Just found this place - checking in

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Hardlyrob
New Member


Date Joined Sep 2017
Total Posts : 12
   Posted 9/11/2017 11:38 AM (GMT -7)   
Hi Guys;

Just found this place a couple of weeks ago, and checking in.

I was diagnosed with a PSA of 34.2 in May at age 53 - no symptoms of anything. That started the dance of the urologists. TRUS biopsy of 14 cores, 9 positive. Of those 4 were 4+3 and involved 90% of the core, and the other five were 3+4 involving 5% to 80% of the core. These were read by Urology Consultants of North Shore, and Lahey Burlington (MA) with the same results.

Changed urologists to get into the Lahey Burlington (MA) Institute of Urology - very experienced RA RP group. Went ahead with abdominal CT - didn't show much; bone scan - negative, more blood work, and an MRI pre-surgery - no surprises in any of it. Decided on RA RP vs. radiation as this would give a definitive staging of the cancer. And when discussing with both old and new urologists (old urologist is about to retire, and doesn't do surgery any more, but was willing to consult with me), both used the same argument that the worst case scenario with surgery is better than the worst case scenario with failed radiation (salvage surgery, 50/50 chance of permanent incontinence).

Had the RA RP on August 24, the surgery went well, and I'm healing well (some drainage that started 10 days after surgery - a bit odd, but not unheard of). Surgery at Lahey Burlington with Dr. Canes (4,000+ RA RP surgeries and very well regarded in the "industry").

Went back on this past Friday and got the catheter out, met with Dr. Canes to discuss the case, next steps and the final pathology report. Final pathology was a surprise to both him and me, and not very good news:
- extraprostatic extension through the capsule (Surprise!)
- 4 of 8 pelvic lymph nodes positive for metastatic cancer (Surprise!) (i know metastatic can be argued as they are still in the pelvis)
- One positive margin in the posterior of about 5 mm (Surprise!)
- Invasion of the seminal vesicles - both sides
- Cancer on both sides of prostate
- The Gleason was the same as the biopsies
- So that makes me T3b N1 M0
- Partial nerve spring on right side, none on left
- Stress incontinence; ED

So not a great set of outcomes, now I wait for 7 weeks for a PSA which will determine what we do next. Most likely HT and ART.

Any and all thoughts and opinions are welcome.

Cheers!

Rob

Herophilus
Veteran Member


Date Joined Sep 2009
Total Posts : 635
   Posted 9/11/2017 11:44 AM (GMT -7)   
Bummer Rob, Good Luck!
Hero
Father died from complication of metastatic prostate cancer
I was Diagnosed at age 52
10 of 12  cores positive with 4/3 G7, Post-Op Status = T2NoMoG7-(StageII)
Robotic Surgery, Wash-U/Barnes, St.Louis, Mo. Adam Kibel M.D. who is now Chief at Brighams

fiddlecanoe
Regular Member


Date Joined Oct 2016
Total Posts : 199
   Posted 9/11/2017 12:54 PM (GMT -7)   
I'll echo what Hero says: What a bummer! You seem much more well-informed than I was at your stage. The big question at this point is whether the cancer has spread beyond the pelvis. If it has, ART probably can't help. I waited ten months after my surgery to begin radiation. I started SRT as soon as I regained continence. Good luck.
Age: 62
Diagnosed in July 2016 with G7 (4+3) PC & PNI
Bone & CT scans clear
Surgery at Lenox Hill Hospital in NYC, 9/12/2016
Post-surgery pathology showed G7 (3+4), with SVI and PSM
Lymph nodes clear
First post-surgery PSA October, 2016: <.008
Second post-surgery PSA December, 2016: 0.01
Third post-surgery PSA June 2017: 0.05
IMRT begun: July 18, 2017 (35 fractions)

John_TX
Veteran Member


Date Joined Jan 2015
Total Posts : 861
   Posted 9/11/2017 1:08 PM (GMT -7)   
Yikes, not a great path report! My PSA was undetectable 6 weeks after RALP but my radiation oncologist (MD Anderson) started me on Lupron anyway. I was node positive as well. I thought doing hormone therapy would be a given in your situation. By the way, welcome aboard to our not so exclusive club.
DX - 1-13-2015 (age 66) -- PSA 4.02 (9-16-2014) to 4.38 (12-5-2014)
RALP on March 2, 2015
G6 to G7(3+4) to G7(4+3)
Stage pT3aN1
06/2017 PSA < 0.1
7/31/2015 HT - six month's injection of Lupron
ART 11/2015, 33 sessions

Skypilot56
Regular Member


Date Joined Mar 2017
Total Posts : 206
   Posted 9/11/2017 2:15 PM (GMT -7)   
Hi Rob, no that's not really the post rp report u really wanted I'm kinda surprised your Gleason wasn't higher. I had a pre Gleason of 7 after Rp
They changed it to 9 you can see from my signature the rest of the story going back October 11 meeting with RO after psa check probably start SRT the next week he likes to wait at least 6 months after surgery to start radiation. Hoping to hold off on ADT for a while. Hang in there and hope for a non detectable #

Larry
Male 61 DX age 60
Father had PC
2002. Psa. .08. Enlarged Prostrate
2014. Psa. 3.8
2016. Psa. 19
3-08-17 RP Mayo Clinic Mn
Pathology Report: Gleason 9, Seminal vessels and one nerve cancerous and removed, negative on margins, 35 lymph nodes removed no cancer, tumor was pt3b. Prostrate 45 grams
4-20-17 Incarcerated Umbilical Hernia repair
6-13-17 1st psa check 0.13
7-19-17 psa 0.12 MRI clear

rancherdave
New Member


Date Joined Jul 2017
Total Posts : 11
   Posted 9/11/2017 4:17 PM (GMT -7)   
Rob There is good news for a PCa dx and pathology reports like yours and mine. My high psa was 85 and was put on 6 months of Lupron pre surgery to shrink prostate before RARP on Sept 15 2016. My pathology was T3b N1 M0 Gs 3+4-7 prostate 54 grams seminal vesicles both involved non nerve sparing 23 lymph nodes removed with 3 cancerous. Very minimal short term incontinence but complete ED, this was not a concern for me. My three month psa was <.01 in December and the urologist(she was not the surgeon) told me how great I was doing physically and I felt 100% mentally and emotionally. Next psa on 2-21-2017 was .33 and was a big letdown IT was back in less than 6 months. Returned to Mayo for a prostate MRI which showed no changes from previous MRIs and no mets. I met with local urologist to set up IMRT for salvage RT 5-1-2017 psa was .91 triple in just over 2 months. Started SRT on 5-30 and ended on 7-19 33 sessions with 66 Gy, started Lupron on 5-1 and again on 8-24. Had a psa done during treatments on 7-7 <.01. I have been on pins and needles about outcome until today, just had another psa that was <.01. What a major relief and load off of my mind. I will be doing psa tests every 2 months for awhile. I also had a CT bone scan done in may that showed no mets. I have been an emotional and mental wreck the past months but this current psa is better news than winning the lottery. It is tough to put the cancer concerns to the back of our minds but there are many good and positive outcomes on this forum. Be positive and best wishes. Dave
DX age 61 2-16-16 psa 85 biopsy 14 of 20 5 to 90% involved no mets started casodex G 3 +4=7 5-4-16 Mayo MRI 3 mo Lupron no casodex, 8-4 3 mo Lupron psa .24, 9-15 RARP & lymph 54 grams 3 of 23 & seminal vessicals involved. 12-16 psa .01 2-17 psa .33 4-17 Mayo MRI no mets 5-1 psa.91 4 mo Lupron 5-30 started 33 SRT, 7-7 psa .01, 9-11-2017 psa .01

Skypilot56
Regular Member


Date Joined Mar 2017
Total Posts : 206
   Posted 9/11/2017 4:50 PM (GMT -7)   
Rancher Dave are you being treated at the mayo in Rochester?
Male 61 DX age 60
Father had PC
2002. Psa. .08. Enlarged Prostrate
2014. Psa. 3.8
2016. Psa. 19
3-08-17 RP Mayo Clinic Mn
Pathology Report: Gleason 9, Seminal vessels and one nerve cancerous and removed, negative on margins, 35 lymph nodes removed no cancer, tumor was pt3b. Prostrate 45 grams
4-20-17 Incarcerated Umbilical Hernia repair
6-13-17 1st psa check 0.13
7-19-17 psa 0.12 MRI clear

Hardlyrob
New Member


Date Joined Sep 2017
Total Posts : 12
   Posted 9/12/2017 9:23 AM (GMT -7)   
Thanks Guys!

Good to know others have been through similar and worse, and had a good outcome.

I'll post here again when I get the PSA results.

Cheers!

Rob

InTheShop
Veteran Member


Date Joined Jan 2012
Total Posts : 7924
   Posted 9/12/2017 4:35 PM (GMT -7)   
Welcome to HW.

Not the best report. Still you've plenty of options.

That PSA will tell. Now just rest and heal for awhile.

Andrew
I'll be in the shop.
Age 57, 52 at DX
PSA:
4.2 10/11, 1.9 6/12, 1.2 12/12, 1.0 5/13, .6 11/13,
.7 5/14, .5 10/14, .5 4/15, .3 10/15, .3 4/16, .4 10/16, .4 5/17
G 3+4
Stage T1C
2 out of 14 cores positive
Treatment IGRT - 2/2012
My latest blog post

Break60
Veteran Member


Date Joined Jun 2013
Total Posts : 1763
   Posted 9/12/2017 5:10 PM (GMT -7)   
Hardly rob

Sorry to hear ur pathology which seems unusual given your Gleason score. It's similar to mine but I am Gleason 9. You can see by my signature below what I've been through. All I can say is aggressive treatment is your new normal. Sucks but it is what it is.
Bob
DOB January 1944 (now age 73)
PSA: 8/12 2.7; 5/13, 6.6 (actually double due to finasteride)
7/13 (age 69) Bx GS 4+5=9 (Epstein); 2 of 6 cores, 10%, 40%; stage Pt1c
9/13 ORRP, GS 4+5=9, BLSVIs+, margin+ (4mm,G7), EPE, 10 Nodes resected (clear); stage upgraded to pt3bN0M0
PSA: 11/13 0.1; 2/14 0.2; 5/14 0.3
6/14 SRT by IMRT/IGRT, 68.2 grays/38 Fx to prostate bed, ADT (6 months Lupron)
PSA: 9/14 to 8/15: <.1, <.1, .1, .3, .7, 1.2
9/15 MRI, CT-PET finds two iliac lymph nodes suspicious for PCa; organs and soft tissue clear ; Start ADT3 plus plus Metformin, Cabergoline, Estradiol patch, Prolia , Vitamin D3, calcium. IMRT 75 grays/50 Fx to pelvic lymph nodes. Stopped ADT 11/16.
11/15-5/17: PSA rises from .03 to 2.3.
5/17: F-18 Fluciclovine (axumin) PET/CT scan finds abnormal uptake in intertrochanteric region of the proximal right femur compatible with skeletal metastasis measuring approx. 9 mm. No other adverse findings. Restart ADT3; start monthly Xgeva
6/17 SBRT, 30 grays/ 3 Fx to femur met.
7/17 PSA 0.3, T 3.0

ddyss
Regular Member


Date Joined Apr 2017
Total Posts : 128
   Posted 9/12/2017 8:32 PM (GMT -7)   
welcome to this not so lonely place on the lonely planet. Its a miracle we are here and it sucks that our own body is whats trying to hurt us. We have to be gladiators and keep fighting.
DX@ 48 Yrs PSA 03/15 4.45 DRE: Firm Right Base
04/18 Biopsy Right: Base 4+3, Middle 3+4, Apex: HPIN
Left 6 cores : -ve
5/20 MRI: Pirads 5, ECE:+ve
RALP 05/26 Mt. Sinai Miami - Dr. A. Bhandari
Path:
Gleason downgraded to 3+4 !! Stage T2C
Prostrate Size: 49grams Tumor:20%
LN/SV/ECE: -ve PNI: +ve
Cath Removed : 6/1
Full continence: 7/4
PSA: 7/7 <0.1

RandyJoe
Regular Member


Date Joined Jan 2015
Total Posts : 274
   Posted 9/14/2017 5:22 AM (GMT -7)   
Welcome Rob. Those "surprise" pathology reports have a way of knocking the wind out of your sails. So sorry about that. We'll be hoping and praying for a good PSA in a few weeks.

Donna
55 at dx PSA-7/'14: 26
Bx-8/14: 8 of 8 cores+(80-100%) GL7;
9/14-Bone/CT Neg.
10/22/14: RP
Post-Surg Path:GL9; LN+; margins+; SV+, L Bladder neck+
pT3bN1
PSA-7 wks post op-10.0; 11 wks post op-14.2;
ADT 1/15 to1/16
F18 PET/Chest CT/MRI-Neg. (3/15)
SRT complete 7/6/15
9/15 to 3/16 PSA <.05
PSA 6/10/16 .46; 7/8/16 1.0; 8/2/16 1.2; 8/26/16 1.7; 9/22/16 2.5
10/16- EMBARK
6/17-PSA<.05-meds stopped

Hardlyrob
New Member


Date Joined Sep 2017
Total Posts : 12
   Posted 10/26/2017 6:34 AM (GMT -7)   
Hi Guys;

Just got my post-op PSA 0.13 Right in the middle of wait and see and do something. Not the result I was hoping for.

I see the doc on Friday and we'll see what he says. I already know he is on the more aggressive side of treatment, so likely he will recommend HT and SRT due to the lymph node involvement.

I guess I'm a full fledged member of the pT3 club at this point.

Rob
5/2017 PSA 34.2 age 53
6/2017 Dx by biopsy - 9 of 14 positive; Gleason 7 (4+3) 5% to 90% cancer
8/24/2017 RARP prostatectomy, Dr. Canes - Lahey Burlington (MA)
4/8 lymph nodes positive
Extraprostatic extension
Positive margin 5 MM
Seminal vesicle invasion
pT3b; pN1; M0
Waiting to do next PSA
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