New and Blue

From a fellow t3b, hi eaglekeeper, and welcome.

T3b and G6 -- that is an interesting combination. T3b is relatively bad and G6 is relatively good. I don't have any advice off the top of my head. What did the rad onc recommend?

I forgot to mention that U of M Cancer Center reevaluated my G6 to a G7 (3+4), I talked to my uro and he told me he was sticking to the G6. My wife and I figured we'd stay a couple of days in Detroit and I loved a saying I saw, "life isn't about waiting for the storm to pass, it's about learning to dance in the rain." The rad onc suggested 40 rounds of 70 grays to the pelvic bed before 6 months. My uro suggested SRT when PSA started rising.

Hello and welcome to our world. Yes, you have an interesting combination of stats there. Bad on one hand, good on the other. Considering the risks involved with radation, and certainly not telling you what to do, I would be inclined to wait and see if you have any recurrance, and if so, then do the SRT. You may never need it, and it could be done later if proven to be needed. Just my take.

David in SC

Eagle, if you were pT3b, it means cancer was found in at least one seminal vesicle. If so, I would say the chances are very good that you weren't G6 (3+3). For example:

"...
One of the 3,290 Gleason score 6 cases (0.03%) showed seminal vesicle invasion compared to 93 of the 4,202 (2.2%) of Gleason score 3 + 4 = 7 (p <0.0001).
...
Conclusions: It is not rare for pure Gleason score 6 prostate cancer to locally extend out of the prostate 3.9% focally and 2.4% nonfocally. In extremely rare cases Gleason score 6 can be associated with seminal vesicle invasion and yet not lymph node metastases. Our overall findings support the argument for continuing to use the term cancer for these tumors." (From a 2018 study)

(Bladder-neck invasion should be now be graded the same as extraprostatic extension, pT3a.)

If you were G7 (3+4) with SVI+ as your only adverse finding, I believe current standard of care would not be adjuvant RT, but rather to hold off until/unless your PSA goes up. Keep in mind that since the seminal vesicles are removed along with the prostate, it is possible that all you PCa was eliminated at surgery.

I would have my RP tissue and slides sent to Dr. J. Epstein at JHU in your case for a definitive answer regarding your pathology. If you are then still concerned, you could ask your docs about having a Decipher test done on your RP tissue to determine your risk (low, intermediate, high) for developing mets within 5 years.

Djin

Eagle - I chose adjuvant radiation (ART) which is loosely described as RT within 6 months of surgery with a non-detectable PSA <0.10. It is commonly done without hormone treatment so that would not be surprising. It is a preemptive treatment without having a rising PSA to justify additional treatment.

Why do that? - Early RT treatment has better results than delaying treatment in higher risk situations. You have to have a couple of bad things in your post-op that causes one to make that decision. You have only shared the pT3b classification as your bad news and the rest of the news is decent.

I think I would try to get more information, a second/third opinion on the pathology slides from Dr. Epstein’s group at J Hopkins and a Decipher genomic test on a sample of the prostate cancer tissue to assess the risk. Both are easy to arrange with your urologist or whoever has the slides and tissue.

This will give you more reasons to do treatment now or wait for rising PSA if that happens. If you confirm the Grade 4 cancer and get a poor score on the Decipher test, the argument for prompt treatment is greater. If not, monitoring your PSA is probably all you have to do for now. Just my thoughts based on what you have shared so far.

Djin, that is possible. Even so, he's only then just over 3 months since surgery, and is non-detectable PSA. Doesn't that override other considerations? Why do adjuvant radiation if he's non-detectable, regardless of pathology?

Eagle:
Who is the RO you are seeing at Umich?

Mel

Something is wrong with the time stamp. Eagle keeper last posted in 2019. And my friend Robert SouthernComfort last posted in 2017. I do not think this is a current thread and somehow got bumped yesterday with a current time stamp.

You guys are right. The mystery of time stamps continues. I’ll ask some questions and report back if I get an6 answers