what I was hoping for, the cancer was not confined to the prostate and Gleason is higher than presurgery biopsy, but it is what it is. Next step will be talking to a radiation oncologist specializing in PCa and waiting to see results of 3 month PSA test in August.
In the mean time, I am working on recovering from surgery and doing very well. I'm slowly starting to get back to working out, getting my fitness level improved and I'm keeping a strong and positive attitude.
I still have a lot to learn about my present staging and potential further treatment. Any comments would be appreciated.
All for now,

Lower left groin hernia: mesh and large scar: surgery early 2006
Nov/Dec 07 and March 08 and now Dec 08: Severe perineal pain (between scrotum and rectum). Septra/Bactrim for 8 months (Nov 07-Jun 08) for diagnosed prostatitis.
PSA start of 2008: 5.3..... PSA June of 2008: 7.3
14 DRE all benign or nothing felt
TRUS Biopsy Nov 08: Got copy of pathology (see below). Prostate about 40 cm sq.
General Health: pretty good, 5' 10", 180 lbs, slim.
Bone scan Dec 08: Negative
Barium enema X-ray (March 09 due to several days of blood in stool)
MRI with endorectal coil (April 09 as part of a study)
3D advanced TRUS (April 09 as part of a study)
CT (April 09 as part of a study)
Biopsy Pathology: 5 of 8 cores positive, adenocarinoma in both lobes. 30%-65%. One core perineural invasion. 2 cores "foamy" and suspicious. All +ve cores, 3+3 GS 6.
Open RP surgery: May 5/09 Surgeon spoke to my wife and was very positive. Said both nerve bundles spared and not damaged. Bilateral lymph node dissection performed. Discharged 48 hours after surgery. Staples out, catheter out and pathology sheduled for May 21.
Physical State: Home office in basement. Up and down 10-20 times a day. Walking lots of circles around inside of house and back patio. Bit sore but coping very well so far.
Mental State: Pre-surgery anxiety gone. Now waiting for path report, cath removal and staples out. 

Post Edited (mikey1955) : 6/4/2009 7:22:09 PM (GMT-6)

Veteran Member

Date Joined Apr 2009
Total Posts : 990
   Posted 6/4/2009 8:50 PM (GMT -6)   
Not a home run, but headed toward healing. I felt much better when I found out that 90% of extra prostatic extensions are less than 1/10 of an inch (pretty much microscopic) I'm still waiting to get to the three month test, but I'm confident that it is just a matter of time until that guy from the zeros club starts dunning us for dues.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3 + 4 = 7
CAT scan 1/09 negative, Bone scan 1/09 negative

Robotic surgery 03/03/09 Catheter Removed 03/08/09
Post surgical pathology report. Lymph nodes negative, Seminal vesicles negative
Surgical margins positive, Capsular penetration extensive Gleason 4 + 3 = 7
At 6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.

Regular Member

Date Joined Sep 2006
Total Posts : 187
   Posted 6/4/2009 10:04 PM (GMT -6)   
Seems like almost everybody gets upgraded post -surg. Clear margins is a nice thing to see here. At this point, its all about the PSA results. Good for you to consult with a radiation oncologist --- not that you'd leap into treatment (too soon anyway), but best to explore all the options. Nothing like throwing everything you have at the beast!

Happy healing and recovery!
Age 49 - pre-surgery PSA 39 (at age 45)
Open Radical Prostatectomy 6/9/2006
Pathological Stage T3a, Positive Surgical Margin
Gleason 3+4
PSA rose to .24 in November of 2006
6 month hormone therapy initiated December 1. 2006
36 sessions of IMRT Ended Feb 1, 2007
PSA as of May 25, 2007 undetectable
PSA as of November 29, 2007 undetectable
PSA as of May 14, 2008 undetectable
PSA as of November 25, 2008 undetectable
PSA as of May 22, 2009 undetectable

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