My pathology results following RP

FF, welcome back. No, it's not the ideal pathology report, and now you've entered wait and see land.

It might not be a bad idea to talk to a RO while you're healing up from the surgery, they can't do anything radiation wise for a while anyway, but it wouldn't hurt to have a consult based on your pathology to at least get them thinking about it.

You're just 2 weeks post surgery, and the PSA in May will tell a lot of the tale. Keep up with exercises, keep walking, keep pouring in the water. How's your continence now that you're minus the catheter? Don't push too hard, you've had major surgery and it takes time to recuperate.

The upcoming PSA test is important, because if you have "persistent PSA" (0.1 or higher) and it's confirmed, adjuvant therapy will most likely be recommended after a healing period.

I suggest asking your doctor to send some RP tissue for a Decipher exam. The test looks at your cancer's RNA and gives you a score that will fall into one of three categories: low-, average-, or high-risk of your cancer's propensity to metastasize. Decipher, your PSA level (and the rate of climb, if any, of your 3-month PSA tests), and the path report you have in hand (including the bladder-neck invasion, EPE, positive margins, and cribriform tissue architecture), and possibly a PSMA scan can all be useful in forming a plan for monitoring or further treatment.

How many lymph nodes were removed and examined?

All the best,

Djin

NewspaperLover, thank you for the insight. One thing I’ve learned through the process and reading message boards is that indeed PCa is humbling and can be so individually different. Continued good luck with your journey, sir.

FF - Your three month PSA will be an important factor. Glad you are doing well otherwise.

The cribriform pattern and extensive positive margin situation noted would make me a bit uneasy. I would expect there will be some discussion about adjuvant radiation even if your PSA is undetectable and there will definitely be some discussion about early salvage RT if and when any measurable PSA shows up.

I like the idea of visiting with a RO to get another opinion while you wait (keeping in mind that is what they do). I did that and it made it a lot easier and quicker to start ART when I made that decision. My RO said exactly the same thing as URO, pluses and minuses explained and solely my decision to make with a PSA <0.10.

It seems from my 5+ years at this that G7(3+4) designation does not give one a guaranteed free pass to a happy carefree life. Seems that there are just too many men that have BCR with the "favorable intermediate" classification to get cocky so you just wait and see what happens. Hang in there until May.

Fightingfalcons said...
Djin , as always your advice in this forum is always appreciated. My biopsy decipher came back at the high end of intermediate, .56. But I concur some rp tissue for a new decipher post rp sounds good. They did take a two lymph nodes with nothing invasive found. Thanks for the info. Read your post earlier with your journey; good luck, sir.

Thanks!

According to the company, a Decipher RP score correlates with the Decipher Biopsy score about 70% of the time (I think this is stated in tiny print at the bottom of your Decipher report.) As you know, some men are upgraded at RP because the biopsy missed a more serious lesion of a higher Gleason score and the earlier Decipher could obviously not test that category lesion. Although your Gleason score wasn't upgraded, you and your doc could look into the advisability of repeating the test--or just adopt the chicken soup philosophy ("It wouldn't hurt!") and retest.

Two lymph nodes removed/examined is certain better than nothing (the sentinel node, which is the first one lymph from the prostate drains to, is likely to be positive if you have lymph node invasion, and is usually among those removed)--however, your pathology underlines why taking nodes for all men is always wise.

Did the path report mention whether lymphovascular invasion was seen? If so, it is yet another negative finding. I agree with Mumbo that a RO consult would be prudent.

IMO your situations merits being followed with an ultrasensitive PSA test (preferably Labcorp's). Although persistent PSA is defined as 0.1 or greater, if your PSA is <0.1 you may want to know by how much it is less. For example, a post-RP uPSA of 0.009 would be much more reassuring than one of, say, 0.089.

Djin

Fightingfalcons said...
Djin, “lymphatic and/or vascular invasion:not identified”. I’m using LabCorps for my PSA in May. Thanks again for the advice!

That's good x 2. Stay positive!

Post Edited (DjinTonic) : 2/24/2024 1:03:04 PM (GMT-8)

Food for thought, Mumbo. Thank you, sir!