When the doc gets in there question

So a little update. We have now been to 3 Uro's and and RO. They have all suggested surgery would be a great option for my husband as he is in such good shape and his cancer is contained. They have all been a bit perplexed that his Gleason is 8 but only in 1 out of 12 cores. The one positive core only had 5% cancer. The Uro told us that the prostate has some shading or something in the center according to the MRI. The biopsy showed the tumor in the left apex. So Dr. Epstein has just confirmed that the Gleason is in fact an 8.
My husband is scheduled for surgery with Dr. Ahlering on 5/10. My question is will it be likely that the dr will find more cancer in the prostate when he is in there. Is it possible that the 1st Uro got it all in that one core? He did tell us that he could have just caught the tip of it and there is more. We feel blessed that the cancer seems to be contained but are anxious about what the final pathology. Is it also possible that the Gleason could be upgraded to a 9?

It's like poking a blueberry muffin with a needle. Sometimes you get blueberry, sometimes you don't. Has there been any kind of imaging that can show spots suspicious for high-grade cancer? That would give you more info, but even then it's not conclusive.

As to what you'll find at pathology, some guys get upgraded, most don't. And I've even seen a guy here where they couldn't find any cancer upon pathology. But one of the benefits of surgery is that you'll get a complete pathology.

Good luck to you and your husband!

up4thefight,

Reality is that surgical pathology differs from diagnostic pathology about 30% of the time. And sometimes it's an upgrade, and sometimes a downgrade. The important thing is to get him ready for surgery. Kegals, walking, even weight lifting to strengthen the pelvic and abdominal muscles are all good things. Make sure he has a comfortable recliner with a stack of his favorite DVD's and a handy remote for the first week or so after surgery.

I went back to work after three weeks--which may have been too soon. But...if he's active, then regular walks after surgery are needed.

Oh, and between now and surgery--make sure he has plenty of sex.

Most surgeons tell us to take stool softeners (dulcolax) for the first week and to really work at not straining for the first BM. Seriously. I had a steak dinner the night the catheter came out. The first few days I didn't feel like eating. His gut won't work at all for a few days.

Drink plenty of fluids, take your dulcolax and metamucil, and eat whatever works. It was mid winter and cold and snow outside, so I think on day 2 home I had oatmeal with craisins. Heck, at lunch time at the hospital, 24 hours after surgery, they brought me meat loaf and mashed potatoes. It was pretty good, too.

Tall Allen said...
I'm hoping for no upgrades, but even if it is, if it hasn't spread or metastasized and he gets it all, what difference does it make? Does Ahlering look at frozen sections during surgery?

After 9 years on the forum I believe this is the first time I have seen intra-operative frozen section raised.
I had my robotic surgery in Sydney (St Vincent's) in 2007 and it was normal practice to do a frozen section on the removed prostate before completing surgery. In my case this showed the (extensive 7/8) tumour extended to the prostate margin and prompted the surgeon to take an additional wider margin before closing up. (sadly this involved loss of the nerves).
I have often wondered if quite a few of the failed surgeries we see here on the forum might have been successful if doing a frozen section during the operation was the norm.

I do not have the same information that you and your doctors do. Over the past ten years I have become a NO Surgery advocate. I blame the limited diagnostic techniques available 10 years ago for my current outlook. I talked to urologists back then and they talked surgery. After my surgery I still had to go through RADIATION treatment and that might not be the end.

I might have had 10 years of improved erectile and urinary function if I did not have surgery in 2007.

I look on surgery the same as blood letting and leeches in prior centuries. That, of course is major hyperbole, but good medical care keeps changing and I think that surgery for prostate cancer should be replaced with newer and more advanced treatments.