Final path

Beaverduck,

Very much like mine. G6 at biopsy, G7 (3+4) after surgery. No SVI (good), no LNI (good again). An upgrade post surgery isn't uncommon--I seem to recall hearing 15% or so. So, now, it's about recovery from the surgery, and wait for your 3 month PSA, and after that....let's hope for years of good reports.

Regarding post surgery PSA: My surgeon told me that he did a PSA at 6 weeks--to confirm the trend, but that the 3 month was the definitive answer. And, generally, that's what we see here--a lot of surgeons want a 6 week PSA--but they use it only to make sure the trend is moving properly.

halbert said...
Regarding post surgery PSA: My surgeon told me that he did a PSA at 6 weeks--to confirm the trend, but that the 3 month was the definitive answer. And, generally, that's what we see here--a lot of surgeons want a 6 week PSA--but they use it only to make sure the trend is moving properly.

Yes. The ultrasensitive PSA studies of whether post-op PSA can prognosticate BCR risk use the 3-month values (<0.03 is good, <0.01 even better). As halbert said, docs like a quick check that the surgery was a succes, i.e., that persistent PSA isn't likely. For what it's worth, my uPSA nadir occurred at 9 months post-op.

While Gleason Grade Group 1 and 2 men don't need to be folowed with a uPSA test, knowing your nadir is nice, especially if you do encounter BCR.

Djin

Post Edited (DjinTonic) : 3/2/2020 7:15:07 PM (GMT-7)

Thanks for the replies everyone.
My doc has set my first PSA test for 3.5 months after surgery (6/1/20).
They use a scale that goes down to <0.05.

Quick question: Any reason to seek genomic testing or a 2nd opinion on my path report?

Thanks all, BD

beaverduck said...
Thanks for the replies everyone.
My doc has set my first PSA test for 3.5 months after surgery (6/1/20).
They use a scale that goes down to <0.05.

Quick question: Any reason to seek genomic testing or a 2nd opinion on my path report?

Thanks all, BD

BD: your call. No real need for the 2nd opinion--they have the whole gland sliced and diced to look at, vs a biopsy that is only looking at a very small fraction. As far as Genomic testing--my view is, do you want something to stress about for the rest of your life? If it came back high risk for BCR, what would you do about it?

IMO, get ready for the PSA for life situation. FYI, I had my 5 year since RALP blood draw yesterday morning. Definitely a ho-hum. But....I'm watching for the email from labcorp to tell me that my results are up.

Nicely done! Congrats and good luck on your recovery.

All is up to you regarding 2nd opinion and Genomic testing and your mental state after going through all of this. I am pretty sure I would have stopped doing anything prostate related other than PSA monitoring if I ended up with your pathology. Life would be good and I might still visit HW but with a completely different interest level.

However, it is not something you can easily do in 10 years so best to get it done while everyone still knows where the prostate and pathology slides are if you are interested. The 2nd opinion is cheap, <$300, and the Genomic test is expensive so insurance coverage would have to be reviewed. Maybe you do the 2nd opinion and if it says anything concerning, move to step 2. Then file it all away and worry about it someday if needed. Maybe skip it all and move on with life.

Djin Tonic your probably right I didn't actually see the 0.0 result that is what I was told by the nurse of my Surgeon at MDA.
I need to go see if I can find that in My Chart.

Thanks for looking. It's nothing dramatic or anything of concern. I was just making a technical point.

Djin

Thanks I understand
Hoping the same thing for the Beav

Holidayhill said...
My post RALP report also indicated the presence of perineural invasion. I wonder about the chance of having the cancer spreading outside the prostate and any increase in mortality risk? Although my 4.5 month post op PSA was great at <0.01, I am concerned this will not continue longer term. I have a scheduled meeting with urology on Thursday and will discuss.

Hi HH. What were the details of your post-op path report. Your final path details are much more important than your biopsy details and should be in your signature. Did it confirm your G7 (4+3) and was the only finding PNI? Perineural invasion is more important when seen in at biopsy, since it correlates with negative findings at the time of surgery. Estimates for finding PNI somewhere in the whole prostate after surgery run as high as >80% of men! It's significance is still debated, but I would not worry about it if it's the only negative path finding! You post-treatment PSA of <0.01 is a good predictor of avoiding BCR in your future. Of course, nothing is certain in this game.

The Perineural Invasion Paradox: Is Perineural Invasion an Independent Prognostic Indicator of Biochemical Recurrence Risk in Patients With pT2N0R0 Prostate Cancer? A Multi-Institutional Study (2019, Full Text)

"Methods and materials
We identified 1549 patients who received a diagnosis of margin-negative pT2N0M0 prostate cancer at 3 separate institutions between January 1, 2008 and December 31, 2014. We reviewed the electronic medical records of these patients and collected clinical and histologic data. A multivariable analysis was performed to assess the association between PNI and biochemical recurrence.

Results
Of the 1549 patients identified, 936 (60.4%) had PNI and 96 (6.2%) had biochemical recurrence. The median time until recurrence was 16 months.
...
Conclusions
We found that PNI was not an independent indicator of the risk of biochemical recurrence. Instead, PNI may be an indicator of unfavorable histology such as a high Gleason score or diffuse disease within the prostate in pT2N0 patients."

[Emphasis mine]

Djin

Holidayhill said...
My post RALP report also indicated the presence of perineural invasion. I wonder about the chance of having the cancer spreading outside the prostate and any increase in mortality risk? Although my 4.5 month post op PSA was great at <0.01, I am concerned this will not continue longer term. I have a scheduled meeting with urology on Thursday and will discuss.

just remember. where you are at in the journey it's common to think the cancer will return.