Should I hope?

My husband was recently diagnosed with prostate cancer - we got the "call" Christmas Eve. It has been quite a detour in what we were expecting for our retirement years. The hardest part for me is trying to get my head around what is ahead of us. I am so worried yet trying to be positive and supportive.

My husband's PSA had been a little high in 2013, but following antibiotics, dropped down under 4 (which his family doctor said was the line between normal and check it out with a biopsy). But in December 2014, his PSA was 12.5, so a biopsy was ordered. It found 8/14 cores with cancer, the most serious were Gleason 7 (4+3). Since we live not too far from the Mayo, we decided to go there. The Mayo did a bone scan and CT scan of the abdomen and said they were clean and recommended surgery. He had a robotic assisted prostatectomy last week, which found that the cancer had spread to one of the seminal vesicles, but the lymph nodes and margins were clear. They staged his cancer as T3c. His doctor, who is excellent and I trust completely, recommends frequent PSA checks every 3 months before doing additional treatments. The hard part is looking ahead to the future. Dare we hope that the surgery took care of the cancer completely? He seems to be on the border line - the fact that the lymph nodes and margins were clear point to a positive outcome, but the Gleason and seminal vesicle invasion are less than optimal. Have others had similar diagnoses and if so, what has been your experiences?

_______________________________________________________________________
Age at Diagnosis 64
PSA 12/2012 3.78; 12/2013 4.9, following antibiotic regimen dropped to 3.8: 12/10/2014: 12.5 with DRE negative (according to local urologist)
Biopsy 12/16/14: 2 of 14 GS7 (4+3) @ 80% & 80%; 4 of 14 GS7 (3+4) @ 95%, 95%, 90%, & 50%; 2 of 14 GS6 (3+3) @ 100% & 45%; perineurial invasion seen
Mayo Clinic said DRE positive; bone scan & CT negative; PSA 12.6; stage T2c, 20-30 cc total volume; recommended prostatectomy
Robotic assisted radical prostatectomy with extensive lymphadenectomy at Mayo Clinic Rochester by Dr. Tollefson & team 2/11/15; GS7 (4+3), one SVI, margins & nodes negative. Stage T3b; Recommended PSA rechecks every 3 months

MN wife, really sorry you had to find your way to this forum, but it's a great place to get knowledge and support.
I'm going to leave it to the more knowledgeable guys here to get into specifics, but I'll just say that this is NOT a hopeless situation by any stretch. Is it serious? Sure. But highly treatable. Prostate Cancer is slower growing than other cancers, with many many treatment options and many more in the pipeline. There are many men here with GLeason 8 and 9, more serious than g7 (4+3) , that have survived and thrived, with treatment,
And you are in a great place at Mayo.

Many of the big Cancer centers have "Nomograms" on their website, they are like calculators where you put in your information and based on their database of thousands of men treated with your specific numbers, tells you the chance that you will have a biochemical recurrence or die pf PC.

I put your husbands numbers into the MSKCC nomogram, and the numbers should at least give you hope, and I hope make you feel better.

It showed that a man with your hisbands GLeason after surgery, with his stage and seminal vesicle invasion, ECE, but negative margins and lymph nodes, has a 91% chance of NOT dying of Prostate cancer in the next 15 years. 91%.

So Yes. You should hope.

The numbers on his chance of biochemical recurrence are not as good, but keep in mind, that BCR is when the PSA starts to rise after treatment, and most often, it's years before any symptoms show up after BCR. And with proper treatment your husbands chances of hanging around to drive you crazy till age 80 are pretty darn good.

If you want to do the nomogram yourself, go here

www.mskcc.org/nomograms/prostate/post-op

Stick around here it's a very helpful place

Howdy MN and welcome to the forum. I'm one of those G9 guys Prato eluded to. I see no reason not to be optimistic at all. The 4+3 puts you guys on the high-intermediate risk scale and is still quite manageable. As others have stated 3 month PSA checks are the norm and may cause some "PSA anxiety" but that's part of game. My recomendation is focus on surgery recovery and researching what "might" be next if further treatment is required. Any questions pop up ask away! Again welcome!

Cheers, Doug

Hi and sorry to hear you and your husband are part of our club. I'm not a surgery guy so I'm not as skilled as some here are at reading the pathology report, but the fact that the lymph nodes and margins are clear is very significant, so yes you should hope!

And under the worst case scenario, I'm sure you know that he can have radiation to clean up anything in the prostate bed. Many folks here have had that and can weigh in as needed.

But first, I wish him a speedy recovery and a great first PSA reading! Keep us posted.

Logos, he had RP surgery this week. So there wouldn't be a post op PSA

Thank you all. Your responses brought tears to my eyes. I'm so glad to hear your experiences & the nomogram - I hadn't heard of that. Thank you!

MN Wife. Not much I can add to the excellent advice already given. Apart from saying welcome to HW. You have certainly come to the right place for all your worries and concerns regarding PC. You will find a lot of good information and advice here from guys who have taken the surgery rout. So please don't be afraid to ask any questions that you may have.

All the very best to you and your husband. It looks like he has a great wife by his side. Who could wish for more

The probability of remaining recurrence free with a path report diagnosis of T3b is probably 50-60% in 10 years. You can check it for yourself:
www.mskcc.org/nomograms/prostate/post-op

Radiation may be curative. The odds of that with seminal vesicle invasion and a pre-op PSA>10 is also probably around 50-60%. The earlier you do it, the less chance that it will progress before treatment. However, the earlier you do it, the greater the risk of lasting incontinence and impotence. I recently reviewed some research that showed there is no risk to waiting for a 3-month PSA (not on Lupron!) before deciding - that will give tissues a chance to heal too. If the PSA≥0.03 on an ultrasensitive test then, you can stop it from progressing further with early salvage radiation.

No one yet knows if stopping the progression will translate to a survival advantage because survival is usually so long. The current studies do not stretch out for more than 10 years, which isn't nearly long enough. That is a very hopeful aspect about his current diagnosis.

I think it's prudent to begin conversations with a radiation oncologist. Your urologist has outlived his usefulness, and lacks the knowledge you need from this point forward.

- Allen