My prostate cancer

Hi and welcome!

None of the information you've provided (pT2c and 3+4) so far indicates a high risk case.

Here's an idea for you to gather more information...   Go to the Memorial Sloan-Kettering nomograms web site, and find the prediction tool especially to predict likelihood of recurrence after surgery.  Go HERE and look for this:

Post-Radical Prostatectomy (Recurrence After Surgery)

This nomogram can be used to predict the probability that a patient's cancer will recur after radical prostatectomy, that is, the probability at two, five, seven and 10 years that the patient's serum PSA level will become detectable and begin to rise steadily. The nomogram should only be used for patients when radical prostatectomy is the sole, primary treatment.

Nomograms are statistical prediction tools based on the actual results of thousands of men before you.  It is important to understand that statistics give you an overall picture (and probability) of similar outcomes but every man is unique and stats can't predict exactly what will happen in your case.  Nonetheless, they are an excellent educational tool.

Hope this is helpful...

Thanks for your comments/ suggestions.

I copied more from the lab report, hope it gives more info.

Margin(s) involved by invasive carcinoma
Bladder neck margin(s) involved by invasive carcinoma
Treatment Effect on Carcinoma: 
Not identified
Lymph-Vascular Invasion: 
Not identified
Perineural Invasion: 
Present
Pathologic Staging (pTNM): 
Primary Tumor (pT): 
pT2c: Bilateral disease
Regional Lymph Nodes (pN): 
pNX: Regional lymph nodes cannot be assessed
Number of regional lymph nodes examined: 0
Number of regional lymph nodes involved: 0
Distant Metastasis (pM): 
Not applicable
Additional Pathologic Findings: 
High-grade prostatic intraepithelial neoplasia (PIN)
Gross Description
Received in formalin labeled with the patient's name and medical
record number designated "prostate" is a prostate gland with
attached bilateral seminal vesicles and vas deferens stump weighing
50 grams in toto. The prostate measures 3.5 cm apex to base, 5 cm
left to right, and 4 cm anterior to posterior. The right seminal
vesicle measures 4.5 x 2.5 x 1.3 cm. The left seminal vesicle
measures 3 x 1.5 x 1.2 cm. The right vas deferens measures 3 cm in
length x 0.5 cm in diameter. The left seminal vesicle measures 3.5
cm in length x 0.5 cm in diameter. The prostatic capsule is
gray-tan, rough, and focally disrupted. The right anterior surface
is inked black, left anterior surface is inked green, and the
posterior surface is inked orange. The prostate has a gray-tan
parenchyma which reveals multiple small clear fluid-filled cysts
and an approximately 2.5 x 1.5 x 3 cm homogeneous firm area which
occupies approximately 30-40% of the gland. Sections are submitted
as follows: A1 - right apical margin radially sectioned; A2 - left
apical margin radially sectioned; A3 - bladder margin radially
sectioned; A4-A5 - right apex; A6, 7, 8, 9 - right mid; A10 and 11
- right base; A12 - right prostate seminal vesicle junction; A13 -
right seminal vesicle vas deferens margin; A14-15 - left apex; A16,
17, 18, 19 - left mid; A20, 21 - left base; A22 - left prostate
seminal vesicle junction; A23 - left seminal vesicle vas deferens
margin. (cb) 

prv/8/19/2011

April1952 said...
I was diagnosed as having 7% cancer in prostate volume on pre surgery biopsy with Gleason 3+4, but post surgery report shows its 40% in volume. Can such a discrepancy occur normally?

7% of biopsy core vs. 40% of whole prostate.

I suspect that your doctor is concerned about positive margins. While there was a close call at the apex, a positive margin was found at the base. When surgery results in positive margins, it is common for doctors to recommend adjuvant radiation. That doesn't mean you should jump into it.

There have been a number of discussions on this forum about the decision to have adjuvant radiaton when there are positive margins. A recent study suggested that ART was appropriate if there was at least a 70% chance of recurrence. With Gleason 3 + 4, the study indicated that there would need to be some other condition such as spread to seminal vesicles to reach a 70% chance of recurrence.

When the chances of recurrence are not so high, some doctors prefer to wait and see if the PSA actually does rise. Some use the ultra-sensitive PSA test, as appears was done with you. Any PSA at or below .03 can be explained by benign sources, whether benign prostate glands left at the margin or peri-urethral glands in the penis. Above .03, unless the surgeon was sloppy and didn't get the whole prostate, the rise is assumed to be from the cancer. Some doctors are not waiting for the traditional rise to .2 before taking further action. Some studies suggest that it is best to act before the PSA rises to .1, and that the chance for biochemical free survival goes down 4% for each .01 rise. Studies also suggest that if radiation is started quickly after a rise, the effectiveness is about the same as ART begun right away.

So, if your doctor is indeed concerned about positive margins, you might see what he thinks about watching your situation very closely and taking action only if there is a confirmed PSA rise.

Here's an article you can read that may provide more insight: "Nine Decisions Before Electing RADIATION THERAPY After Radical Prostatectomy", www.prostate-cancer.org/pcricms/sites/default/files/PDFs/Is13-2_p8-17.pdf

Nellie

Looking at your pathology report:

pT2cNxMx - T2c, Stage 2 with both lobes involved; Nx, your doctor did not take out any lymph nodes, so, don't know if your lymph nodes are involved. Mx, metastasis unknown.

You have positive margins: THE TUMOR INVADES THE PROSTATIC RIGHT APEX; Margin(s) involved by invasive carcinoma; Bladder neck margin(s) involved by invasive carcinoma

Your doctor is correct that you are higher risk than normal, especially since your lymph node involvement is unknown. I would not question his assessment. However, if you are not comfortable, you could seek out a second opinion.

Best of luck to you.

clocknut said...
Not knowing everything about your case that your doctor knows, I wouldn't presume to question his judgment.
Why don't you talk to him and find out exactly why he considers your case to be high risk. The pathology shows a large tumor volume and that the cancer extended to the absolute edge of the prostate capsule in a couple of areas, and that may be influencing his thinking.

Ask the doctor for a clear explanation and then see how you feel. He's not comfortable about something that he's seen, regardless of what the pathology report says. Find out what that is.

Thanks. Doctor will be back from vacations tomorrow, I will contact him for more details and update the forum.

Maybe ask him if adding any HT drug therapy prior to radiations is worth while (as like in Bolla abstracts studies-you could google that to find such info) and see what he replies about that. You could start the HT therapy basically immediately, some surgeons do not like the HT prior to surgery as it makes the gland shrink and get a little stickish and harder to remove, but in radiations can be a nice addition to mopping up PCa cells. Anyway you have alot of contemplations to consider, also you could ask 'IF' getting radiations would you radiate any particular pelvic areas????

Dx-Apr 2002 total urinary blockage emergency room, bPsa 46.6, 12/12 biopsies all 75-95% PCa in every sampling, Gleasons scores found 7,8,9's (x2 sets), ct and bone scan appear clear, ADT3 5 months prior to radiations: neutron/Cyclotron 10 sessions & photon/IMRT 24 sessions, ADT3 cont'd., changed drug to DES after 2 yrs.,
still doing decent thus far, considering super high risk patient.

The part that stands out to me is the involvement of the bladder neck. I lost half of my sphincter and was incontinent until I had a sling installed 18 months post-surgery.
Ask the surgeon how much, if any, he took.
Do your kegels but don't blame yourself if you are not continent at 3 months.
Buy a cheap kitchen scale and weigh your pads to determine your daily leak rate. That data will be important to see if you are improving or not. You can the n use that info to tell you when it's time to throw in the towel and get it fixed.
Good luck to you.
J

April1952

Wow - really shows the value of a second opinion!

If we are ever uncomfortable with what the first doctor says, do as you did and go for a second opinion!

That must have greatly relieved you

Bud

PS : Nice Handle - I could have used April1948 (my birthday month and year)

My surgeon is back from vacation and he replied giving the reasons for going to Radiation:

It's primarily the +margin.
Studies show that you may benefit from adjuvant radiation.
IMRT is usually used nowadays.
It will primarily involve treatment to the area of the prostatic bed (where the prostate was before surgery).

To get greater details to your questions, I would defer to the radiation oncologists.