Post-DaVinci pathology report

I had DaVinci surgery couple weeks ago and unfortunately my post-surgery pathology report found more cancer than originally thought. I have not seen the report, yet but in a phone conversation with my surgeon he shared that it was a good thing I pursued surgery.

My Gleason score was upgraded from 3+3 to 4+4
Margins clear
Lymph nodes clear
Cancer did reach seminal vesicle.

In my readings a Gleason score of 8 and seminal vesicle involvement leans toward a poor prognosis.

Post-op PSA is set at 8 weeks and at that time we will discuss treatment options. Since Im traveling a distance he has made arrangements for me to meet with the radiation oncologist at the same appointment.

Im interested in thoughts, insights. My concern as stated above is the Gleason upgrade and SV involvement.

Hi Evets,
Welcome, sorry you have to join our club. Don't get too negative(in case you are feeling that way) yet. Wait on the PSA and the discussions with surgeon and oncologist. Your path report is not quite as poor as mine was. I am 20 months out and still waiting to see what the future holds. You may choose a quicker, more aggressive secondary treatment as many here do, and as many experts recommended.

However, my recommendation from a major high-volume RP center, as they gave me the bad news on my path report, was to just wait. Admittedly that was a couple of years ago and things may or may not have changed, but my surgeon– who was also a major researcher and highly published expert –was of the opinion that early treatment(i.e. before any sign of rising PSA's) did not have any significant long-term survival benefits. Where as it often does have a higher incidence of side effects. I hope he is right about the "no survival advantage".

In the meantime, I have remained less than .01 for at least one year post surgery, and just recently lost my < at the 18th month check up. I have now become detectable at .01. So I'm grateful that I have at least had that additional time to heal even if I do progress to needing further treatments. I don't think my guys have changed their mind yet about wanting to see 0.1 before considering new treatments. So as of a couple of months ago I still have a long ways to go to get to that point, it would have to rise by factor of 10.(Even though it might not necessarily take it a long time to do that). But, at the very least I will be waiting to see the level of .03 before considering any other treatments. I could be wrong, but that does not seem to me like a careless approach.

So, you really have to wait to see what your first PSA is, and if it is very low or undetectable, how long it takes it to rear its ugly head. No, actually you don't HAVE to wait for that, many people will choose to go ahead and get it treated regardless. However, I just wanted to say that there are differing opinions about that out there by very smart people on both sides, and that just because you are a Gleason eight with seminal vesicle involvement does not automatically mean you are going to go rapidly to recurrence. It does not even 100% mean that you will ever get to the recurrence, though you are at a fairly high risk to do so. I think my doc gave me approximately 50% odds. Plus, you can look at this long-term study to see that all is not necessarily lost, and that in fact your odds might be a little better than you are assuming. Only 12.9% of this group had adjuvant radiation therapy:
www.renalandurologynews.com/prostate-cancer/study-supports-surgery-for-high-risk-prostate-cancer/article/338483/

Bill in MS

The surgeon comment re good thing I pursued surgery was due to the belief/second and third opinion belief that I only had 5% involvement and G6 based on biopsy. That surgery could be viewed as aggressive treatment and even watchful waiting was on the table. I believe once the pathology report came back his response simply ment that it was good I didn't wait longer.

I appreciate the comments. The actual location of the SV involvement will be important.