I'm going to start a treatment thread if that's OK as the odds against one and done look a little longer now.
I was diagnosed and rebiopsied as T2 3+4 but final pathology is T3a (1mm EPE but all caught with NSMs) 4+3 with 9.9ml main tumor with the EPE and elsewhere allsorts of 3+4 through the gland. Final size 73ml. Lots of cancer, lots of gland so hopefully all the PSA is coming from in there.
Surgeon laying great emphasis on NSMs but I think we can all agree I will be lucky not to BCR at some point and the risk is I never get undetectable. Fingers crossed for 7-8 week first PSA... Wish me luck.
Good news is on day 0 of catheter removal I am not even having to think about continence till the OAB kicks in. Then it's all over, so I need pads. But that will pass.
Rising PSA about 2008. Negative MRI 2013, positive MRI 2016: biopsy 3+4 10% of 7 of 27 cores 10Oct16, 58yo PSA at diag 11.3 T2aNxMx 54cc. RALRP 15Oct21, 64y less 2 days PSA 15.7 76cc.
“The reasonable man adapts himself to the world: the unprostated one persists in trying to adapt the world to himself. Therefore all progress depends on the unprostated man" GB Shaw: Man and Superman
Let me the first to wish you luck and based on how I've seen so many guys do around here, you'll likely do very well even if you're not one-and-done like you had hoped for. I'm not a surgery guy or smart enough to comment on the pathology specifics, but I'm sure the smart guys will be here soon. (Paging Djin and Halbert, as well as several others.)
Good luck on the recovery, which I'm sure if your main focus now.
Age 60, Diagnosed at 51
PSA 9.6, Gleason: 9 (5+4), three 7s (3+4)
Chose triple play of HDR brachy, IMRT and ADT (Casodex, Lupron and Zytiga)
Completed ADT (18 months) in April 2014
9/20: PSA = 0.03
Good luck on the recovery, which I'm sure if your main focus now.
Age 60, Diagnosed at 51
PSA 9.6, Gleason: 9 (5+4), three 7s (3+4)
Chose triple play of HDR brachy, IMRT and ADT (Casodex, Lupron and Zytiga)
Completed ADT (18 months) in April 2014
9/20: PSA = 0.03
Shaw, sorry about the upgrade, but as Michael said, you should do very well.
No continence issues to worry about is something i would call huge.
Good luck with your first PSA. Keep in mind, 7-8 weeks is a bit soon, even though many surgeons do a psa at that point, or even 6 weeks (as mine did) for an extra data point. I think the 3 month PSA will be the tell.
Best of luck, we will look forward to a good result along with you
I am not a doctor, just a guy without a prostate
Dx Age 64 Nov 2014, PSA 4.3
BX 3 of 12 cores positive original pathology G6
RALP with Dr Ash Tewari Jan 6, 2015
Post surgical pathology G7 (3+4), - ECE, - Margins, -LN, -SV (+ frozen section apex converted to negative)
PSA @ 6 weeks 2/15, .<02, remained <0.02 until January 2017, .02, repeat Feb 2017, still .02. May 2017-.033, August 2017- .033 November .046, March 2018 .060. June 2018 .068, July 2018 - .082, August 2018, .078, August 2018 - .08 Start ADT. Sept 2018 Start SRT
Sept 2018 thru May 2021 –PSA = <.05
Decipher test, low risk, .37 score
My story.... https://tinyurl.com/45w7789x
No continence issues to worry about is something i would call huge.
Good luck with your first PSA. Keep in mind, 7-8 weeks is a bit soon, even though many surgeons do a psa at that point, or even 6 weeks (as mine did) for an extra data point. I think the 3 month PSA will be the tell.
Best of luck, we will look forward to a good result along with you
I am not a doctor, just a guy without a prostate
Dx Age 64 Nov 2014, PSA 4.3
BX 3 of 12 cores positive original pathology G6
RALP with Dr Ash Tewari Jan 6, 2015
Post surgical pathology G7 (3+4), - ECE, - Margins, -LN, -SV (+ frozen section apex converted to negative)
PSA @ 6 weeks 2/15, .<02, remained <0.02 until January 2017, .02, repeat Feb 2017, still .02. May 2017-.033, August 2017- .033 November .046, March 2018 .060. June 2018 .068, July 2018 - .082, August 2018, .078, August 2018 - .08 Start ADT. Sept 2018 Start SRT
Sept 2018 thru May 2021 –PSA = <.05
Decipher test, low risk, .37 score
My story.... https://tinyurl.com/45w7789x
Glad to hear these guys say you will do well. This is a scary road to travel. You'll be in my prayers and I'll hold you in my thoughts.
Thanks guys: I really appreciate it.
An addendum is I have ductal adenocarcinoma of the prostate. Bad news. Cue furious googling and turns out it's not INDEPENDENT bad news (i.e. it drove the upgrade/upstage and doesn't itself add to the damage) https://pubmed.ncbi.nlm.nih.gov/31711982/
I thought seriously about a new thread in terms of what I am going to post next, but I already have set a couple of surgery v radiation hares running and that is enough. But it turns out that I had some blind luck (it wasn't on my biopsies) because this stuff responds better to surgery than radiation. https://pubmed.ncbi.nlm.nih.gov/33996481/
This is all bleeding-edge stuff: what these guys are learning all the time works to the benefit of all of us
Rising PSA about 2008. Negative MRI 2013, positive MRI 2016: biopsy 3+4 10% of 7 of 27 cores 10Oct16, 58yo PSA at diag 11.3 54cc. RALRP 15Oct21, 64y less 2 days: 4+3 T3aNxMx PSA 15.7 73cc.
“The reasonable man adapts himself to the world: the unreasonable one persists in trying to adapt the world to himself. Therefore all progress depends on the unprosta
An addendum is I have ductal adenocarcinoma of the prostate. Bad news. Cue furious googling and turns out it's not INDEPENDENT bad news (i.e. it drove the upgrade/upstage and doesn't itself add to the damage) https://pubmed.ncbi.nlm.nih.gov/31711982/
I thought seriously about a new thread in terms of what I am going to post next, but I already have set a couple of surgery v radiation hares running and that is enough. But it turns out that I had some blind luck (it wasn't on my biopsies) because this stuff responds better to surgery than radiation. https://pubmed.ncbi.nlm.nih.gov/33996481/
This is all bleeding-edge stuff: what these guys are learning all the time works to the benefit of all of us
Rising PSA about 2008. Negative MRI 2013, positive MRI 2016: biopsy 3+4 10% of 7 of 27 cores 10Oct16, 58yo PSA at diag 11.3 54cc. RALRP 15Oct21, 64y less 2 days: 4+3 T3aNxMx PSA 15.7 73cc.
“The reasonable man adapts himself to the world: the unreasonable one persists in trying to adapt the world to himself. Therefore all progress depends on the unprosta
SUM: yeah, the upgrade, especially ductal variety upgrade, sucks. There's no other word for it.
So, a few things come to mind, in all that:
I'm with my buddy Pratoman about the 3 month PSA. Many doctors do one at 6-8 weeks, to make sure you're moving in the right direction. You may not be undetectable then. By 3 months, you should be if you're going to be.
Here's the thing: you can be thinking about BCR and rapid radiation as an add on--but you still can't start it until that magic three month window. Why? the more time you give the surgical injury to heal, the better your chances of going through the radiation with no issues. So, in the mean time, keep doing the kegals. Your OAB will settle down soon. If you're like most of us, what you're reporting is not really OAB--it's the new normal.
The time lag between "I need to go soon" and "I need to go Right F'ing NOW" is a lot shorter than it used to be. It all has to do with the anatomical changes from the surgery. It can get a little better with time, but it's also a thing of just adjusting to it, I think.
It sounds like you're on a good path, and while the next weeks may be nerve-wracking waiting for the PSA results, keep on keeping on. It's wait and see time...and, honestly, the pang of anxiety as PSA time comes close never really goes away. At least it hasn't for me, and I'm at 6.5 years plus.
Age at Diagnosis: 56
RALP on 2/17/15, BJC St. Louis, Dr. Figenshau
58.5g, G3+4, 20%, 4 quadrants involved
PSA Non-Detect since April, 2015
My Story: www.healingwell.com/community/default.aspx?f=35&m=3300024
So, a few things come to mind, in all that:
I'm with my buddy Pratoman about the 3 month PSA. Many doctors do one at 6-8 weeks, to make sure you're moving in the right direction. You may not be undetectable then. By 3 months, you should be if you're going to be.
Here's the thing: you can be thinking about BCR and rapid radiation as an add on--but you still can't start it until that magic three month window. Why? the more time you give the surgical injury to heal, the better your chances of going through the radiation with no issues. So, in the mean time, keep doing the kegals. Your OAB will settle down soon. If you're like most of us, what you're reporting is not really OAB--it's the new normal.
The time lag between "I need to go soon" and "I need to go Right F'ing NOW" is a lot shorter than it used to be. It all has to do with the anatomical changes from the surgery. It can get a little better with time, but it's also a thing of just adjusting to it, I think.
It sounds like you're on a good path, and while the next weeks may be nerve-wracking waiting for the PSA results, keep on keeping on. It's wait and see time...and, honestly, the pang of anxiety as PSA time comes close never really goes away. At least it hasn't for me, and I'm at 6.5 years plus.
Age at Diagnosis: 56
RALP on 2/17/15, BJC St. Louis, Dr. Figenshau
58.5g, G3+4, 20%, 4 quadrants involved
PSA Non-Detect since April, 2015
My Story: www.healingwell.com/community/default.aspx?f=35&m=3300024
Well to quote another “it is what it is”.
You now know much more and must move forward with the knowledge and experience you have. I wouldn’t commiserate about recurrence or potential failed initial treatment. Why speculate? Stay on top of the situation, continue to learn, rethink the future approach regarding the medical team as to radiation oncology and potentially a medical oncologist. What is your surgeon’s experience and results with men in your situation especially the ductal aspect?
But, most of all for now, do what it takes to heal from the surgery and move on to a better level of overall health. Best wishes on great outcomes from whatever comes next.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard and Jalyn started on 10-7-2010. IMRT to prostate and lymph nodes started on 11-8-2010, HDR Brachytherapy December 6 and 13, 2010.
PSA < .1 since February 2011. Located in Cumming Georgia north of Atlanta
You now know much more and must move forward with the knowledge and experience you have. I wouldn’t commiserate about recurrence or potential failed initial treatment. Why speculate? Stay on top of the situation, continue to learn, rethink the future approach regarding the medical team as to radiation oncology and potentially a medical oncologist. What is your surgeon’s experience and results with men in your situation especially the ductal aspect?
But, most of all for now, do what it takes to heal from the surgery and move on to a better level of overall health. Best wishes on great outcomes from whatever comes next.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard and Jalyn started on 10-7-2010. IMRT to prostate and lymph nodes started on 11-8-2010, HDR Brachytherapy December 6 and 13, 2010.
PSA < .1 since February 2011. Located in Cumming Georgia north of Atlanta
Persistent PSA of 0.18 after 8.5 weeks, so pretty clear-cut. Remains to be seen (perhaps) whether a hot node or the remains of the EPE.
Tentative plan is another PSA and meet uro and radiation onc on 11Jan, PSMA-PET and MRI. Assuming no target, saturation SRT but not before about 6 month anniversary (mid-April). Bicalutamide till then (after scans). Fun! (You won't like it, says uro: thanks Doc!)
Comments? Ideas? (Not of the woulda shoulda coulda variety please, which will be refuted and blocked).
"Radicalized" Prostatectomy for 3+4 T2 PCa + BPH 15Oct21, 64y less 2 days. Final: 4+3 IDC-P T3aNxMx PSA 15.7 73cc. 1st PSA .18: I said ***k, loudly. Sorry Dr.
“The reasonable man adapts himself to the world: the unreasonable one persists in trying to adapt the world to himself. Therefore all progress depends on the unprostated man" GB Shaw Man and Superman (or "Urologist")
Tentative plan is another PSA and meet uro and radiation onc on 11Jan, PSMA-PET and MRI. Assuming no target, saturation SRT but not before about 6 month anniversary (mid-April). Bicalutamide till then (after scans). Fun! (You won't like it, says uro: thanks Doc!)
Comments? Ideas? (Not of the woulda shoulda coulda variety please, which will be refuted and blocked).
"Radicalized" Prostatectomy for 3+4 T2 PCa + BPH 15Oct21, 64y less 2 days. Final: 4+3 IDC-P T3aNxMx PSA 15.7 73cc. 1st PSA .18: I said ***k, loudly. Sorry Dr.
“The reasonable man adapts himself to the world: the unreasonable one persists in trying to adapt the world to himself. Therefore all progress depends on the unprostated man" GB Shaw Man and Superman (or "Urologist")
SUM - My signature is similar without the persistent PSA so far, sure makes the journey eventful 
I assume by "saturation SRT" you are including the lymph nodes? Seems to be a reasonable plan if your signature means that none were sampled previously.
I am not so sure that the PSMA scan will help much with your low PSA and further suppression from the bicalutamide but if they are willing to do it, why not? Another MRI and/or CT scan would be worth a look after the post-op carnage.
I wish I had words of wisdom for you but no one is control of the cards they are dealt with prostate cancer and your followup plan looks solid. There is little more you can do at this point other than heal up. I did not find ART to cause many significant issues so it is just a time waster more than anything then you wait.
Good luck with your scans and ADT. The weather will be better soon.
7/2018 (66yr), PSA 4.1->5.1
8/2018-MRI PI-RADS 5, MRI guided biopsy, 8/14 cores, G7(4+3)
9/2018-CT/Bone scans clear
11/6/18-RALP Surgery
11/2018-Post-Op Path G7(4+3) 5% Tert Gr 5, pT3a pN0 Gr 3, SM, EPE, <3mm
11/2018-Decipher 0.47, Ave Risk
1/2019-Epstein-G9(4+5) Gr5, pT2x, margin vs. incision not clear
4-6/2019 ART 37 days
PSA<0.10: 2/19, 5/19, 8/19, 11/19, 2/20, 6/20, 9/20, 3/21, 10/21
I assume by "saturation SRT" you are including the lymph nodes? Seems to be a reasonable plan if your signature means that none were sampled previously.
I am not so sure that the PSMA scan will help much with your low PSA and further suppression from the bicalutamide but if they are willing to do it, why not? Another MRI and/or CT scan would be worth a look after the post-op carnage.
I wish I had words of wisdom for you but no one is control of the cards they are dealt with prostate cancer and your followup plan looks solid. There is little more you can do at this point other than heal up. I did not find ART to cause many significant issues so it is just a time waster more than anything then you wait.
Good luck with your scans and ADT. The weather will be better soon.
7/2018 (66yr), PSA 4.1->5.1
8/2018-MRI PI-RADS 5, MRI guided biopsy, 8/14 cores, G7(4+3)
9/2018-CT/Bone scans clear
11/6/18-RALP Surgery
11/2018-Post-Op Path G7(4+3) 5% Tert Gr 5, pT3a pN0 Gr 3, SM, EPE, <3mm
11/2018-Decipher 0.47, Ave Risk
1/2019-Epstein-G9(4+5) Gr5, pT2x, margin vs. incision not clear
4-6/2019 ART 37 days
PSA<0.10: 2/19, 5/19, 8/19, 11/19, 2/20, 6/20, 9/20, 3/21, 10/21
I believe you first PSA will be negative. How many tests after that is the question.
ShawsUnprostatedMan said...
I'm going to start a treatment thread if that's OK as the odds against one and done look a little longer now.
I was diagnosed and rebiopsied as T2 3+4 but final pathology is T3a (1mm EPE but all caught with NSMs) 4+3 with 9.9ml main tumor with the EPE and elsewhere allsorts of 3+4 through the gland. Final size 73ml. Lots of cancer, lots of gland so hopefully all the PSA is coming from in there.
Surgeon laying great emphasis on NSMs but I think we can all agree I will be lucky not to BCR at some point and the risk is I never get undetectable. Fingers crossed for 7-8 week first PSA... Wish me luck.
Good news is on day 0 of catheter removal I am not even having to think about continence till the OAB kicks in. Then it's all over, so I need pads. But that will pass.