Blown out of the water by Dr again!

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Jerry1
Regular Member


Date Joined Mar 2007
Total Posts : 460
   Posted 6/22/2009 2:17 PM (GMT -6)   
 
Hi All,
 
Well just when I thought I could not get anymore conflicting information from my surgeon I was just told that when I sent them my most recent PSA 9 months and it went from 0.0 to
<0.1 they decided to look at my slides again with anothe pathologist and now they feel that  
the first report was incorrect and now the score is a Gleason 8 not 6.  I have read and reread the pathology report as shown in my signature all good now they say well maybe some cells jumped before the surgery.  First I was told they spared the nerves then I was told they took the nerves now this.  They are going to sent the slides to some big deal doctor at John Hopkins for another opinion but are pretty sure now they were wrong the first time.  I am schedule for another PSA test on July 15th and a Cat Scan on July 10th because I still also have the frequency and buring when urinating.  I am now stress out completely I was on my way to my son's in NC when I got the call so put a downer on the whole trip.  Did anyone ever here of this before?  What are the next steps if it continues to go up.  I was one of the lucky one and lost the pads pretty quick and would hate to lose that does radation mess you up again?  I went to a world known doctor in Orlando Fl that has done thousands of these operations to be sure I got the best care possible but I guess everyone screwes up.  What causes the PSA to go up again does it mean the cancer spread somewhere else in my body how do they know where to do the radation.  Try to find infor on the internet but so confusing so I thought I would come to the experts.
 
Thanks guys for any information you can provide.
 
Jerry1
Age 69
DX 8/13/08 , PSA 4.0, Biopsy 14 samples 1 positive 12% of sample,
Gleason Score 4+4 =8  Bone scan and MRI negative
Da Vince surgery on Oct 17, 08 Florida Hospital Dr Vipul Patel
Post Gleason report  3+3= 6 Lymph nodes on both sides negative
margins Negative  Stage II (pt2a) 
Cath out on October 29th left in longer due to small leak.
11/19/08 dry no more pads
12/2/08 first PSA <0.1
 3/6/09 6 Month PSA 0.0
6/3/09 9 month  PSA <0.1
new gleason score of 4=4
 


Mavica
Regular Member


Date Joined Jun 2008
Total Posts : 407
   Posted 6/22/2009 2:31 PM (GMT -6)   
Sympathy and underestanding, and encouragement will be here, but not the "expert" advice you need.   None of us knows what was and wasn't in the written and verbal reports and test results you've received nor do we understand your medical history before this time, so since you have lost confidence in your medical advisors it seems to me that the next step for you is to find someone or a group of specialists the advice from which/whom you can or will believe.  We typically expect medical professionals to have all of the answers, but they don't.  Hang in there.

Age:  59 (58 at diagnosis - June, 2008)

April '08 PSA 4.8 ("free PSA" 7.9), up from 3.5 year prior

June '08 had biopsy, 2 days later told results positive but in less than 1% of sample

Gleason's 3+3=6

Developed sepsis 2 days post-biopsy, seriously ill in hospital for 3 days

Dr. recommended robotic removal using da Vinci

Surgery 9/10/08

Northwestern Memorial Hospital, Chicago, IL

Dr. Robert Nadler, Urologist/Surgeon

Post-op Gleason's:  3+3, Tertiary 4

Margins:  Free

Bladder & Urethral:  Free

Seminal vesicles:  Not involved

Lymphatic/Vascular Invasion:  Not involved

Tumor:  T2c; Location:  Bilateral; Volume:  20%

Catheter:  Removed 12-days after surgery

Incontinent:  Yes (1/2 light pads per day)

Combination of Cialis and MUSE (alprostadil) three times weekly started 9-27-08

Returned to work 9-29-08 (18-19 days post-op)

PSA test result, post-op, 10/08: 0.0; 12/08: 0.0; 4/09: 0.0

 


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 6/22/2009 2:54 PM (GMT -6)   
Jerry1,

I had somewhat similar experience. My path slides were reviewed by Sloan Kettering and I just learned (months later) that they staged me higher than the original report from Duke. I have a rising PSA and am scheduled for a radiation treatment in Aug.

Now to what I think is the most importnant point in your post - 0.0 and <0.1 are the same. This is how they indicate that the PSA is below the sensetivity of the test. So, aside from confusion, you may not have anything to worry about.

As to your questions:

- I was told the salvage radiation rarely results in urinary incontinence, but it does stop recovery from RP. Since you are continent, you can expect to continue to be so, even if you need to do salvage radiation.

- Rising PSA can mean either a local recurrence (a few cancer cells left behind in the prostate bed and grew enough to produce detectable levels of PSA) or systemic failure (the cancer cells are else where in your body). Sometimes it is hard to know which it is. The PSA doubling time, Gleason score, positive margins, and time from prostatectomy to recurrence will tell whether it is more likely local or distant recurrence.

- They only do salvage radiation (of prostate bed) if they believe it is a local recurrence. They do not do radiation of other parts of the body unless they can see mets (extremely unlikely with your PSA levels). The other options to deal with recurrence include hormonal therapy and active surveilance.

All of this aside, I am a bit confused by your surgeon's reports. If you have lost nerves on both sides wouldn't it mean the cancer spread beyond prostate? (T3a v. T2a). At this point, I would go for a second opinion to someone outside this guy's group. You may also want to talk to a medical oncologist specialising in PCa (and not a urologist). Wach your PSA level very closely, but most importantly - don't allow this to run your life.

This disease robs us of not only health, but ability to lead a normal life and we need to fight on both fronts. As my Onc said, this is a chronic disease, most people die with it, not from it.

Best of luck - I hope you sort out your situation with the docs and more importantly, I hope PSA will remain undetectable (i.e. <0.1).

Greg

Previous 5 biopsies over 4 years negative

PSA going from 3.8 to 28

Father died from PCa @ 78 - normal PSA and DRE

Dx Nov 2007, age 46

PSA 29, Gleason 4+4=8

Decided to participate in clinical trial at Duke

6 rounds of chemo (Taxotere+Avastin)

1/8/2008

33.90

1/11/2008

29.50

1/31/2008

38.20

2/21/2008

32.00

3/13/2008

26.20

4/3/2008

26.60

4/24/2008

20.60

followed by RRP at Duke (Dr. Moul) on 6/16/2008

Pathology

Gleason downgraded 4+3=7

  Duke: T2c N0MX, one positive margin

  Sloan Kettering: T3a N0MX, extraprostatic extension, two positive margins

PSA undetectable for 8 months, then

2/6/2009

0.10

4/26/2009

0.17

5/22/2009

0.20

6/11/2009

0.27

6 Months ADT started 6/12/2009

IMRT to start mid-Aug


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25372
   Posted 6/22/2009 4:42 PM (GMT -6)   
Greg - It thought your post was good and well thought out, thanks for posting
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 5/9 .10, 6/9 .11, July 13 - meet with radiation oncologist
 
 


Jerry1
Regular Member


Date Joined Mar 2007
Total Posts : 460
   Posted 6/22/2009 4:51 PM (GMT -6)   
 
 
Geebra,
 
Thanks for the information not quite sure what is going on but Surgeon said he took nerves because on my original biopsy Gleason was 4+4 and wanted to be sure he got it all.  Final Path report downgraded to 3+3 said cancer contained in Prostate all surgical margins and lymph nodes negative Stage PT2A .  Second pathologist recently viewed agreed  cancer contained all margins and lymph nodes negative just raised Gleason score to 4+4.  Surgeon agrees 0.1 still undetectable but raise from 0.0 using same lab.  Fist lab was showing <0.1 this lab uses 0 to 4 no less then he assures me still undetable but slight increase said could be lab error will retest in si weeks.  You are right I cannot live worrying every day about my PSA score I am 70 years old in good shape but will probably die of something completely unrelated or from worring about this.
 
Thanks again for the support.
 
Jerry1
Age 69
DX 8/13/08 , PSA 4.0, Biopsy 14 samples 1 positive 12% of sample,
Gleason Score 4+4 =8  Bone scan and MRI negative
Da Vince surgery on Oct 17, 08 Florida Hospital Dr Vipul Patel
Post Gleason report  3+3= 6 Lymph nodes on both sides negative
margins Negative  Stage II (pt2a) 
Cath out on October 29th left in longer due to small leak.
11/19/08 dry no more pads
12/2/08 first PSA <0.1
 3/6/09 6 Month PSA 0.0
6/3/09 9 month  PSA <0.1
new gleason score of 4=4
 


Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 6/22/2009 6:08 PM (GMT -6)   
Gleason scores are not cut-and-dried. If you have cells on the borderline between 3 and 4, some analysts will categorize them as 3 and others as 4. It may even depend on what they had for breakfast! So your Gleason varying between 3+3 and 4+4, shouldn't be a cause for concern -- think of it as 3.5+3.5=7.

For higher Gleason scores, it is common for nerves to not be spared. Taking a wide margin, including the nerves gives the best chance of a "cure". I was in that category.

I agree any PSA reading of <0.1 is nothing to worry about. The body produces small amounts of PSA even without a prostate, and we should expect to see fluctuations. And of course, we don't really know what goes on in the testing labs -- what did they have for breakfast? :-)

If the worst happens, and your PSA continues to rise, you have the choice of radiation and/or hormone therapy. My reading from these forums is that salvage radiation has few side effects, but you still don't want to have it until you really need it. And even in this worst case, you should have a fairly normal life for many more years.
Pre-op:
Age 63 at diagnosis, now 64.
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores.
Operation:
Non-nerve sparing RRP on 7 March 2008.
Two nights in hospital; catheter out after 7 days.
Post-op:
Continent; no pads needed from the get-go.
Pathology showed organ confined and negative margins. Gleason downgraded to 4+4=8.
PSAs:
6-week : <0.05
7-month: <0.05
13-month: 0.07 (start of a trend?)
ED:
After a learning curve, Bimix injections (0.2ml) are working well. VED also works but we find it inferior to Bimix.


ChrisR
Veteran Member


Date Joined Apr 2008
Total Posts : 818
   Posted 6/22/2009 6:20 PM (GMT -6)   
O.K.  First of all I don't understand what your Dr. is worried about.  <.1 is undetecable. PERIOD!  Even the big wigs a Johns Hopkins state that <.1 is undetecable.  They also don't even require the ultra sensitive PSA.  I know, I had surgery by Dr. Partin and that is what he said.  When you get your slides read at J.H. you can bank on what they say.  Piano, I have never heard anyone claim what you stated about Gleason scores.   And there is a big difference between 4+4 and 3+3.
 
If you have a PSA of <.1 or 0.0 any rational Dr. would not be doing anything with your slides.  YOUR PSA IS UNDETECABLE AT <.1  This is one of the craziest stories I have heard on this web-site next to the one from the guy whose Dr. didn't take all of his prostate out and then sent him for radiation.  I would find another Dr.

Post Edited (ChrisR) : 6/22/2009 6:26:07 PM (GMT-6)


CaPCa
Regular Member


Date Joined Aug 2007
Total Posts : 118
   Posted 6/22/2009 10:06 PM (GMT -6)   
I'm not sure that I follow this story completely, but there is no such thing as a "0.0" from any PSA test. If that is what you were told or what was written, someone is distorting the true lab reading, either by mistake of to simplify the result. Also, a "<0.1" is considered "undetectable" almost universally.
 
CaPCa
Age:45 (44 when diagnosed)
Father diagnosed and cured at age 52.
08/21/07: Diagnosed with T1c cancer
1 of 12 biopsy cores positive; 10% tissue
Gleason score: 3+3=6
PSA level prior to biopsy: 4.3 (velocity < 0.4ng/ml)
10/19/07: da Vinci prostatectomy by Dr. Vipul Patel
              Difficult surgery due to prostate inflammation.
              Both nerve bundles spared.
              Spongy erections began within 24hrs of surgery!
10/24/07: Catheter out; down to 1 Serenity pad/day next day.
              Final pathology: neg margins, no capsular penetration,
              Gleason 3+3=6, 5% tumor involvement, multi-focal.
11/04/07  First usable erection with Cialis
11/22/07  Thanksgiving - Bye-bye, pads
01/17/08  First post-surgery PSA result: < 0.008 ng/ml
03/17/08  Erection quality mostly back to pre-surgery levels with Cialis;
              have not tried without meds yet.
04/23/08  Second post-surgery PSA result: < 0.008 ng/ml
07/30/08  Third PSA: 0.01 ng/ml
11/04/08  One year PSA: 0.01
              Still taking 10mg Cialis every other day - enjoying the results
              too much to stop yet.
02/07/09  Taking 5mg Cialis every other day - having too much fun to try
              to stop for now.
03/23/09  PSA: 0.02
 


mlbsm
Regular Member


Date Joined Mar 2008
Total Posts : 85
   Posted 6/22/2009 11:09 PM (GMT -6)   
If my Doctor first told me he spared a nerve bundle, and then changed his mind later, I'd find a new Doctor faster than he could sober up.

Have a PSA test done tomorrow and if it's 0.01, hit the links.
DIAG. 2/08
DRE POSITIVE
PSA 6.8
CONTAINED, LEFT SIDE, GLEASON 9
LUPRON, (3 MO.) 2/28
RRP, 3/26, HOME 3/31
GLEASON SCORE, 3+4
TUMOR CONFINED TO THE PROSTATE, INKED EXTERNAL SURFACE FREE OF INVOLVEMENT. VD AND SV CLEAR AS WELL AS LYMPH NODES AND A BLADDER SECTION.
PSA 5/21 O.O1 UND TESTOSTERONE 0
PSA 6/30 O.OI UND TESTOSTERONE 10
PSA 9/30 O.O1 UND TESTOSTERONE 311
PSA 1/12 O.O1 UND. TESTOSTERONE 219
ED, BUT I CAN FIND WAYS AROUND IT.
PSA 4/10 O.O1 UND. TESTOSTERONE 119 Rx. FOR ANDRO GEL
PSA 6/15 O.01 UND. TESTOSTERONE 217


KeyWestPirate
Regular Member


Date Joined May 2009
Total Posts : 60
   Posted 6/22/2009 11:15 PM (GMT -6)   

Jerry, you have my heartfelt sympathy.  This inability to settle on a Gleason score with the prostate in hand is unsettling.  Maybe they just mis-labeled your slides.

If you do the homework, and you did,  you should be able to expect a good outcome, consistent with your situation going into the surgery.  At least you're dry!  I hope you are getting upset for no good reason.

 I've read studies where a small amount of benign prostate tissue will be left behind and produce a small and fluctuating psa.  Of course, the number never goes anywhere significant if it is benign.  I've had the same issue with conflicting PSA numbers, my GP uses a lab that reports .01, my urologist's lab reports .1   So far my insurance has not complained about getting psa tests from both the GP and urologist. 

  >>> I agree with Zufus,  I'd have my eye doctor request a psa if I though he would do it. There is no such thing as too much information.

Both doctors claim that their number is "undetectable",  with the GP agreeing to short term testosterone replacement therapy two months after the surgery.  The urologist is probably still not speaking to him.

I have a few questions to pose to the group  (and I'm going to pose them to my urologist/surgeon at our July meeting):

If you have a robotic RP, like Jerry,  shouldn't your surgeon be able to carefully inspect surrounding tissue, take a snippet of lymph tissue or any other suspicious tissue for immediate pathology review?  With the camera illumination and magnification available with the Da Vinci,  shouldn't he see suspicious tissue?  This is touted as one of the big pluses of going Da Vince rather than open, the ability to see under, around, big and bright, and in 3D.

We may be getting into a new area of concern, where time on the Da Vinci is so tightly scheduled that the surgeons are rushing the surgery. 

If there is any question re: malignant vs benign tissue, can't the hospital do immediate pathology work even prior to removing the prostate?  They do this with other surgeries.  Biopsies and the resulting Gleason are notoriously iffy, the surgeon must have some indicators when he gets in there as to extent of the cancer.  Going in, my surgeon said he didn't think that there would be any problem keeping the nerves, based on my numbers,  but he couldn't promise until he was actually there.  That indicates to me that there is some visual indication of the extent of the cancer.

Another question, unrelated to this post, but still relevant to our group, and something I've been wanting to ask:  Is there really any purpose to doing a DRE anymore to Dx PCa?  I understand that it is an insurance reimbursible procedure, but does it really identify any Pca that the psa test would not catch much earlier?  I guess my real question is, if your psa is below the threshhold for concern (and prostate size, condition, presence of BPH can create a pretty big psa number by themselves),  is there a possibility of a "silent tumor" that does not generate a significant psa number and needs to be found by some other means?  Can a tumor be manually detectable without creating a psa number that would indicate a biopsy?

 

Finally, a comment:  Jerry might not have had the renowned surgeon he so carefully sought out actually do the surgery!    His assocates have to learn somewhere, somehow, sometime.  His surgeon was undoubtedly there, but it may have been another's hands at the Da Vinci console.

Where is the post about the doctor who took part of the prostate out??  I'd like to read it.

 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25372
   Posted 6/23/2009 7:21 AM (GMT -6)   
Keywest:

You would have dig back till around mid-January of this year to still catch the posts of the guy who only had part of his prostate removed, forgot what name he used, but he lived in my state, in Florence SC. He is in the middle of a lawsuit for malpractice as we speak. It was a story like his that makes me weary of robotic surgery (no offense to anyone with a succesful one). There is something to be said about the benefits on open surgery, where the surgeon can see your innards with his real eyes and touch things with his real hands. Only speaking for myself, I didn't want to think of my surgeon playing some video game of my body, too old and set in my ways for that.

Value of DRE for PC dx? I think it is still a good an inexpensive way to catch the obvious tumors in advance. I have had 2 since my surgery. I realize that many, myself included, never had a positive DRE, plenty of men do, and it can make it easier to hone in on the location of the PC.

A PSA score of <.1 is undetectable. There is no true complete .00 or .000. Chasing micro variations on the ultrasensitive tests will keep you crazy in fear all the time. And I am just as guilty as the next guy.

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 5/9 .10, 6/9 .11, July 13 - meet with radiation oncologist
 
 


Jerry1
Regular Member


Date Joined Mar 2007
Total Posts : 460
   Posted 6/23/2009 10:19 AM (GMT -6)   
 
 
Hi All,
 
I want to thank you all for your advice and comments.  I am going to another urologist here in  in Palm Beach  he is the one that gave me the last two PSA Tests and felt it could just be lab error but said he cannot retest for six weeks.  If its just for insurance I will go to my internist and have it done again.  Appartently this doctor and the surgeon feel a 0.0 is a valid number and then 0.1 is a rise.  At first I also thought no problem it is still undetectable but thought I would send to the surgeon for his opinion then all this mess started.  They cannot give me any good reason for the different in scores especially since my original biopsies were a 4+4 going in I thought it would be that or more on the final and was shocked when they said they took everything with a final score of 3+3 . I guess they did not do any testing on tissue during the biopsy now if it is truely a 4=4 I guess it was better to take the nerves but it is to much miss information.  It is indeed going to Jonathan Epstein in JOhn Hopkins I also have an offer from a family friend to have his brother who is a respected pathologist also look at it does anyone feel this is necessary or is John Hopkins opinion the best.
 
Thanks again,
 
Jerry1  
Age 69
DX 8/13/08 , PSA 4.0, Biopsy 14 samples 1 positive 12% of sample,
Gleason Score 4+4 =8  Bone scan and MRI negative
Da Vince surgery on Oct 17, 08 Florida Hospital Dr Vipul Patel
Post Gleason report  3+3= 6 Lymph nodes on both sides negative
margins Negative  Stage II (pt2a) 
Cath out on October 29th left in longer due to small leak.
11/19/08 dry no more pads
12/2/08 first PSA <0.1
 3/6/09 6 Month PSA 0.0
6/3/09 9 month  PSA <0.1
new gleason score of 4=4
 


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 6/23/2009 1:54 PM (GMT -6)   
I asked my doc about sending tissue to pathology while the operation was going on and he told me that he used to do that but found out that it didn't really make any difference in the outcome. I don't quite understand but this is a guy that is well over 500 operations and I trust his judgment. On nerve sparing, my doc told me up front that his first aim was to get the cancer and then, if he could, to spare the nerves. He said that I was a close case and that he wouldn't know until he got in there. I agreed.
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.


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 6/23/2009 2:28 PM (GMT -6)   
Key West Pirate

I had a palpable tumor for 3 years, and negative biopises, and a PSA of 2.7. My rate of change was slow. Finally my 2009 biopsy finds a Gleason 9 tumor, but only in 2 cores.

So, I am guessing that PSA, while slighly elevated, did not detect what the DRE found. They would never have biopsied if the DRE had not found the tumor.
Age 58
PSA 4.47
Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09
Nerves spared
0/23 lymph nodes involved
pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck.
Try 3 tubes where no tubes are supposed to be for 2 weeks !
Neg Margins, bladder neck negative
Thankful for early diagnosis, and U.S. healthcare
Living the Good Life, cancer free
6 week PSA undetectable. 


Jerry1
Regular Member


Date Joined Mar 2007
Total Posts : 460
   Posted 7/2/2009 11:05 AM (GMT -6)   
 
 
Hi All,
 
Well received a copy of the second biopsy that was done at the Hosp. where I had my surgery.   All it said was that it was reviewed and modified on 5/28/09 and Addenda if any, were at the top of the report.  There was one Addendum to add a revision to the tumor summary as follows:
Tumor quantitiation: Approximately 10% of the entire gland is involved by tumor.
Gleason score: 4+4
Thats it, everything else is the same :
Negative for periprostatic or seminal vesicle invasion pT2c
Surgical margins Negative
Lymph Nodes on both sides Negative
 
I have no idea from this report why the gleason was changed and cannot get and answer maybe when the report comes back from John Hopkins it will have more information.  However, another strange thing is my slides were reviewed again on May 28th and I had not been in contact with the surgeon for months until the PSA issue in mid June.  They told me that is why the slides were reviewed but it happen before I ever contacted them and cannot get a answer to this question.  I feel like I am missing something big with all this miss information.  If I had never contacted them about the rise in PSA would I have never been told about the revised Gleason Score?  My wife tells me you have to keep following up with these doctors and questioning them or who knows what will happen.  Sorry for going on so long.
 
Jerry1
Age 69
DX 8/13/08 , PSA 4.0, Biopsy 14 samples 1 positive 12% of sample,
Gleason Score 4+4 =8  Bone scan and MRI negative
Da Vince surgery on Oct 17, 08 Florida Hospital Dr Vipul Patel
Post Gleason report  3+3= 6 Lymph nodes on both sides negative
margins Negative  Stage II (pt2a) 
Cath out on October 29th left in longer due to small leak.
11/19/08 dry no more pads
12/2/08 first PSA <0.1
 3/6/09 6 Month PSA 0.0
6/3/09 9 month  PSA <0.1
new gleason score of 4=4
 

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