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10 Years Post Surgery

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Posted 3/30/2023 11:29 AM (GMT 0)
Good Morning All:

I'm a long time lurker and have never posted before but I wanted to share my story to give others here hope. I've just reached the 10 year mark for my prostate cancer surgery. My PSA was 4.1 at the time of my diagnosis but given my family history, both my father and paternal uncle had prostate cancer my GP thought I should have a biopsy, which I did. The biopsy came back positive, Gleason 3+3 and 3+4. I was given the option of watchful waiting but I had to get it out. My surgery was done by Ash Tewari at Weill Cornell in NYC and the post surgery pathology revealed some nasty Gleason 4+5 lurking in there. Fortunately it was caught early on (I'm sure as hell was glad I didn't opt for "watchful waiting") and the cancer was entirely contained to the prostate and no post surgery treatment was recommended. I went through 5 years of PSA tests every three months, 2 years every six months and am now tested annually. My PSA remains undetectable and I remain cancer free. I am still here thanks to my GP and Dr. Tewari's exceptional skills. I am living my life to it's fullest.

"Yesterday is a cancelled check, tomorrow is a promissory note, all we have is today"

Good health to all,

Jeff M
Posted 3/30/2023 12:42 PM (GMT 0)
Good job staying on top of the cards you were dealt, Jeff! Congrats on reaching your 10-year mark! I too was G9 (4+5) pT2 with negative margins after surgery and, largely thanks to very early diagnosis, also managed to avoid RT and ADT (so far), approaching 6 years post-op.

Djin
Posted 3/30/2023 12:56 PM (GMT 0)
10 years is awesome! It's an interesting case study given your biopsy results vs pathology result. I'll assume 10 years ago most biopsies were blind and more men with significant cancer were not treated timely if the biopsy missed enough of the lesion.
Posted 3/30/2023 3:16 PM (GMT 0)
Congrats on 10 years — especially with a Gleason 9. I imagine having had an excellent surgeon plays a big part with with your success. My biopsy showed a Gleason 9 and the MRI just days before surgery had my surgeon a bit concerned but he pushed forward anyway, saying he would “cut wide”. Surgery failed to rid me of the cancer so radiation followed and I’m undetectable 4 years later. If I could do it all over again, I would’ve gone with a top-notch surgeon like you did. Best of luck to you moving forward!
Posted 3/30/2023 4:42 PM (GMT 0)

MotownPaul said...
Congrats on 10 years — especially with a Gleason 9. I imagine having had an excellent surgeon plays a big part with with your success. My biopsy showed a Gleason 9 and the MRI just days before surgery had my surgeon a bit concerned but he pushed forward anyway, saying he would “cut wide”. Surgery failed to rid me of the cancer so radiation followed and I’m undetectable 4 years later. If I could do it all over again, I would’ve gone with a top-notch surgeon like you did. Best of luck to you moving forward!

I don't see that your surgeon 'failed'; your case was just more complex, unfortunately.
Posted 3/30/2023 6:12 PM (GMT 0)
Congratulations on your 10 year anniversary Lakeridge. May you celebrate 20 years in ten years!

Ron (Boomer)
Posted 3/30/2023 6:15 PM (GMT 0)
Congrats. Here’s to at least 30 more great years for you.
Posted 3/31/2023 10:13 AM (GMT 0)
I also had a dramatic upgrade in the postop path report. I regularly use the mskcc risk calculator and I have recently noticed that, in addition to the path report data, you may introduce now your biopsy results as well, and the results change. Also, I have read some articles stressing that an update in the path report significantly increases risk, but those articles also show that it does not not reach the same level than in the case when both biopsy and path reports are similar. A lower biopsy grade may indicate that it did not catched cores from the significant cancer regions, but also that the microsocpic aspect tissue is ambiguous and admits different interpretations. Of course, this opinion can be biased by my desire to find some favorable explanation in everything I read.
Posted 3/31/2023 10:55 AM (GMT 0)
Congrats! That's a milestone we all think about reaching! Cheers! 🍻
Posted 3/31/2023 2:00 PM (GMT 0)
Hi jmadrid. The good news is that your PSA, while fluctuating, has basically remained stable. A pT2 path status also augers well, regardless of one's Gleason score.

Since you don't have it in your signature, I'm assuming that, based on your G6 (3+3) biopsy, your surgeon chose not to remove any lymph nodes. That's OK for G6 men who aren't upgraded, but means that all the men who are upgraded after RP are have no information about their pelvic-node status when deciding on their treatment. My advice to all G6 men opting for surgery is to ensure ahead of time that their surgeon will take some nodes even if they hadn't planned to.

I would de-emphasize your biopsy findings: more than 50% of your cancer was Grade 5. Since your cancer burden on one side was 30%, it was bad luck that all your biopsy cores on that side missed the Grade 5 entirely, especially given that your mpRMI was scored as PIRADS 5. Do you remember how many total cores were taken in your biopsy? Was it a targeted + systematic biopsy, or targets only? I'd be curious to know. If I remember the studies I've seen correctly, the overall risk associated with G8 (5+3) is ranked about the same as the risk for G9 (4+5).

Did you have a Decipher test done on your RP tissue?

Thanks,

Djin
Posted 4/2/2023 1:09 AM (GMT 0)
Hey Jeff. My surgery was also 10 years ago this week with Dr. Tewari (April 3, 2013 to be exact). We probably passed each other in Dr. Tewari's office before the surgery or during follow-ups.

https://www.healingwell.com/community/default.aspx?f=35&m=4317570

Gedman
Posted 4/2/2023 3:11 PM (GMT 0)
Gedman - as the Spanish say, the world fits in a handkerchief! I'm glad to hear that you too remain cancer free. I've heard that some people didn't have a good experience with Tewari but I found him to be very compassionate and he would even personally respond to emails that I sent him. The guy saved my life.

Jeff
Posted 4/3/2023 9:26 AM (GMT 0)
DT:
You are right. I did not have any lymph node removed. I was saved from additional side effects and I guess that my psa would have increased soon without being truly contained, but it is also true that I had my doubts about this point after knowing the path report. Also, I have reached the conclusion that my fluctuations in psa are instrumental noise. I am not having the ultrasensitive test and all my figures can be just interpreted as <0.1.
Although it was not a fusion biopsy, they took 8 cores with locations based in my previous MRI results. The biopsy guys told me that it any significant cancer could not be missed if it was present, but, apparently, this was the case. They were prostate specialists, as a difference with the pathologist who signed the postop report. The path report gave me the 5a type Gleason grade that it is not very common and has features similar to ductal PCa, non-invasive intraductal PCa associated with G6 or even PIN. In summary, who knows... No genetic test was performed. Time has passed on since then and the periodic psa tests are the most important thing to do, right now.
Posted 4/4/2023 3:39 AM (GMT 0)
Jeff,
My feeling for Dr Tewari are exactly like yours. Such a sweet guy and saved my life.

Gedman
Posted 4/5/2023 2:30 PM (GMT 0)
Congratulations!!!!!!!!!!!!
Posted 4/5/2023 4:04 PM (GMT 0)
Lakeridge...adding my congratulations for your great results!

Jim
Posted 4/5/2023 10:35 PM (GMT 0)
Lakeridge, congrats on a great outcome. I also was treated by Dr Tewari. Although I subsequently needed SRT 3 years later due to a rising PSA, i feel very good about my decision to have him treat me. He is knowledgeable, engaged and compassionate.

Here's to the next 10 years
Posted 4/6/2023 1:14 PM (GMT 0)

Sr Sailor said...

MotownPaul said...
Congrats on 10 years — especially with a Gleason 9. I imagine having had an excellent surgeon plays a big part with with your success. My biopsy showed a Gleason 9 and the MRI just days before surgery had my surgeon a bit concerned but he pushed forward anyway, saying he would “cut wide”. Surgery failed to rid me of the cancer so radiation followed and I’m undetectable 4 years later. If I could do it all over again, I would’ve gone with a top-notch surgeon like you did. Best of luck to you moving forward!

I don't see that your surgeon 'failed'; your case was just more complex, unfortunately.

Too many times men fail to realize a clean pathology report doesn’t mean cancer cells didn’t escape the prostate prior to surgery. Especially when LVI or PNI is listed the the report
Posted 4/6/2023 1:48 PM (GMT 0)
jmadrid, the majority--but not all--studies conclude that a targeted + systematic biopsy misses less cancer than a target-only one based on a MRI. While both a biopsy and an MRI can miss exisiting cancer, any MRI has a limit of resolution, whereas a random core can get lucky and sample a tiny lesion that didn't show up on imaging. If I remember correctly, the chances of this happening are about 5-8%. It's a small, but not insignificant, gain.

One study put the ideal number of cores to take per MRI-identified target at 2-3 (sufficient to ensure the target will be sampled without excess cores). My takeaway from all this is that for a "standard" (non-saturated) biopsy, the total number of cores if there are, for example, 1 MRI-identified target in each of 2 prostate zones would be 4-6 cores for the targets plus 1 core in each of the remaining 10 zones, for a total of 14-16 cores. Frankly, you are lying there on the table, presenting your butt to your uro. You have no place to hide; the jig is up. You may as well have all prostate zones sampled. Don't skimp smile

Djin
Posted 4/6/2023 3:55 PM (GMT 0)

DjinTonic said...
br />
One study put the ideal number of cores to take per MRI-identified target at 2-3 (sufficient to ensure the target will be sampled without excess cores). My takeaway from all this is that for a "standard" (non-saturated) biopsy, the total number of cores if there are, for example, 1 MRI-identified target in each of 2 prostate zones would be 4-6 cores for the targets plus 1 core in each of the remaining 10 zones, for a total of 14-16 cores. Frankly, you are lying there on the table, presenting your butt to your uro. You have no place to hide; the jig is up. You may as well have all prostate zones sampled. Don't skimp smile

Djin

Cheaper by the dozen (and a half)!
😀
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