DVQ - I would like to think that it is strange to have an increase in Gleason score but the biopsy samples are small reflecting a small percentage of prostate vs. the entire gland to analyze post-op. It happened to me and many others here so not that strange to have an increase from intermediate to high risk scores.
There are two reasons to wait: your body needs to heal from surgery and you need to see the 3 month PSA results for a starting point. I might suggest having your pathology slides sent to Dr Epstein at Johns Hopkins for a second opinion while you are waiting for the PSA like I did. It will help knowing you have confirmed pathology classification data.
The problem areas in your report are “non organ contained... infiltration of seminal vesicles”, “regional lymph node metastasis” and “G9 Gleason”. The combination of these negative factors will most likely require the full treatment scenario that your doctor recommended. I would not be surprised if they want to do a PET scan of some sort if you have a significant PSA at 3 mos to see what else they can find prior to treatment.
I am sorry to be the first responder here but your post-op report is the not the best news to get and you should expect aggressive treatment recommendations from everyone you see. You may wish to visit other cancer centers with your results and see what the collective treatment wisdom is for your situation. The good news is that there are ways to address the situation that should control the situation of which hormone therapy is part of and probably cannot be avoided at this point.
Others will follow me with their thoughts and recommendation so please be patient as you try to understand your version of PCa.
7/2018-66yo, PSA 4.1->5.1
8/2018-MRI, PI-RADS 5
8/2018-MRI Biopsy, 4+3
11/6/18-RALP @ St. Johns
11/2018-Post-Op Path G7 (4+3) 5% Tert Gr 5, pT3a pN0 Grade 3
Pos. Marg (SM+), EPE, <3mm, L=0.1mm?
11/2018-Decipher 0.47, Ave. Risk
“Difficult to distinguish EPE vs intraprostatic incision, 3mm” Extent:pT2x
Post Edited (Mumbo) : 7/7/2019 9:02:46 AM (GMT-6)