Positive Margins and Seminal Vesicle Involvement, T3b

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dadwillsurvive
New Member


Date Joined Dec 2009
Total Posts : 6
   Posted 12/10/2009 7:19 AM (GMT -6)   
Hi,

My Dad recently got his pathology report back from his prostatectomy and it showed he has T3b prostate cancer with seminal vesicle involvement, positive margins, but thankfully no lymph node involvement. I was wondering if anyone else had this diagnosis and what/if any follow-up treatment did you do? How soon did you have your post-surgery PSA, if you started radiation, how soon after surgery?
It would be really great to hear from someone who has gone down this road already. Looking for any comforting words- thank you very much.

Have a good day,
Pauline

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/10/2009 9:17 AM (GMT -6)   
Hello and welcome to HW, Pauline.

Another daughter watching out for her day, I always love to see that.

His pathology report does have a lot of seriousness to it. One of two things will probably happen next. They will either watch his post surgery real close, and if they verified reaccurance, then they would want him to have Radiation Treatments. Or, with his report, they may reccomend that he start Radiation as soon as he's well enough from his surgery.

I had my first PSA exactly 3 months after open surgery.

If you could put his stats at the bottom of your posts, it would help. Go to "Control Panel" at the top of the screen and set up his profile info. It would make it easier to understand his journey so far.

Please keep us posted and ask as many questions as you need.

Several of us have had radiation after our surgeries, I just completed mine 2 weeks ago.

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
Incontinence:  1 Month     ED:  Non issue at any point post surgery
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 sess/72 gys ,cath #8 33 days, Cath #9 in 35 days, 12/7/9 - Cath #10 in place


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 12/10/2009 10:36 AM (GMT -6)   
The most current studies say that if adjuvant radiation is begun within 4 months after surgery, the chances of success is much higher.
 
On the downside, if the patient is not continent when the radiation starts, he most likely will not improve.  Same for ED.
 
Goodlife 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injections


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4223
   Posted 12/10/2009 12:27 PM (GMT -6)   
Pauline,
If there was seminal vesicile invasion there is a high probability of lymphnode involvement. The lymphnodes sampled during surgery are not the lympnodes that are most likely to be involved through seminal vessicle invasion as there are two lymphatic paths that PC can take. Most doctors don't know this as it was just discovered in a large study just released in Germany and Holland. You didn't mention his pre surgery PSA or his Gleason grade or % involvement. All of these have a bearing on what his next steps should be.
I would definately be looking for another opinion from a good prostate oncologist as he is better able to guide you through your next steps. You must determine if the PC is still contained in order to have an effective salvage treatment or your Dad will just add to his side affects without any befefits. From what you have discribed salvage radiation will have a very low probability of success.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


Opa N
Regular Member


Date Joined Sep 2009
Total Posts : 150
   Posted 12/10/2009 6:12 PM (GMT -6)   
Hi Pauline,
Sorry that your Dad has to walk this path. Please check my stats below. They will give you the dates and timeline of my pT3b diagnosis. I saw my urologist/surgeon, a medical oncologist/hematologist, and a radiation oncologist. The consensus was that I needed to start Adjuvant Combination Therapy as soon as possible. My positive margins were fairly extensive at the base, and the seminal vesicle involvement was the clincher for doing both Androgen Deprivation Therapy (Lupron) and IMRT. 1st Lupron injection was on Oct 20. IMRT will begin on Jan 12. My 1st PSA was at 1 month and was undectable at <0.01. 2d PSA at 2 months gave the same result. With pT3b, you don't want to wait for a rising psa to start salvage radiation therapy. Hope this helps.
Roger


 Age 67 at diagnosis. Treated for coronary artery disease (CAD) since 1998, and under control with medications.

2/6/09              Routine physical, with DRE and PSA Test. PSA 4.02. Referred to Uro

4/20/09            TRUS  w/needle biopsy

4/23/09            Diagnosis PCa with Gleason 4+3 in 2/2 cores, Gleason 3+3 in 5/10 cores.

                        CT scan and Bone Scan both negative. Stage T2C.

8/27/09            DaVinci RP at WakeMed Cary NC with Dr. Tortora. Discharged 8/28.

9/8/09              Catheder removed. Path post-surgery confirms PCa, with Gleason 3+3 with scattering of 4. Positive margins in L & R posterior, R and L seminal vesicles, with perineural invasion.  Stage pT3b.

9/30/09            PSA Post-Op <0.01. Met w/Uro/Surgeon to review surgery and path report. Referred to Prostate Oncologist and Radiation Oncologist. Appointments set for 10/8.

10/8/09            Met w/ both oncologists. Adjuvant Combination Therapy to begin ASAP.

10/21/09          First Lupron injection. 30 mg dose (4 month)

11/2/09            PSA 2-month <0.01. Cystoscope w/calibration and dilation to remove scar tissue from urethra. Big relief.

 

Initial incontinence pretty bad, starting w/6 Depends pants/day. Gradually getting better, with dramatic reduction in leakage around 9/20. Currently on 1 pad during the day and one at night (for security). Actually totally dry at night.

 

 

 

Post Edited (Opa N) : 12/10/2009 6:42:08 PM (GMT-7)


keysailfisher
Regular Member


Date Joined Dec 2009
Total Posts : 346
   Posted 12/10/2009 6:31 PM (GMT -6)   
Not to change the subject, but i just signed up yesterday. Opa n Dr.Tortora is also my uro, how do you feel about him? I just found out 12/9 that i have Pc. How was the procedure? I also see that you were a GC. I have my own little home improvement business. Nice to see someone in this area. Maybe i should of started a new thread. sorry
age 45
3+4=7
psa 3.09 at time of physical
Biopsy done 12/9


Opa N
Regular Member


Date Joined Sep 2009
Total Posts : 150
   Posted 12/10/2009 7:39 PM (GMT -6)   
Keysailfisher:
I sent you an email so we can be off this thread.
Roger

 Age 67 at diagnosis. Treated for coronary artery disease (CAD) since 1998, and under control with medications.

2/6/09              Routine physical, with DRE and PSA Test. PSA 4.02. Referred to Uro

4/20/09            TRUS  w/needle biopsy

4/23/09            Diagnosis PCa with Gleason 4+3 in 2/2 cores, Gleason 3+3 in 5/10 cores.

                        CT scan and Bone Scan both negative. Stage T2C.

8/27/09            DaVinci RP at WakeMed Cary NC with Dr. Tortora. Discharged 8/28.

9/8/09              Catheder removed. Path post-surgery confirms PCa, with Gleason 3+3 with scattering of 4. Positive margins in L & R posterior, R and L seminal vesicles, with perineural invasion.  Stage pT3b.

9/30/09            PSA Post-Op <0.01. Met w/Uro/Surgeon to review surgery and path report. Referred to Prostate Oncologist and Radiation Oncologist. Appointments set for 10/8.

10/8/09            Met w/ both oncologists. Adjuvant Combination Therapy to begin ASAP.

10/21/09          First Lupron injection. 30 mg dose (4 month)

11/2/09            PSA 2-month <0.01. Cystoscope w/calibration and dilation to remove scar tissue from urethra. Big relief.

 

Initial incontinence pretty bad, starting w/6 Depends pants/day. Gradually getting better, with dramatic reduction in leakage around 9/20. Currently on 1 pad during the day and one at night (for security). Actually totally dry at night.

 

 

 

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