Pathology results from Prostatectomy 09-26-2022

As you may have surmised, the adverse findings were (a) the positive lymph node, (b) the focal extraprostatic extension ("focal" meaning it was seen at only one small spot), (c) the (small) --and some would say not very significant-- positive surgical margin, and (d) the lymphovascular invasion (within the prostate itself). The last-mentioned is not surprising in light of the positive lymph node.

His first post-op PSA will aid your docs in their advice as to the need for and timing of any further treatment. Six weeks is enough time: an undetectable PSA will give you peace of mind, and anything higher can be rechecked in a subsequent retest.

Since the biopsy Gleason score was just G7 (3+4), it's typical that only 8 nodes were removed; in retrospect, however, it would have been nice to have a larger sampling, given that one was positive. But hindsight is 20/20.

My hunch is that the advice will be to off on any further therapy if the first PSA is <0.1 until and unless his PSA trends upwards afterwards. A high-risk Decipher result might lower the threshold PSA at which RT is advised (e.g., 0.1 rather than, say, 0.2 or higher).

Adjuvant therapy is usually advised if there is persistent PSA (0.1 or greater) after surgery. That amount of PSA suggests that prostate tissue and/or metastases remained behind after surgery. Given the positive node, if his PSA is indeed undetectable, I suggest you talk his doc about following his PSA going forward with an ultrasensitive PSA that gives you two or three decimal places (e.g. Labcorp's or Quest's uPSA test). Those tests will give you better accuracy/sensitivity as well as more head's-up planning time should his PSA trend upward.

If your husband didn't have a bone scan in his workup--very unlikely with his G7(3+4) biopsy--one may be suggested now.

Keep us posted with your husband's recovery progress and any questions you think we can help you with.

Djin

Indeed, Mumbo caught the presence of spots of cribriform glands that I missed. This is a type of altered tissue architecture that increases the risk of recurrence.

You and your husband can discuss the meaning of the adverse findings in the report with your doc and the implications for any further treatment.

Djin

Thank you Djin Tonic, Mumbo and 60Michael.
Of course, I have been a bit upset by the report. But with all your advice and information, I feel we have an idea of what to do moving forward. I know it is wait and get results and see what the Doctor suggests. Now I have a path forward. I thought about the second opinion and Epstein at John Hopkins is what I believe is the suggestion ?
I will keep trying to get Mike to engage on this forum. It would be excellent for him. At least he does listen to me, most of the time.

Thank you Mumbo, I am working now to get the slides sent.

Wife#1 said...
I don't know if I start a new post or continue with this.

Definitely keep your posts to one thread. Makes it easier for us to understand the full history. I had to go hunting to find the previous thread, once I knew there likely was one.

Sorry to hear about your husband’s infection. My father went through similar trials following a TURP procedure. Felt bad, ER, admission and IV antibiotics. All I can say is follow doctor’s orders and keep looking forward to the next meal.

Sending strength, Wife#1!

I just returned home, the Vancomycin and Piperacillin, Tazobactam have kicked in and he is feeling a bit better. The Doctor drained the larger abscess and he has a stent and drain. He also has the dreaded catheter again.
Yes, a day by day journey and I think it hit him hard today. It has been almost 2 weeks of pain, complications and the pathology report. Yesterday was the peak of sickness and the nurse told him straight out, this would have ended badly if you continued to stay at home. So now we know and the acceptance and no more denial are our plan forward. We can't change anything and now we will concentrate on healing and our next steps.
Thank you so much for the encouraging words.

I think you are the first 3+4 pathology report I have seen online with perennial invasion, Lymphovascular invasion, and cribriform. I suspect the decipher report will have a high risk value.

Well hello wife#1
I hope your husband is feeling better. It is a long road. I had surgery in 2007 and salvage radiation in 20015. I was 3+4=7 and T3a. You can compare my signature with your husband’s. He is a little higher the risk scale than i was. My urologist/surgeon recommends radiation treatments at >.03 on ultra sensitive psa test. I waited until I reached >.06. I had no trouble with radiation treatments.
I had world class treatments here in Houston. M.D. Anderson is the best cancer treatment center in the country. I would be for your post surgery second opinion.

We saw the surgeon today the blood cultures and fluid drained from abdomen both were "No Growth". So he feels all the symptoms and fever, were due to the removal of the lymph nodes. He stressed how much time he spent removing the lymph nodes. Probably an infection too. He was very positive and removed the drain but he still has the catheter. Another cystogram and removal next week, an over abundance of caution he said. But he looked everything over and felt really good about the connection from last cystogram and hospital CT.
The nurse came in to set up for the drain removal and he had to remove his pants. I being the wife asked does he get a gown or a drape to cover himself. She is just standing there watching him. Her answer was "I have seen it all, I have been doing this for years" Well, it's not about you seeing his stuff, it's about protecting his privacy and dignity. He was not thrilled with me, "I have had so much stuff shoved in me, I don't care." Sorry, but I am not really. She gave him a drape and he kept his underpants on until the Dr came in.
This is the only thing I could do to help him. Not rational but I need to do something to try and make this better.
His prostate removal pathology has been sent to Dr. Epstein at John Hopkins. So that I took care of too. Hopefully, my next post will have a more positive vibe.

Maxwellcatmom, Yes, it has been very stressful, and we had a bit of a setback with the fever, abscess and hospitalization. So, he only was without catheter for 4 days. It is like starting over today after removal of catheter.
Yesterday, we went for another cystogram and catheter removal. Yes, it was successful. As careful and meticulous as he was with keeping clean and the ointment on catheter, he had a terrible time with it. Removal was painful and he actually had me bring the car up, first time ever ! He did say the nurses and Dr were excellent and tried to make it comfortable. But as miserable as he was yesterday, today he is much better. Drainage incision and all incisions look good. I am hopeful he can start healing with no more issues. I know he needs to get back on schedule with walking, Kegels and fluids. He asked me last night to "give me a break, I can't even walk right now". He gets a pass for a few days.
We have our return appt on 11-16 for decipher results and first PSA. I do expect at some point he will have to have more treatment. I stay positive and tell him, we will handle whatever comes along. We cannot change what will happen, we can only hope and pray for the best results. We will conquer anything that is in our way. I am very anxious too, but I try and put that feeling into taking care of all the details. Good luck to you and your husband too.

There are a number of people on this site who would not know what to do without our wife’s. It is very humbling to ask for help, and that pride thing can get in the way. Please make sure that you take care of yourself on this journey. And thanks for all that you do.
Michael

As tough a time as your husband's recovery from surgery is proving, it is a one-time chapter that now has an end in sight. Fortunately, it all has to do with the invasiveness and complications of this major surgery and is not related to the cancer per se. What's important now is that your husband make one-way progress toward recovery: do not hesitate to contact his doctor if there is any setback or concern.

Right after my TURP surgery for BPH, I had to stay an extra day in the hospital because the catheter was causing excruciating pain cause by bladder spasms which were, frankly, the worst pain I had ever experienced. (I was bleeding a little more than expected after surgery. My hematocrit was low and just on the cusp of requiring a transfusion, but my uro opted to put a little more traction on the catheter bulb in the bladder to help control/stop the bleeding and avoid a transfusion). Despite the few hours of pain, the urine went from a true red with blood clots to a light orange. I asked my uro if he was sure I could go home and he said with a smile "Yes, that's the color we call clear"). All went well, at a certain point the spasms stopped, and I my stay was just one day longer.) My point is that the TURP itself was a huge success and my urine flow went from almost blocked pre-surgery to a powerful stream just after the catheter was removed. The spasms were just an unfortunate complication and, as they say, pain has no memory.

Chin up!

Djin