T3b... Bone and abdominal scans clear

Doing some post surgery (11/26) test ie; scans. Thankful for scan results (Neg) but a little perplexed.
Dr. says remaining cancer must be "microscopic".... meeting with radiologist next week.
Setting up game plan going forward. Thoughts?
Have learned so much since joining this forum a week back. Thanks Guys.

John, just echoing Larry’s comments. Right now, focus on healing. See what your PSA is.
Just because it escaped the capsule, doesn’t mean it’s a forgone conclusion that you will need treatment right away. PCa is a funny (not haha funny, peculiar funny) disease, it’s like the stock market, it fools lots of people lots of the time.
It’s really important to give yourself time to heal before starting salvage radiation. And remember that PCa moves real slow. No emergencies in Pca unless one is in advanced stages, which you are not.

Not a bad idea to meet with an RO, but don’t let yourself get rushed into things.
And great idea to get another opinion from EPSTEIN on the pathology.

"Dr. says remaining cancer must be "microscopic".... "

All cancer is microscopic so not the most helpful observation. The only question is the location of "microscopic" cancer cells. They may be in your prostate, adjacent to your prostate, and/or anywhere the blood or lymphatic system might take them. The first and second locations have been identified in your pathology, T3b, thus secondary treatment is highly probable. The last item you will probably not know for some time which is the curse of PCa with everyone.

Were there any lymph nodes removed and examined in the pathology report? Radiation treatment (RO) would want to know if the lymph nodes should be treated in addition to the immediate removed prostate area (prostate bed).

Your PSA at 3 months (even 6 weeks for that matter) will go a long way towards identifying what is left. If there is a significant PSA at 3 months, a special PET scan will be probably be recommended to locate the probable source of the PSA generation if it can. Without a later PSA, there is really no guidance on what to do next except the shotgun approach of ADT and RT on everything possible.

Now is the time to see other doctors (RO) with your pathology report and all scans and get opinions. Your doctor seems to be moving too fast with too little information to make me feel comfortable based on what you have reported so far.

It's microscopic because scans didn't find any mets, but he was positive on:

Bladder neck ;present
SV invasion present (seminal vesicles) This is the one that gets you a pT3b
margins pos.;
right base pos.

My Uro called mine micro metastatic.
I agree it's too early for another PSA test.

aleph - I know what the intent was regarding microscopic but the bone and CT scans are macroscopic and will only detect cancer if there are millions/billions of microscopic cancer cells in a location, less than that, they come up negative. I get the feeling his doctor is looking at a PSA of 3.9 at 10 days and saying the cancer is coming from microscopic sources and he must do something fast which I think we all agree is premature. John will have to do something, the full extent is not yet known or there is additional information not yet shared.

I just ran the post-surgery nomogram from MSKCC using the signature information. Probability of being recurrence free at 2 years = 42%, at 5 years = 22%, at 7 years = 17%, and at 10 years 13%. To me these indicate you need your doctor to be in front of this and prepare for a strong probability of additional treatment. As others have said you have to heal from the surgery. When you have salvage or adjuvant radiation, it basically stops the recovery from surgery in many regards and the side effects at that time aren’t expected to improve. Plus SRT brings on side effects as well since there is no prostate to absorb most of the radiation. . Thus the longer you can heal, the better, but not at the expense of potentially aggressive PCa spreading.

John,
I would say there is no evidence to indicate that you aren't well on your way to an undectacle PSA.

Try to relax and worry about crossing bridges only when they come. 🙂

https://pcnrv.blogspot.com/2017/12/second-opinions.html John, read this report and then you will find a link on there on how to send your biopsy results. lots of good info

Larry

John - Back to your original question for RO where halbert was going. Some similar questions I would consider:

How long should I wait before starting ART or SRT after surgery?
What would be your recommendation if my 3 month PSA is <0.10? What would it be if PSA was >0.50?
Would you recommend HT (hormone therapy) if PSA was very low or undetectable at 3 mos?
Would you treat the lymph nodes in the absence of any data about them?
What would the treatment consist of? IGRT/IMRT? How many sessions? Dosage?
What would the probable side effect profile be in his/her experience with the proposed treatment?
What would be the probable outcome benefit to proposed treatment

I suggest visiting this Cleveland Clinic site where they have a post surgery calculator that you enter your data with and without ART and lymph node info:
http://riskcalc.org:3838/prostatecancerpredictingpostradicalprostatectomy/.
The RO may do this also when you are going over your items.

Good luck next week.

John: As a fellow pT3b, it looks to me like u are doing all the right things, and you have a doctor who is on top of this situation. The uPSA will/ should be the tale of the tape, the longer u can stay undetectable the better, giving yourself time to heal, and hopefully avoid the potential SE that can occur with 3 treatment modalities. Keep in mind goal # 1 is to shoot for a possible cure ( I assume) so listen to your RO, he/she appears to be a good one. Best of luck, MM

John - Your RO's plan sounds like the right idea but wonder if you might be pushing the schedule a bit. I still think it might be best to get your 3 month PSA (12 weeks or Feb 25th±) before undergoing ADT or RT although a 7 week PSA will go a long way towards letting you know where you are heading if not close to undetectable by then.

Your continence issues are quite normal at 2 weeks post-cath. While I was continent after removal, the urinary system was not even close to being normal for weeks/months. I wore a pad at night for a week or so at first as I was waking up every few hours at night worried about having an accident with the first signs of any urinary pressure or spasm while asleep. This went away with time as my capacity and confidence increased.

Coffee, tea, wine and beer do not help the urinary tract at all so I avoided them completely for a month or two and then slowly phased them back in to my diet. I would only drink one cup of coffee or have one beer as I tested my system. Drinking a beer an hour or so before bed was a sure way to get up a few extra times that night so I watched the timing also. Going on the first long car ride is equally fun as you tend to stop at many rest stops just to make sure you are drained for the longer runs. It is a good idea to not drink 3 cups of coffee, pee, then drive for 400 miles when you are still training the bladder. A wee-wee travel jug is helpful for the first few trips as a safety precaution.

On the other hand, you should always be drinking lots of water to keep the system clean after surgery but the side effect is peeing a lot which increases the potential for your bladder having urgency phases at inconvenient times. They all go away with time but getting from catheter out to 3 months out is a trying time. ART/SRT does irritate the bladder and urethra after a number of treatments so it is best to have good control over urinary functions before doing RT.

Keep in mind you will probably start ADT prior to radiation thus this buys you a little more recovery time but ADT will start knocking down your PSA so you will not be able to get a true reading of surgery results once you start ADT.

Hope your next PSA and meeting go well