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Posted 10/27/2021 8:10 PM (GMT 0)
I'm going to start a treatment thread if that's OK as the odds against one and done look a little longer now.

I was diagnosed and rebiopsied as T2 3+4 but final pathology is T3a (1mm EPE but all caught with NSMs) 4+3 with 9.9ml main tumor with the EPE and elsewhere allsorts of 3+4 through the gland. Final size 73ml. Lots of cancer, lots of gland so hopefully all the PSA is coming from in there.

Surgeon laying great emphasis on NSMs but I think we can all agree I will be lucky not to BCR at some point and the risk is I never get undetectable. Fingers crossed for 7-8 week first PSA... Wish me luck.

Good news is on day 0 of catheter removal I am not even having to think about continence till the OAB kicks in. Then it's all over, so I need pads. But that will pass.
Posted 10/27/2021 9:32 PM (GMT 0)
Let me the first to wish you luck and based on how I've seen so many guys do around here, you'll likely do very well even if you're not one-and-done like you had hoped for. I'm not a surgery guy or smart enough to comment on the pathology specifics, but I'm sure the smart guys will be here soon. (Paging Djin and Halbert, as well as several others.)

Good luck on the recovery, which I'm sure if your main focus now.
Posted 10/28/2021 1:51 AM (GMT 0)
Shaw, sorry about the upgrade, but as Michael said, you should do very well.
No continence issues to worry about is something i would call huge.
Good luck with your first PSA. Keep in mind, 7-8 weeks is a bit soon, even though many surgeons do a psa at that point, or even 6 weeks (as mine did) for an extra data point. I think the 3 month PSA will be the tell.
Best of luck, we will look forward to a good result along with you
Posted 10/28/2021 2:41 AM (GMT 0)
Glad to hear these guys say you will do well. This is a scary road to travel. You'll be in my prayers and I'll hold you in my thoughts.
Posted 10/28/2021 7:49 AM (GMT 0)
Thanks guys: I really appreciate it.

An addendum is I have ductal adenocarcinoma of the prostate. Bad news. Cue furious googling and turns out it's not INDEPENDENT bad news (i.e. it drove the upgrade/upstage and doesn't itself add to the damage) https://pubmed.ncbi.nlm.nih.gov/31711982/

I thought seriously about a new thread in terms of what I am going to post next, but I already have set a couple of surgery v radiation hares running and that is enough. But it turns out that I had some blind luck (it wasn't on my biopsies) because this stuff responds better to surgery than radiation. https://pubmed.ncbi.nlm.nih.gov/33996481/

This is all bleeding-edge stuff: what these guys are learning all the time works to the benefit of all of us
Posted 10/28/2021 12:18 PM (GMT 0)
SUM: yeah, the upgrade, especially ductal variety upgrade, sucks. There's no other word for it.

So, a few things come to mind, in all that:
I'm with my buddy Pratoman about the 3 month PSA. Many doctors do one at 6-8 weeks, to make sure you're moving in the right direction. You may not be undetectable then. By 3 months, you should be if you're going to be.

Here's the thing: you can be thinking about BCR and rapid radiation as an add on--but you still can't start it until that magic three month window. Why? the more time you give the surgical injury to heal, the better your chances of going through the radiation with no issues. So, in the mean time, keep doing the kegals. Your OAB will settle down soon. If you're like most of us, what you're reporting is not really OAB--it's the new normal.

The time lag between "I need to go soon" and "I need to go Right F'ing NOW" is a lot shorter than it used to be. It all has to do with the anatomical changes from the surgery. It can get a little better with time, but it's also a thing of just adjusting to it, I think.

It sounds like you're on a good path, and while the next weeks may be nerve-wracking waiting for the PSA results, keep on keeping on. It's wait and see time...and, honestly, the pang of anxiety as PSA time comes close never really goes away. At least it hasn't for me, and I'm at 6.5 years plus.
Posted 10/28/2021 12:48 PM (GMT 0)
Well to quote another “it is what it is”.

You now know much more and must move forward with the knowledge and experience you have. I wouldn’t commiserate about recurrence or potential failed initial treatment. Why speculate? Stay on top of the situation, continue to learn, rethink the future approach regarding the medical team as to radiation oncology and potentially a medical oncologist. What is your surgeon’s experience and results with men in your situation especially the ductal aspect?

But, most of all for now, do what it takes to heal from the surgery and move on to a better level of overall health. Best wishes on great outcomes from whatever comes next.
Posted 12/18/2021 7:11 PM (GMT 0)
Persistent PSA of 0.18 after 8.5 weeks, so pretty clear-cut. Remains to be seen (perhaps) whether a hot node or the remains of the EPE.

Tentative plan is another PSA and meet uro and radiation onc on 11Jan, PSMA-PET and MRI. Assuming no target, saturation SRT but not before about 6 month anniversary (mid-April). Bicalutamide till then (after scans). Fun! (You won't like it, says uro: thanks Doc!)

Comments? Ideas? (Not of the woulda shoulda coulda variety please, which will be refuted and blocked).
Posted 12/18/2021 7:56 PM (GMT 0)
SUM - My signature is similar without the persistent PSA so far, sure makes the journey eventful smile

I assume by "saturation SRT" you are including the lymph nodes? Seems to be a reasonable plan if your signature means that none were sampled previously.

I am not so sure that the PSMA scan will help much with your low PSA and further suppression from the bicalutamide but if they are willing to do it, why not? Another MRI and/or CT scan would be worth a look after the post-op carnage.

I wish I had words of wisdom for you but no one is control of the cards they are dealt with prostate cancer and your followup plan looks solid. There is little more you can do at this point other than heal up. I did not find ART to cause many significant issues so it is just a time waster more than anything then you wait.

Good luck with your scans and ADT. The weather will be better soon.
Posted 12/19/2021 1:31 AM (GMT 0)
I believe you first PSA will be negative. How many tests after that is the question.

ShawsUnprostatedMan said...
I'm going to start a treatment thread if that's OK as the odds against one and done look a little longer now.

I was diagnosed and rebiopsied as T2 3+4 but final pathology is T3a (1mm EPE but all caught with NSMs) 4+3 with 9.9ml main tumor with the EPE and elsewhere allsorts of 3+4 through the gland. Final size 73ml. Lots of cancer, lots of gland so hopefully all the PSA is coming from in there.

Surgeon laying great emphasis on NSMs but I think we can all agree I will be lucky not to BCR at some point and the risk is I never get undetectable. Fingers crossed for 7-8 week first PSA... Wish me luck.

Good news is on day 0 of catheter removal I am not even having to think about continence till the OAB kicks in. Then it's all over, so I need pads. But that will pass.

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