Rod Update: cath out; no path report; question re OR report; adhesions;PSA; Gleason; etc.

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mariateresa
Regular Member


Date Joined Jun 2007
Total Posts : 95
   Posted 10/2/2007 9:24 AM (GMT -7)   
Hello everyone,

We just came home from the hospital. The catheter has been removed. The pathology report was not available - this troubles me. Now the nurse will have to call with the results. I think the communication would have been better if we were told the results in person and not over the phone and that we would have gotten an immediate copy. I get so easily frustrated over having to wait yet again.

We were given the O.R. report which reads Clinical stage: T1C; SHIM: 18; IPSS: 2 (0). I don't know what any of this means. And is it significant? Wouldn't the pathology report be more significant than the O.R. report? AND does it even matter what the pathology report states? I'm getting the impression that the more important factor is the post-op PSAs over the course of time. Is this accurate?

The O.R. report states that adhesions were noted along the pelvis involving the lateral aspect of the sigmoid colon and taken down sharply. Is this a normal finding?

The O.R. report states a nodule was not detected on digital exam under anesthesia. Is this a good thing?

The O.R. report also states nerve sparing performed was a left standard and right standard procedure given his history of prostatic biopsy findings and clinical exam.

When the surgeon came out to speak to me after Rod's surgery he left a very good impression that no further therapy would be needed, but then a few hours later I heard him be more cautious by saying we'd have to wait and see because the Gleason score was 8. Now the nurse said the same thing today. What is the significance of the Gleason score being 8? Does this mean it is more likely that the cancer has already spread and that Rod will need further treatment?

Last Saturday Rod started having a lot of drainage from the site that used to have the drain in it. At the same time a large hematoma appeared up and down Rod's right side. I thought the drainage was causing that and I was so worried that I had Rod call the nurse yesterday. Today when she looked at it, she said it was actually the hematoma causing the drainage and not something internally. What would cause a hematoma?

While we were waiting, one of the other surgeons in the group walked by, Rod acknowledged him with a smile and this surgeon just ignored him. This did not leave a good impression. One of the residents noticed us and came over and shook our hands so that was a much better interaction.

There was so much commotion at the hospital today and I am aggravated because they were supposed to come and get me after the cystogram, but they didn't so I feel like I missed out on information. Then I'm aggravated because the pathology report was not ready. Rod is ready to send me to the moon because my aggravation is irritating him big time (not good to make stress for a recovering patient). I'm having a pity party today because I want things to go back to normal. I can see that Rod is feeling troubled today. Today I think I stink at being a support system.

We need you guys big time!!!!!

THANK YOU!!!!!

Love,

Maria Teresa
Husband Age 55 Maria Teresa age 44
Total PSA 8 on 05/21/07
DRE: prostate bumpy
Biopsy on 07/16/07: 5 out of 8 cores positive, Gleason Score 8 (3+4+5)**
CT of the abd/pelvis; Bone Scan; Xrays done on 08/13/07: Normal
Robotic Surgery Scheduled for September 11, 2007 - Cancelled due to anesthesia complications
Robotic Surgery September 25, 2007

**"Report to the Nation on Prostate Cancer" published by the Prostate Cancer Foundation, page 11: "In some cases, the pathologist might identify a third pattern, which is less common but that has a higher grade than either of the first two patterns that comprised the Gleason score. The presence of this third pattern might indicate that the tumor is more aggressive than the Gleason score would otherwise imply. For example, if a Gleason 4+3 tumor also has some grade 5 cells, the cancer would be considered as being of higher grade disease overall."


pasayten
Regular Member


Date Joined Mar 2007
Total Posts : 424
   Posted 10/2/2007 10:37 AM (GMT -7)   
Maria,
 
I think all the OP "figures) relate to pre-op conditions to give surgeons a "before" state and to help define procedures to be taken...
 
TIC  - was this your pre-op biopsy status
 
SHIM , Sexual Health Inventory for Men
(Not a great link, but talks a lot about it)
 
 
IPSS - International Prostate Symptom Score
 
I was a Gleason 6...  On the Gleason score table,  an "8" indicates a more "agressive" cancer cells...  There is a ton of info here and on the web about Gleason scores.  Some of the members here have had an "8"...  Maybe they can explain to you in better detail what this means... 
 
 
On the pathology report, I got mine at the 8 day mark when I went in and got the catheter removed.
 
 
Avis & I are praying for you and Rod...  I know this is very stressful!!!   Stay calm, you have Rod safe at home now...  You are on the other side now!
 
Wrap yourself in the comfort that Jesus is with you on this journey...  Along with all of us!
 
God Bless,
 
Ray & Avis
Age 59 y/o - Last 3-4 years of annual general health checkups - PSA 5-6
3/13/2007 - 12 point biopsy - Left 0/6  Right 1/6 Gleason 3+3 Diagnosed as T1c
4/24/2007 - DaVinci performed at Virginia Mason hospital in Seattle
5/2/2007 - Catheter Out! Final pathology of Gleason 6  T2c Nx Mx,   approx 20% of prostate involved, positive margin, but only at 2 focal points.  
6/28/2007 9 weeks post-op incontinance... Overnite, went from 4-6 soaked pads a day from prev 8 weeks to 2 barely wet pads a day.
7/12/2007 11 weeks post-op  Minimal leakage...  one small pad a day
7/18/2007 First Post-Op PSA...  0.01 !!! 
7/30/2007 ED improved to about 60% erection and "functional". Only using 50mg Viagra generic every 2-3 days.
9/10/2007 Ran out of pads one day and had no dribbles all day...  Now pad free. :-)


Tamu
Veteran Member


Date Joined Oct 2006
Total Posts : 626
   Posted 10/2/2007 10:42 AM (GMT -7)   
MT,

You seem to be rushing things so take a deep breath and relax. The path report is the key. What you want to see on the path report is clear margins, no seminal vessel or lymph node involvement. The Gleason of 8 means that the cancer is moderately aggressive. I think what the surgeon was saying to you after the surgery is based upon his visual assessment he could not see any signs of the cancer on the prostate membrane. Do not jump to any conclusions about additional treatment. Your urologist and his team got Rod through the surgery in fine shape and they will get the information to you as soon as they can. The focus now is recovery and stress does not help that outcome. Rod is probably feeling fairly well and elated to have the catheter out.

Blessings to the both of you.

Tamu
Diagnosed 7/6/06, 1 of 10 core samples, 40%,Stage T1c, Gleason 3+3
Da Vinci on 11/01/06, Catheter out on 11/13/06
56 Years Old
Post Op Path, Gleason 3+3, Approx. 5% of prostate involved
Prostate Confined, margins clear
Undetectable PSA on 12/18/06
No more pads as of 1/13/07
Began injections in April '07
Undetectable PSA on 6/25/07


lawink
Veteran Member


Date Joined Oct 2006
Total Posts : 621
   Posted 10/2/2007 10:45 AM (GMT -7)   
Maria - we are all here with you. It's normal for you as a wife to also be emotional over this whole situation. Our surgery was last Sept 27, 2006 and I didn't find this forum until mid October. I had many "pity parties" before that time and it was the support and shared experiences in here that helped me through and in turn made me a way better support system to Bob.

Just think before you know it you'll be saying . . . hey that was last year and look where we are now.

Please hang in there; don't beat yourself up; and stay with us.

;o) Linda & Bob
Bob (61) - Laproscopic Prostate Removal Sept 27, 2006.
2 of 12 malignant biopsy samples - gleason 3 + 3 = 6.
 
Pathology - cancer completely contained, even a second more aggressive, previously undetected cancer)
PSA UNDETECTABLE Nov 2006, Feb and May,2007.

Bob also has two secondary conditions -- Polycythemia (elevated red & white cells & platelets) and . . Myelofibrosis) -- If anyone has experience with or information on these, please email us.


biker90
Veteran Member


Date Joined Nov 2006
Total Posts : 1463
   Posted 10/2/2007 10:51 AM (GMT -7)   
Dear MT,

Breathe honey!!!!! Everything that you know so far is good. The post-op pathology report will be the determining factor in how Rod is doing. Waiting for it is really hard but its not like anything has to be done right away. We all have this frustration with PCa, from diagnosis, through treatment, then waiting for PSA results. Its just something that cancer leaves us with.

Take it one day at a time Maria Teresa, and look for the bright and positive things that happen each day.

Good luck,
Jim
Age 73. Diagnosed 11/03/06. PSA 7.05. Stage T2C Gleason 3+3.
RRP 12/7/06. Nerves and nodes okay.
Pathological stage: T2C. Gleason 3+4. Cancer confined to prostate.
PSAs from  1/3/07 - 7/18/07 0.00. 
T level on 4/2/07 - 48     On 7/16/07 - 613
Started Tri-Mix on 8/7/07.  .02 ml and 50 mg Viagra.  It works!!!
Next PSA and T tests on 10/17/07
 
"Patience is essential, attitude is everything."
 


Cedar Chopper
Regular Member


Date Joined Mar 2007
Total Posts : 432
   Posted 10/2/2007 12:33 PM (GMT -7)   
Maria Teresa,

I remember your first posts here...
You have learned an incredible amount and
  you have done all those things that at the time seemed so impossible!
You two have come so far - and like the others here have said -
  - all the news you have so far is good news!

Get Rod to:
Walk a little more each day - without hurting himself.
Drink LOTS of water while the catheter is in
   - it speeds both healing and  expells that lingering anesthesia.
and
Take it easy!  If Rod is not walking he should be resting!

Holding you close.

CCedar
ICTHUS!

Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 10/2/2007 1:19 PM (GMT -7)   

MT-

I think we are a lot a like.   :-)     I will tell you what I learned from my experience.  Be happy with the success of today.  Rod made it through surgery! That is fabulous!  Rod got his catheter out! Great news!  My dad was sooooo happy on that day!  As hard as it is for me to give him a break, they need a break to heal mentally and physically.  Waiting is the hardest part, however, unfortunately from experience, there is nothing we can do for awhile after the pathology report comes back.  Regardless of the result.  Unfortunately, part of this horrible disease is that we will never be truly comfortable.  My dad's path report wasn't the report I was hoping for and it devastated me, however, we still have to wait six weeks until his post-op PSA to start any treatment...maybe even another two weeks after that.  It has been a hard 4 weeks of waiting, but this is an important time for my dad physically and mentally.  (and for us)

The path report will come that is for sure and you will have time to soak it in and hopefully celebrate a great report!  If not, you will still have time to make your next plan of attack.  Either way...it's a waiting game.  A good friend of mine who is an Oncologist told me that I need to wrap my mind around the idea that there are no answers with cancer.  No if A then B.  You will see this from a lot of the posts.  It doesn't make sense to me why my dad's PSA of 5.5, Gleason 7 spread outside the prostate and into a lymph node, when people with PSA's of 100 didn't.  It doesn't do me any good to ask why.  We've got to "play it where it lays".  We make the best decisions we can with the information we have and don't look back.  I keep reminding myself of this. 

I am type A and I want everything done now and I am a fixer.  It's hard when I can't fix things.  I'm learning to be patient and to celebrate the litte things right now.  My dad's continence is getting a little better and his infection is feeling better after being on antibiotics for a few days.  I have to celebrate the little wins, otherwise, I will drive myself crazy. 

So, today I am going to celebrate with you that Rod is through surgery, through with the catheter and pray that his path report comes back with good news and he has a speedy recovery.  I will also continue to pray!  Cheers to your husband and all that he has been through successfully!  You guys can and will do this!  Hang in there! 

Doting


Father's Information
DX July 15, 2007
Age 62 (now 63)
PSA 5.5
Original Gleason 3+4=7 
Post Surgery Gleason- 4+3=7
DaVinci Surgery Aug 31, 2007
Positive Right Margin
One positive node
Bone Scan/CT Negative (Sept. 10, 2007)
T3a N1 M0
In process of determining follow up therapy
 
 


mariateresa
Regular Member


Date Joined Jun 2007
Total Posts : 95
   Posted 10/2/2007 1:50 PM (GMT -7)   
Doting - I agree with you that we are a lot alike! I can totally relate! I want things to be perfect and I want things to be black and white. And I definitely want everything to be done NOW and I'm also a fixer. I have no patience. And I don't know about you, but I am very emotional. Thank you for pouring light into my mind and heart!!!

Ray & Avis - Thank you for the links! I had no idea! Thanks for enlightening me! God bless you both!

Everyone - Thank you for helping me pull myself together today and help me readjust my attitude. I only hope in the future I can pay it forward and help others as all of you have helped Rod and I and continue to help us!

Love,

Maria Teresa
Husband Age 55 Maria Teresa age 44
Total PSA 8 on 05/21/07
DRE: prostate bumpy
Biopsy on 07/16/07: 5 out of 8 cores positive, Gleason Score 8 (3+4+5)**
CT of the abd/pelvis; Bone Scan; Xrays done on 08/13/07: Normal
Robotic Surgery Scheduled for September 11, 2007 - Cancelled due to anesthesia complications
Robotic Surgery September 25, 2007
Post Op Gleason 4+5; Positive margin right base of prostate; tumor into seminal vesicle; lymph nodes negative
Next step is the post surgical PSA to determine need for additional treatment

**"Report to the Nation on Prostate Cancer" published by the Prostate Cancer Foundation, page 11: "In some cases, the pathologist might identify a third pattern, which is less common but that has a higher grade than either of the first two patterns that comprised the Gleason score. The presence of this third pattern might indicate that the tumor is more aggressive than the Gleason score would otherwise imply. For example, if a Gleason 4+3 tumor also has some grade 5 cells, the cancer would be considered as being of higher grade disease overall."

Post Edited (mariateresa) : 10/2/2007 3:31:46 PM (GMT-6)

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