Path report back ... disappointing!

The surgery was Feb 10th and although the doctor thought everything went well I guess you can never be too sure.

The path report came back --- parents were somewhat confused by all the big terms the doctor used on the phone. The jist of what I understand is:

-Although it appeared localized path report shows it broke outside the capsule and invaded the seminal vescile.

-One side of the surgical margins (cant remember which side) was free of cancer

-The side that was invaded was diagnosed/classified as a G9

-Staging --- T3 (not sure of any further details)

-Current plan -- follow up with radiation and most likely hormone therapy (not sure what the outcome will be?)

-Lymph node invovlement @ the time of surgery = Negative

-Current status --- catheter until at least Friday-- then they have to do some test to make sure it's ready to come out. He's currently had a fever since last week --- highest has been 101.5 --- on call doctor wasn't worried --- however, his surgeon said if its not gone by tomorrow he'll need to see him .... possible infection in the catheter.

We had a little over a week to feel cancer free and normal again--n ow we are back to worry about what this new "staging" means... and where this "aggressive cancer" might be hiding in his body!

So frustrating!

Thanks. We have the book. He found it depressing to read... probably because he views his cancer as the "aggressive" type and that's all he really thinks about.

They did say the lymph nodes were negative --- We will be getting a copy of the path report to review ourselves today... hopefully that will help clarify.

You bring up a good point - with his Gleason a 4+5 , 5+4 I guess we shouldn't have been so hopefully to think surgery would have got it all.

You're also right...I guess I didn't really have a question --- just looking for thoughts/support. I guess I'm hoping other men (or wives/daughters) will tell me they went through the same thing and the outcome was favorable for them/their loved one (PSA undetectable after radiation...etc).

You read all this literature which talks about 5 year survival rates ... I'd like to think we have more than 5 years with him!

Concerned4You,
I had kind of the same disappointing news with my post-surgery pathology. Besides getting 'upgraded' to a gleason 9, my margins were positive. Hence, I'm starting adjuvant radiation this week. The good news was the 6 week PSA was <0.1 since surgery. good luck, <bobr>
--------------------------------
Age: 54
Routine Physical on 10-20-2010 DRE Normal
PSA 4.3, up from 0.6 5 years prior
PSA 0.6 on 10-25-2005
PSA 0.4 on 7-30-2004
PSA 0.5 on 5-9-2002
Followup with Urologist on 11/10/2010 after elevated PSA; DRE noted slight bump
November 30th, 2010 had prostate biopsy.
December 9th, 2010, Biopsy results 3 of 12 cores positive.
LLB: Gleason's 4+3=7, 11 MM Tumor Length/15MM Core Length (73%)
LLM: Gleason's 4+4=8, 12 MM Tumor Length/15MM Core Length (75%)
LM: 0.1 MM Tumor Length (1%)0.1 MM Tumor Length
Urologist recommended robotic removal using da Vinci method.
RALP Surgery 12/27/2010 Released: 12/30/2010
Thunderbird Banner Hospital, Glendale, AZ
Post-Surgery Pathology: GS 4+5=9
Pathologic Staging: pT3a, N0, MX; location: Left Side; Volume: 10%
Margins: Left posterior inked margin focally involved
Extraprostatic Extension: Observed
Seminal vesicles: Not observed
Lymphatic/Vascular Invasion: Not observed
Catheter: Removed 15-days after surgery
Post-OP Followup on 1/11/2011; Catheter/Staples removed
Adjuvant IMRT 8 Weeks Post-OP.
No exercise for 4 Weeks Post-OP.
Radiation Oncologist Initial Consultation on 1/18/2011
Calypso Procedure on 2/17/2011; PSA <0.1; Bone Scan Clear
341 Testosterone

CT Simulation on 2/24/2011.

I am praying for you both both but it's kind of bad news not so bad news. The bad news was it's outside the prostate the not so bad news so far is it not in the lymph nodes. You may have hit bunt to third base with a runner on third. They took  seminal vessel if they got it all there and the surrounding tissues and a little radiation you may be good to go.

 

What a mixed bag of news. You will notice that there are many G9 guys that are doing very well. Sure it means that he will have a battle to fight but in many cases it is very possilbe to have a norman life with T3.

Cajun Jeff

Concerned, sorry for the your pathology report. I wish the best for the next step in your journey. Hang in there and be positive.

C,

I had the first PSA at 7 weeks and a few days (7, according to my surgeon, would be too early to be reliable, but 8 would have been on Christmas ). So, all things considered, 3 months may be OK.

More so when you consider the margins - if he (as I was) is already expecting IGRT, then a few weeks is not significant. It is more important to focus on healing and regaining as much continence as possible.

My surgeon was pretty upliftingly brutal in the "day after" meeting - he said everything looked ok, but the in-OR pathologist had some doubts from some lymph node tissue, so they took more tissue. He explained that you can't tell much of anything by looking at the tissue, and that any pathology-related information had to wait. His "looks ok" meant I didn't bleed out, and that nothing was reeking of rotten. Then he pulled out my drain.

I am also a G4+5.

My father was also stage 3 with SV involvement, Gleason 9 and 10.
He didn't have surgery, his primary treatment was ADT and IMRT radiation. Knock on wood, his PSA 9 months post treatment is undetectable.
So hopefully the salvage radiation treatment that may be ahead of you will catch the rest of it.

Thanks again for all the support.

My other question is how long does it take for him to really start feeling better? We are starting to get really concerned. He is 13 days post surgery and doesn't seem to be making much progress. They are going to do the dye test on Friday to determine whether or not the catheter comes out. His surgeon said some of the doctors have been pulling the catheters out too early leading to complications. Apparently the dye will help determine if there are any clots or other items to be concerned about.

It seems like he has one good day... then one bad. I'm not sure if depression is setting in or what. We have about 10 inches of snow so getting outside to walk isn't an option. He's pretty much stuck indoors in a smaller house.

He says he feels "sluggish". His fever is gone and he's still on antibiotics so I'm not sure what's going on.

His friends were all telling him about being back to work 10 days after the surgery. He can barely take a shower and then he's worn out. Is this normal at this stage post op?