New Information on Surgical Pathology 3 1/2 years after Surgery

So, in the face of a rising PSA, i am going to make a final decision about going ahead with SRT with or without Hormone Therapy after one more PSA which i will do the end of this month. My current PSA is .068 as of a month ago.

For background, i had negative margins, however, my surgeon does a intra operative frozen section which is looked at by pathology, which showed a positive margin, leading to the surgeon to do further resection, to obtain final negative margins.

I saw two prominent Radiation Oncologists who both advised that i should be treated now, saying that they felt 80% sure that the negative final margin actually did contain some cancer cells that were missed and wasnt really negative
My surgeon thinks i should wait and do scans if i reach .2, which he says may never happen.

So as Tall Allen suggested, I recently asked that the slides be relooked at, and that i be informed what % of pattern 4 cells there was in the g7(3+4) which was the "dominant tumor" (1.1 cm) AND also what the gleason was at the positive margin in the frozen section, before the surgeon obtained negative final margins.

Today i got the results as follows:
The tumor shows approximately 5% of a Gleason pattern 4, wiht the remaining 95% pattern 3

And this:
While the final margins are negative, the involved apical margin (part A (which was the frozen section)) showed Gleason pattern 3 at the margin

So now, this new information gives me pause, and i am not so sure whether i should do SRT at such a low PSA.

Any thoughts would be welcome.

Well...only 5% pattern 4 in the tumor. And no pattern 4 at the margin. I certainly don't know, but it could lead to waiting for more info.

Prato- You have done the right thing in getting more information. I'm not you, but after reading the new information, I would lean towards waiting a bit before starting further treatment.

It's your life, and if you feel better addressing this now, then go for it. Good luck.

Prato—
Didn’t they give you a crystal ball when they made you an FM? You got gypped.
How much simpler your life would be if you were 4+4 like me. Don’t you just hate getting good news, Mr. 95% 3?
Jeepers, I’m starting to sound like garyi
When even TA doesn’t know what to tell you to do, you know you’re on a serious bubble.
I think you should consult LifeCoinTosses on this one.
—SP

"Just when ya think you're out, they pull ya right, back, in."

RO at JH said if I wanted to git kured....6 mos. of ADT and hit it now while we know where it is.

RO over here by the house (proton place) said it's cool to wait.

The RO at JH only had the .05 result to go on. Don't know what he'd of said if it were still at the .02 that it went back to. (I suspect the same....it's his job to kill cancer cells...no matter the collateral damage..is my thinking as to how he's thinkin')

The RO at the proton place was goin' off of the .02. He said he could see tx if it goes up...matter of fact...he flat out said he believes I'll end up having to have treatment.


The guys in our situation has the most to lose by not treating. But also the blah blah blah....


I think the PSA will end up making the call for you pratoman. Same with me.


sorry I can't help ya

IT, there is no answer. Like everything else about this disease. And you are right, it will be about the PSA. But the question becomes, what’s the trigger point

@Andrew, thanks, one of my favorite songs of back in the day.

Hang in there buddy, keep asking questions and the right answer will become clear. Denis

Gary......serious post......
You totally misread me. There is zero “anguish” on my part. And surprisingly little anxiety. While we may disagree, I think I’m being very reasoned in my approach, and I’m simply responding to data. In fact, I’ve seen 2 RO’s, which I think is about 176 less than you saw when you were in the decision making stage 😉.

My tumor was 5% of the prostate, and it was 5% grade 4 cells. So if you do the math, the grade 4 cells were 2.5% of a relatively small organ. And there were no grade 4 cells at the positive margin in the frozen section. So I’m thinking if this PSA is coming from grade 3 cells, it could take forever to cause a problem. I realize I’m taking a risk. But I think it’s an acceptable risk. Like I said, I may just go ahead and do it. But I need to speak with the medical professionals, WITH THIS NEW DATA IN HAND, before I do.

I think I’m being pretty rational and unemotional. Especially for me.

I disagree that SRT is inevitable. I think it’s highly probable, but not yet inevitable. I might change my tune in a few weeks after my next PSA, depending on the data. And if I do, I’ll act.

Prato, it sounds like you are doing everything right. Steady as she goes. Your numbers pretty much concur with what I laid out in another forum. You still have a long way to go before any sort of crisis stage, and by then there will likely be many new developments. Just do what you are comfortable with. You have, and have had, a lot going on in your life. If the rise accelerates you will probably still have an ample window for action.

Tur-, you are correct, I meant to say 1/4%.

Thanks guys.

As always, just giving you a contrarian viewpoint, Ken

I visited four RO’s to choose WHO, not WHEN. While our pathologies are quite similar, our situation are very different.

Given all our many discussions, I believe you have much more anguish and anxiety than you admit to yourself. Witness the shear volume of activity, doctor contacts, threads, posts, and soul searching you’ve put yourself through in the last month. Your real logic for delay, given your risk odds, escapes me. All with a PSA of well under .1

It’s easier to search for, and accept, the most illogical path that confirms what you wish for, than the much more obvious facts that denies it. I suggest your challenge is to dig deep within yourself for your true motivations, rather than review 3+ year old slides, and multiple physician additional inputs, hoping for that elusive/impossible answer. The odds are so against you, but your good path, low PSA and your time since surgery, mitigate that somewhat.

Be ABSOLUTELY sure you’re not kidding yourself dear friend. I want the best outcome for you, Mr. moderating drama king....seriously!

Thanks ed. It’s my expectation that I’ll probably go ahead with SRT unless I get a drop in PSA end of this month (highly unlikely, I realize). But I’m way more inclined to skip the HT based on this new data. With Drs guidance of course

on my, that almost felt like a decision.