Tall Allen said...
Please refresh my memory. What was it in your path report that I thought was noteworthy? I thought I sided with your Uro who suggested a retest in 6 weeks?
You remember right. What I was referring to was your saying that both the Uro and the RO had good arguments. Here’s the post:That's quite common that Uros and ROs have different judgments. It's because ROs are the ones who follow patients getting salvage treatment, so they tend to be more cautious.
They both make good cases. On the one hand, pelvic LNs sometimes do get enlarged after surgery. On the other hand, with a Gleason 8 and EPE, it would not be unusual to have a cancerous LN. My layman's opinion is that cancer in LNs usually presents with elevated PSAs, and you did not seem to have the kind of PC that exhibits low PSA. There are some places that can biopsy the LN, but that is difficult and takes expertise you aren't likely to find in Guam. And it could make the pain worse and interfere with LN drainage. The other way they can diagnose cancer is to give ADT and see if it shrinks. However, if it is just a LN inflamed by the surgery, it might go down on its own anyway, so the ADT would not be diagnostic. There is a special kind of MRI, using Combidex, that might diagnose it, but you would have to go to the Netherlands to get it. I don't think much will happen in 6 weeks that hasn't already happened - cancer in pelvic LNs usually progresses slowly.