Experience at Hopkins (VENTING)

fjgolf,

That is a terrible hospital experience, I would have been rasing holy h*** about that. I sometimes wonder myself, if the "big name" surgeons and the "big name" hospitals really add any value to our journeys. Unless you lived in Upstate SC, you would have no reason to have heard of any of my doctors or the hospital I go to for surgeries.

My pathology was organ confined, and one minute positive margin. Unfortunately, the one margin started the PC off again, and thus I am in the middle of Salvage Radiation.

Good luck to you.

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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: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sessions/72 gys.

That's awful. I'm so sorry.

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Co-Moderator Crohn's Forum.

Medications for Crohn's ~~ Diet and Nutritional Therapy for Crohn's ~~ Dealing with Abscesses and Fistulae ~~

fgolf, what a horrible experience you had - at the top PCa hospital on the east coast! What a darn shame, and a disgrace.

Your pathology report is weird...t3a denotes extraprostectic extension (which is not, to my knowledge, organ confined). EPE means that the cancer went into the capsule and broke through it somewhere - it is different that capsular penetration which I believe might still be considered "local." My husband is a t3a and his disease is considered "locally advanced" yet all his margins and seminal vesicles were clean. The chance of recurrence is greater but by no means a sure thing. In my husband's case, the surgeon knew there was a chance of EPE because one of the cores was very close to the edge of the gland. The surgeon cut much wider around the prostate than he needed to in order to obtain a clean margin.

May I suggest you have a discussion with your surgeon about your path report as it seems contradictory especially in light of the statement "don't be shocked if the cancer returns in 2 to 3 years".

Fgolf, I truly hope you are recovering nicely and can leave your hospital experience behind. When do you next see the surgeon?

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Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (extraprostectic extension in posterior left). Perineural tumor infiltration present. Apex margin, bladder neck and SV negative. Gleason 3+4 (no change from biopsy). PSA results: April 2008 0.1; May 2008 0.0; August 2008 0.0; November 0.0; February 2009 0.0; May 2009 0.0; August 2009 0.1; September 2009 0.3. Met with radiation oncologist and began process for salvage radiation. CT scan and bone scan done on October 8. One spot on bone scan (clavicle) being investigated. Third PSA taken on October 16 - PSA IS UNDETECTABLE! Next PSA scheduled for early December. Urged not to begin radiation treatment until it's needed (no problem there!).

FJGolf,

That is pretty crook hospital experience you describe there. The report seems a little contradictory at first glance but all in all I think it is pretty good. The P in Pt3a means it is the pathology stage (report of the removed prostate as opposed to the clinical staging given before removal).   Extent of tumour is a comparison of tumour volume to prostate volume which is moderate (that's good). While the report says organ  confined it makes an exception because there is a point of very small focal extention. There is a point where the tumour is through the capsule ( a fibrous layer around the gland itself much like the skin on an orange) but it does point out that this is a very small focal point extending only 0.1 of a millimetre). Additionally the prostate is never removed clean as a whistle but surrounding fatty tissue is taken with it and the edge of this fatty tissue is called the surgical margin. Your report states that the focal extention ends barely into the fatty tissue therefore your surgical margin is clear of tumour. All in all a pretty fine result and it is a credit to your surgeon that he was completely upfront and  mentioned the slight possibility that it could reoccur rather than say "I got it all!" No surgeon worth his salt should ever say "I got it all and you are cured"

Bill

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1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)
PSA February 09 <0.01
PSA August 09 (2 year mark), <0.01