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Help - changing PATHOLOGY on 2nd opinion - do we get a third?

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Posted 3/28/2008 6:59 PM (GMT 0)
Hello -

Had Robot assisted Laparoscopic Radical Prostatectomy on March 17. The 1st post-op Pathology is quite different from pre-op stats, so unclear if we should be doing anything - more tests, Bone scan, etc? You can read stats in profile, but basically this is the change:

PSA was 4.7, Biopsy Gleason 3+4=7 in one of 4 positive cores (10 total)
Pre-op DRE under anesthesia was given as TC1 - tissue soft, just as at Biopsy
Both Nerves spared, but took wider margins because of the Gleason 7, CLEAR margins, plus the 4 Lymph glands taken were clear, and Seminal Vesicles clear.
Difficult part is now a T3a because of 2 small 'foci of Extra-prostatic extensions' and Gleason now a 4+3=7 and Tumor was 20-30% of Prostate.

2ND Opinion from Johns Hopkins now says the Extra-prostatic extension is 'established' (not focal) and that there is also a positive margin there. They said is was questionable because it was 'crushed', but that the extension went to the ink.

How much do we worry about this new information? We were told pre-surgery, that we were in the 'possible cure group' and now unsure if that is even possible any longer.

Any input appreciated.
Thanks

FairRider
Posted 3/28/2008 9:08 PM (GMT 0)
Hi FairRider,

My stats are very similar to your husbands, except my pre op PSA was a bit higher. After my surgeon examined the pathologists report he stated, " I see nothing here that indicates the necessity for radiation at this time". So, no further action was suggested or done to date. I have sometimes wondered if I should have been more insistent on further treatment (Radiation). Only time will tell whether my surgeon was right.

All the best to you guys in the years to come.

Magaboo

Posted 4/7/2008 3:22 PM (GMT 0)
Thanks for the reply Magaboo and good luck on your psa tracking.

I think I just ask too many questions - its seems the more I ask, the worse our case gets. Now we are told there is a positive margin at the extension. I edited original post to reflect.

Does this mean we now need to consider radiation? This journey is exhausting - I can't believe men have been so quiet so long - its great this forum exists.

FairRider
Posted 4/7/2008 3:42 PM (GMT 0)
Hi FairRider,
There is always Hope. A positive margin does not mean no cure. Radiation and Hormone Therapy are options. But the first option is waiting until that first PSA is completed. You are looking to go to an undetectable PSA. That would be very good news. You will likely be told that radiation is an option, but do understand that any treatments at this point are contraversial as to what to do next. You mentioned worry, and I can advise that too much of it is not productive. I've been through the gambit of treatment for stage III cancer. I am doing well after one year in remission. My motto is stay positive and please do that. Get that PSA to zeroes.

Tony
Posted 4/7/2008 3:59 PM (GMT 0)
I agree with Tony 100%! Cure is an option! Stay positive and wait for that PSA to come back. We will pray that it will be undetectable.
Posted 4/7/2008 4:20 PM (GMT 0)
Thank you for the positive reminders. We know to wait for the first PSA, but wonder about further testing and consulting with others. We did not have the PAP test prior to surgery, or an MRI, or any other testing.

Another question for anyone...so we had nerve-sparing surgery....if we have to radiate, will the nerves then be fried?

FairRider
Posted 4/7/2008 5:22 PM (GMT 0)

FairRider

As you can see by my signature line, my stats are similar.  My 3 month PSA was fine, but then a bit higher at 6 months.  This is when I decided to undergo additional therapy, and thankfully, things are going well now.  You need to relax now and just get stronger.  The PSA tests later will help you make decisions later.

As far as your question, my surgeon did say that the radiation would probably zap the nerves he saved, but that was never a reason for me not to have the additional therapy.  I'm also on hormones for a couple of years, so that lessens the "libido".  I've always put LIFE in front of some of those other things, and I'm thankful that I had a second option following surgery.

You seem to be recovering well, so just keep that up and the rest will work its way out later.

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