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Results of Pathology are back, please give me your advice.

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Prostate Cancer
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Posted 12/31/2009 3:33 AM (GMT 0)
Okay my dads pathology results came back:

PT3b, with perineural invasion. Focal invasion on right seminal vesicle. Upgraded to Gleason 9. 60% of prostate involved, negative margins. I am going crazy right now. Can he still be cured? I put his stats into the prostate recurrence and it gave a meager 15% chance. Has anyone had similar stats and remained BCRF?

Additionally, I want him to get adjuvant radiation. I think it can only help with a gleason 9. If any of you have more experience in this field can you tlel me what you think? Thank you so much

LuvMyDAD

Posted 12/31/2009 3:51 AM (GMT 0)
LuvMyDad,

This is not the time for despair. The perineural invasion is fairly common, and by itself probably doesn't raise too many flags. The seminal vesical is a little more of a red flag. The good news is negative margins. Gleason 9 by itself is not a guarantee that he will have a reoccurence.

I think seeing a radiation oncologist is a great plan.

I wonder if you read the nomogram correctly. 15 % sounds way to low. I would guess he would be in the 60 to 70 % range.

Without a signature telling us his PSA, all the postop pathology, etc., it is hard for us to check his numbers.

You must stay positive. We have seen much worse on this forum.

Goodlife
Posted 12/31/2009 8:40 AM (GMT 0)
I agree that 15% is way too low -- I suggest double-check the calculations. The negative margins are really good news, so you have a lot to be optimistic about.
Posted 12/31/2009 9:40 AM (GMT 0)
Hi


Yes definitely check the numbers. A signature with some extra details about your dad (age PSA etc) would I am sure help others here to give you more assistance)



And when I fed my numbers into a couple of different nomograms or computer models I got different results back.



Also some of the percentages they quoted back at me related to many years in the future, and all that basically means is that the longer you live the more likely you are to have a recurrence. But if you haven't had a recurrence at 5, 10 or 15 years then you remain on the starting line you don't suddenly leap to the finish simply due to the passage of time.



The negative margins is good news.



Happy New Year to you and your dad



Alfred
Posted 12/31/2009 10:53 AM (GMT 0)
Like all the others have said you have good news with the negative margins. Perineural invasion is very common. These are more commonly the nerves within the prostate and in my own case their involvement was "extensive". These along with the prostate are now gone. They can be a pathway for the tumour to escape the gland into surrounding tissue but given negative surgical margins this dows not appear to have happened in your father's case. As the seminal vesicles are also directly attached to the prostate this is another means for the tumour to escape the prostate. These have also been removed.

The Gleason 9 is a bit of bad news but even that does not mean it has escaped. It would be wise to have a consultation with a good oncologist...........they may want to go directly to adjuvent therapy or may even decide to wait on that first PSA and then decide. Either way he has first to recover completely from the operation. It is tough but try to relax and learn all you can about the next step. There are quite a few stories of Gleason 9 fellas to be found here:
http://www.yananow.net/chart-gleasonu6.htm#8
Bill
Posted 12/31/2009 1:23 PM (GMT 0)
Luv, first order of business is to not go crazy (been there, done that). First, as others have already said, the perineural invasion noted likely will have no impact on your dad's prognosis. My husband had PI noted on both the biopsy and surgical report, and our urologist said it's rare that he doesn't see this on a specimen.

The focally positive invasion of a seminal vesicle indicates the cancer had spread out of the prostate but, the good news is that the invasion is focal (single) rather than multi-focal and he has clean surgical margins.

I agree that speaking with both a medical and radiation oncologist makes sense. Your dad should be having his first PSA test soon and that should help give a clear view of what's going on. I'm not so sure that I would make any decisions until you know more but the doctors should be able to guide you better than I.
Posted 12/31/2009 4:00 PM (GMT 0)
Hi guys, thank you for all your help. I am really struggling to come to terms with all that has happened. It all seems so surreal. My dad is 62 years old and his pre-treatment open radical prostatectomy PSA was 4.17. Three months earlier the PSA was 3.71. We are considering moving to adjuvant radiation therapy. I am not sure how long we need to wait between the surgery and radiation.

Also, I wish we had a medical doctor involved (along with the surgeon/radiation oncologist) that could talk to us about all the other treatments like Hormone therapy or possible chemotherapy. It is getting difficult reading all these articles online and trying to formulate a plan of action. I feel like we need someone who understands the whole spectrum. Thank you all for all your help. I really appreciate it so much.

Sincerely,

LuvMyDad

Posted 12/31/2009 5:45 PM (GMT 0)
Luv,

Hang in there,

1st the right thing was that the prostate was removed. You now have a definitive pathology, could not have occurred any other way

2nd, look at getting a PSA for yourself, 62 is on the young side to have this severe PC

3rd a regular medical Dr, like a General Surgeon ? A regular Dr would actually know less than the Urologist and Radiation Docs

4th, the 15% sounds way off, maybe if the PC was still untreated inside your dad, which it is not

You took the right course of action, do not look back, forward is where you need to be focused
Posted 1/1/2010 9:30 PM (GMT 0)
LUV,My urologist Who was My surgeon recomended radiation for me shortly after My surgery.The next time I visited him Hgave Me a lupron injection right in his office.He also got me on the ball to get Me ready for My radiation.They know just about every aspect of the journey.Just try to relax and not run yourself ragged,if you get all run-down you will be able to support him like you want and need to.good luck to you and him.

Zach
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