What will the future bring?

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brad2513
Regular Member


Date Joined Oct 2009
Total Posts : 22
   Posted 10/17/2009 10:34 AM (GMT -6)   
   I had a daVinci prostatectomy seventeen days ago, and things seem to be going fine at this point, except the incontence is some what discouraging. I'm about 75% when at home or at the office, maybe 20% when outside (cool wheather maybe to blame). Allmost everything I read says Kegals will help this greatly, but I have been instructed by my doctor not to do them until 6 weeks postop. What concers me the most is my patholgy report came back stating that was only 2%, but had positive margins in the left dorsolateral of 0.8 and 0.3mm in the same section. My doctor told me that normally radiation is started right away, but because of my age he has elected not to do this at this point. My next visit will be in 3 months. Surgery was done at Fremont area medical center. It's a small hospital, but has very qualified uroligists that do surgery there.          
 
age 46
psa 3.9
preop gleason score 3-4
postop gleason score 3-4
perineural invasion focal
extraprostatic extension negative
seminal vesicle negative
vesical neck margin negative
apex margin negative
peripheral margin positive
               left dorsolateral 0.8mm
               left dorsolateral 0.3mm
               right dorolateral 2.0mm
tumor T2c
lymph nodes negitive

Post Edited (brad2513) : 10/17/2009 6:31:36 PM (GMT-6)


Arnie
Regular Member


Date Joined Aug 2009
Total Posts : 372
   Posted 10/17/2009 11:02 AM (GMT -6)   
Hi Brad2513......welcome to HW. As others will say, sorry you had to be here, but you'll get a lot of support and info from the members. You're very early in the incontinence battle, and at 17 days post-op, your progress seems to be pretty good. I did some kegels before surgery, and some after, but mostly I let nature do its thing, and in 3 months I was completely dry 24/7. But everyone is different and it depends on many factors. As for your path report, your numbers are very similar to mine, but I didn't have any positive margins. Guys that have had such will no doubt begin to chime in......if your MD is suggesting a hold pattern, he probably wants to do so until after the first Post-op PSA check. If it's a statistical zero, he may then do another 3-month wait to see if there's a rise or not. Concentrate on what you can control which is walking at this point, eating well and resting. Keep posting to keep us posted--------P.S.-where did you have your suregery?
                    Arnie in DE
 
 
Age 56 (biopsy & surgery)
PSA at Diagnosis-3.9
Biposy 8/19/08--4 of 12 cores positive; 5% involvement, Gleason 6 (3+3)
 
Surgery 1/26/09-DaVinci Robotic Prostatectomy at Presbyterian Medical Center/HUP-Phila, PA
Dr. David Lee
 
Pathology Report- Adenocarcinoma, no capsular involvement, seminal vesicles clear, lymph nodes clear, negative margins, Gleason 7 (3+4), Stage T2C, Prostate 61.8 grams, gland involvement 2-10%
 
Catheter removed after 8 days, totally dry at 3 months. ED issues continue, Viagra (via ADC) nightly (100mgs), VED use in earnest at 6 months. "Ball Park Frank" plumping at this point.
3 month PSA--<0.1
6 month PSA--<0.1


LenB
Regular Member


Date Joined Jul 2009
Total Posts : 102
   Posted 10/17/2009 11:28 AM (GMT -6)   
Hi Brad,

I had my robotic surgery (/12 and the incontinence is very frustrating but it seems to get a little better every week. I am dry through the night but the days requires 4-5 pads. The cath has been out since 9/23 ( 3 1/2 weeks) Hang in there.

Len

Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 10/17/2009 11:55 AM (GMT -6)   
Statistically speaking, any margin less than 3mm does not significantly raise the chance of recurrence. Dr. Walsh in his book says that 40%+ of positive margins do not leave any cancer behind. So, wait and see may not be a bad idea.

Father died from poorly differentiated PCa @ 78 - normal PSA and DRE

5 biopsies over 4 years negative while PSA going from 3.8 to 28

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)

PSA prior to treatment on 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60

RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small 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

Salvage IMRT + 6 Months ADT: Casodex started 6/12/2009, Lupron 6/22/2009, PSA 6/25/2009-0.1, T=516, 7/23/2009-<0.05, T<10, IMRT to start mid-Aug


Mavica
Regular Member


Date Joined Jun 2008
Total Posts : 407
   Posted 10/17/2009 8:27 PM (GMT -6)   
If you have doubts about the advice being given by your urologist, find another in whom you'll have confidence . . . or from whom to seek a second opinion.  Ignore the books and non-professional advice given on web forums, because it's your life and the risks are to you and your health/life.  Best wishes for a speedy recovery.

Age:  60 (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; 9/09: 0.0

 


Doc
New Member


Date Joined Sep 2009
Total Posts : 18
   Posted 10/17/2009 9:42 PM (GMT -6)   
Brad -

Welcome to the club. You are among friends here.

The positive margins you describe sound quite small - 0.8mm and 0.3mm. You nee to understand that what is seen on the glass slides is the best guage we have of what was going on in your body, but certainly does not tell the whole story and can sometimes be misleading. When a prostate is removed, it does not just shell out, billiard-ball smooth. It typically has to be bluntly dissected out or cut out, producing a much more ragged surface. The pathologist will often apply marking inks to the surface prior to doing the pathologic gross dissection. Then, under the microscope, if you see tumor cells with ink on them along the edge, it is presumed to represent a positive margin. But because the surface is ragged, some of those painted surfaces may actually represent redundant folds that were joined to each other in-vivo, meaning that they may not represent true margins at all. Seeing tumor there coulld represent a very close margin (less than 1mm), but possibly not be truly positive. On the other side of the ledger, consider that the sections the pathologist is looking at are typically 4 microns thick, and your prostate is maybe 5-7 cm from front to back. In order to sample ALL the margins, the patholgist would have to submit a minimum of 1,250 "whole mount" sections to see everything. This is never done - more typically, the patholgist may be looking at 30 - 60 sections, and you cannot report what you cannot see. So, you can have false negative margins due to sampling deficiency, and false positive margins due to ragged surface topography. That is why we all undergo testing for biochemical recurrence periodically after surgery.

Regards,

Doc
PCa Dx 07/09: 3+3 in 2 cores
Age at Dx 54
daVinci RRP 09/17/09
Final path 3+3, <5%, margins neg, pT2a.
 


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 10/17/2009 10:11 PM (GMT -6)   
Walk, walk, walk the best possible recovery activity. Remember that even if some cancer cells were left at the margins they may have been cut off from their blood supply and may have died before you posted. Cancer cells are not super -- just perverted. I would call your path report very good with a high likelihood that you are, in fact, cured.
Of course, you now get to join all of us who wait from one PSA test to the next, but if you check the nomograms you will see that it is about a 70-30 chance that you will never see PC again. So for now, concentrate on healing and living.

Remember that those of us that you find hanging around here are the minority. Many others have passed through and left because PC is no longer an issue for them. We welcome you here, but we hope for your speedy departure.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 10/18/2009 7:26 AM (GMT -6)   
Doc, thanks for that great description of the path. report process and the details. If you don't mind, I'm gonna copy it for possible further use when the subject arises in the far future.. smilewinkgrin

Brad, you've gotten a wide variety of the best advice you will find. Welcome, glad you found us, hate to see ya.. smilewinkgrin
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
24 mts: PSA's: .04 each test since surgery, Bimix .3ml PRN or Trimix .15ml PRN


brad2513
Regular Member


Date Joined Oct 2009
Total Posts : 22
   Posted 10/18/2009 7:33 AM (GMT -6)   
Thanks everyone for your replies, they have been helpfull, and have some piece of mind. I am still learning about all of this, and am finding that allthough the information here is not professional I find it comforting  because it is from people that have gone through or going through the same things I am. I am sure there will be many more questions to come, and will every responce. Thanks again and god bless everyone.
age 46
diognosed age 45
PSA 3.9
preop and postop gleason score 3+4
daVince robotic surgery at Fremont area medical center, Fremont NE, 9/30/2009
stage T2c
involvement 2%
perineural invasion focal
extraprostatic extension, seminal vesticle, and lymph nodes negative
apex margin negative
peripheral margins positive, left dorsolateral 0.8, and 0.3mm, right dorsolateral 2.0mm


Doc
New Member


Date Joined Sep 2009
Total Posts : 18
   Posted 10/18/2009 7:46 AM (GMT -6)   
James -

No problem archiving the description of how the path exam is done. I see this all the time. More typically, it occurs in women who are undergoing lumpectomy for breast cancer. A few cancer cells are seen on a ragged inked surface, and have to be reported as a focally positive margin. So then the woman undergoes a second surgery to remove additional tissue from around the original lumpectomy cavity, and we never find residual cancer in that second specimen. I am always left wondering if this is because the first margin was not truly positive due to its topography, or it was truly positive but there is no way to sample the entire inner surface of the lumpectmy cavity in the re-excision specimen.

Doc
PCa Dx 07/09: 3+3 in 2 cores
Age at Dx 54
daVinci RRP 09/17/09
Final path 3+3, <5%, margins neg, pT2a.
 


Mbshine
Regular Member


Date Joined Aug 2008
Total Posts : 67
   Posted 10/18/2009 7:49 AM (GMT -6)   
brad mny thanks for the post and doc and james tremendous thanks for the fine comments...on the eve of DaVinci I found this thread very reassuring and informative...I am thinking positive thoughts.....off to MSKCC in ayem for Dr Guillonneau to work his magic.

mbshine



AGE 62
DX 7/08
psa HAD GONE FROM 1.7 TO 4.3 IN THREE YEARS...DIGITAL AND ULTRA SOUND EXAM SHOWED NO ENLARGEMENT.
BIOPSY SHOWED 2 OF 12 CORES POSITIVE.
TWO TUMORS SHOWED GLEASON 4+3 AND 3+4
NO INDICATION OF ESCAPE FROM CAPSULE OR METASTASIS
STARTED CONSULTATIONS AT SLOAN KETTERING 8/09
DR GUILLONNEAU SAID NO SURGERY UNLESS MASSIVE WEIGHT LOSS.
AT DX 333 LBS, SLEEP APNEA, AND HIGH BP
BARIATRIC SURGERY RECOMMENDED.
LAP BAND SURGERY IN EL PASO, TX 1/23/09
10/1/09 276 LBS, TRIGLYC AND CHOL NORMAL, NO SIGNS OF SLEEP APNEA, ONE BP RX REMOVED AND OTHERS CUT DOSAGE IN HALF;

STARTED QUARTERLY ZOLODEX BY TAOS,NM UROLOGIST, WHO TRAINED AT MSKCC, INJECTIONS AND CASODEX 50MG DAILY 9/08

davinci scheduled 10/19/09

Mbshine
Regular Member


Date Joined Aug 2008
Total Posts : 67
   Posted 10/18/2009 7:49 AM (GMT -6)   
brad mny thanks for the post and doc and james tremendous thanks for the fine comments...on the eve of DaVinci I found this thread very reassuring and informative...I am thinking positive thoughts.....off to MSKCC in ayem for Dr Guillonneau to work his magic.

mbshine



AGE 62
DX 7/08
psa HAD GONE FROM 1.7 TO 4.3 IN THREE YEARS...DIGITAL AND ULTRA SOUND EXAM SHOWED NO ENLARGEMENT.
BIOPSY SHOWED 2 OF 12 CORES POSITIVE.
TWO TUMORS SHOWED GLEASON 4+3 AND 3+4
NO INDICATION OF ESCAPE FROM CAPSULE OR METASTASIS
STARTED CONSULTATIONS AT SLOAN KETTERING 8/09
DR GUILLONNEAU SAID NO SURGERY UNLESS MASSIVE WEIGHT LOSS.
AT DX 333 LBS, SLEEP APNEA, AND HIGH BP
BARIATRIC SURGERY RECOMMENDED.
LAP BAND SURGERY IN EL PASO, TX 1/23/09
10/1/09 276 LBS, TRIGLYC AND CHOL NORMAL, NO SIGNS OF SLEEP APNEA, ONE BP RX REMOVED AND OTHERS CUT DOSAGE IN HALF;

STARTED QUARTERLY ZOLODEX BY TAOS,NM UROLOGIST, WHO TRAINED AT MSKCC, INJECTIONS AND CASODEX 50MG DAILY 9/08

davinci scheduled 10/19/09

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 10/18/2009 8:22 AM (GMT -6)   
mbshine,

I wish you all the best for your surgery tommorow. I will be most happy to hear that you are on the other side, the recovery side. May your surgeon and davinci have great skills on your body.

We will look forward to your first report when you are able.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/09 met 2 rad. oncl, 7/09 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 - out  38 days, 9/14/9 - met 3rd rad. oncl.agree to start radiation, mapping on 9/21/9, 9/24 - mtg with uro/surg, 9/29- pre-op, 10/1 - 3rd corr. surgery - suprapubic cath/hard dialation, 10/5 - began IMRT SRT - 39 sessions/72 gys.

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