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Posted 8/5/2011 6:02 AM (GMT 0)
Hi Everyone

I had my RALP on 20 July 11 and I am due to see the Uro again in another 4 weeks to discuss my prognosis and PSA test result. In my initial consultation, he had hinted at radiation following my surgery, as he thought I may have been at pT3. My Path report was, however, better than expected and I am thinking he may now defer the radiation to see how my PSA behaves. Some questions:

1  Should I ask for adjuvant radiation therapy, given my Path report (see signature below)?,

2  If he recommends to defer radiation, should I ask for ultra sensitive PSA tesing?

3 Is there any real benefit in this form of test?

Finally, re: post op pain; I am experiencing some pain in the right groin and upper right scrotum, almost like the pain I remember after my vesectomy. I have also had some back pain (I have a grumbling back) since the surgery as well. Anyone else with similar experiences?

Thanks guys

 

Posted 8/5/2011 8:42 AM (GMT 0)
The groin pain could possibly be a hernia...
Posted 8/5/2011 11:06 AM (GMT 0)
Bob, The pathology report sure was a lot better than the pre surgery expectations. GS9 to GS7. I bet you are breathing a lot easier now, congratulations I had some right groin pain that eventually went away after my Robot date in June. It took about 3 or 4 weeks as I remember. My URO said it wasn't anything to worry about, but ask your doc as hernias can happen. I also had some back pains that was caused from the way I was positioned on the operating table, I was told to expect this before surgery. Good luck going forward and here is too you spending the rest of your life in the 0 club.

Terry
Posted 8/5/2011 12:36 PM (GMT 0)
Hi OzBob,

Providing your post-op PSA comes out undetectable (or not so high that it can't be explained as benign PSA), the NCCN Clinical Practice Guidelines in Oncology, which is the bible for oncologists, says that waiting for recurrence is an acceptable option.

Studies are tending to show that within a narrow ‘‘window of opportunity,’’ successful postoperative RT will be equally accomplished whether PSA is undetectable or whether it is barely detectable. That window of opportunity might be a postoperative PSA level within the range of 0.05–0.1 ng/mL. One article stated that 4% of potential freedom from detectable disease is lost for every .1 rise in PSA above undetectable (< .01). See: "Adjuvant radiotherapy after prostatectomy: does waiting for a detectable prostate-specific antigen level make sense?" http://download.journals.elsevierhealth.com/pdfs/journals/0360-3016/PIIS0360301610036692.pdf

Another article, discussing ultra-sensitive PSA tests indicated that PSA levels up to 0.03 could be caused by benign prostate tissue left after surgery, or by periurethral glands in the penis. Of course, there have also been cases where an inexperienced surgeon has left behind a big chunk of noncancerous prostate, resulting in a much higher benign PSA.

In my case -- undetectable PSA, Gleason 9 with positive margins -- I elected to wait for a rise in PSA before going for treatment. Dr. Scholz agreed with my decision, so long as I acted quickly after a rise was confirmed. When my PSA hit .03 and was confirmed, I decided to go ahead. Three oncologists stated that they felt this was a recurrence, even though traditionally, recurrence wouldn't be declared until the PSA hit 0.2 (or 0.1 for some).

I had one other factor that made me decide to move ahead. With today's uncertain job market and the recent restructuring of my company, I wanted to act while I still had the insurance. I might have waited longer to see if my PSA stayed at the .03 "benign PSA" level, but I just didn't dare risk it.

I had seven months to enjoy being "free" of cancer. That also gave my body time to heal and be better able to take the radiation that I will be getting. Perhaps I should have gone right away for adjuvant treatment, but since my PSA didn't rise to even .1, I shouldn't have lost much by the delay.

I wish you the best with this difficult decision.

Nellie
Posted 8/5/2011 2:57 PM (GMT 0)
I'd opt to skip the radiation treatment if the pathology report showed no further signs of cancer.
I too had groin pain (left side) after my surgery. I did go away after a few days, I found I needed some more support then the diaper could provide. Do have it checked out if the pain continues or gets worse.
Back pain. I had tremendous back pain before surgery. Since then it's been gone! Are you over compensating when you move? Straining to get up from a prone position, such as getting out of bed? Have you had a bone scan?
Posted 8/7/2011 8:35 AM (GMT 0)
Hi Guys

Thanks for the replies.

I saw the family doctor today about the groin pain and she ruled out a hernia. She thought it could possibly be an infection and prescribed me some antibiotics. She also advised me to redcue my walking, so I'll wait and see how it goes. It feels worse as the day goes on, so maybe I'm doing too much too soon.

Posted 8/7/2011 4:58 PM (GMT 0)
"Gleason 4+3=7+tertiary 5
EPE: Absent
Surgical margins: Negative
SVI: Not involved
LN's (right 23, left 17) Clear
Lymphovascular invasion: Present
Perineural invasion: Present
PIN: Present"

To me, the tertiary G-5 validates the original Gleason 9 diagnosis..The three words "present" suggest a long talk with your surgeon about further treatment would be wise...
Posted 8/17/2011 12:25 AM (GMT 0)
Hi Everyone

Just a post script to this thread: I returned to the hospital yesterday and saw a Uro about this groin/upper scrotum pain I have been experiencing for the last two weeks. Well, after a lot of feeling and poking in the said area, the Uro has concluded that the pain is coming from the right Vas Deferen and almost probably post op pain and nothing to worry about. I also had a CT scan with contrast as an added precaution and it was clear. I was told that the pain would gradually subside, but if it continued to give me trouble long term they could remove the Vas Deferen.

Anyone else had this post op?

Thanks guys

Posted 8/17/2011 12:33 AM (GMT 0)
Oz you may have seen this post I did last week. But it was information on suggested criteria for adjuvant therapies...

www.healingwell.com/community/default.aspx?f=35&m=2183102

No matter your decision there will be controversy. This is a tough call. You have just one of the necessary criteria with the tertiary score. But everything else looks favorable and active surveillance and a secondary approach would not be considered a bad decision.

Good luck with your decision.

Tony
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