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Any advice after RRP revealed PCa in seminal vasc. ; staging now T3b?

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Posted 10/14/2011 2:49 PM (GMT 0)

Dear Brothers,

Freeedm here, 56 & just had RRP @ St.Vincents;Birm,AL on 10.7.11.

Big complements to: Dr.Bugg (Urol.Ctr.Ala)& staff for their prep., service, compassionate attitude. Great. I lost 30# and got up to 2.5 miles run/walk; situps; pushups;etc. Best shape of my middle life.

PostOp.:No incontentinence - dry pads ; Starting daily Cialis 5mg.(??)

I know -I am blessed. Supportive RN.wife & grown kids & 2 sweet gkids.

BUT, the pathology report showed PCa in right seminal vesc.!! Ouch

No PCa in margins  per rept. I will get pathology rpt./copy in few days.

I THOT my PCa battle was going to be over ...

May go for Radiation?? to be SURE?? Will meet Nov. 14 w/ Rad./oncologist

Dr.Bugg & ED Nurse .

You guys (esp. Water Guy) have been a  big encouragement. I don't always type messages but I Read a lot.

What do you think? ANy guys go in T1c & get an "upgrade" T3b???

Thanks, Freeedm

Age today: 56 ; Self employed

July '10- psa 5.1 ; Nov.'10- First biopsy - didn't find PCa

May "11-psa7.9 ; July '11-Second biopsy - 2/ 14 cores had PCa/Rt.side

RRAP Oct.7,2011 ; Found PCa in right seminal Vasc.; Margins Clear

Oct.13.11 - Cath removed ;Pad free- 2nd day ; Taking 5mg.Cialis;

Posted 10/14/2011 5:07 PM (GMT 0)
I was just a tad younger than you when diagnosed but with a lot more of my prostate affected. Post op I was also staged at T3b but with one positive margin.

I understand that the odds of me being one and done were only about 35% with that pathology but I opted to go against the odds and not have ART. Unfortunately, I was betting against the house so I had SRT this past summer. I balanced the chance of recurrence against the damage from radiation against the cure rate difference between ART and early SRT.

When my PSA hit 0.1 post op I started getting ready and when it hit 0.2 I pulled the trigger on the SRT.

You'll have to balance those issues for you. The smart money advises ART with staging like ours.

(The language of this post just goes to show what happens when most of your grade schooling was in Las Vegas.)
Posted 10/14/2011 5:14 PM (GMT 0)
Hello Freedom...Welcome to the group...

You left out the most important number, your Gleason score..THAT more than anything, will determine what if any follow-up treatment is recommended..You will want your own copy of that pathology report..Ask for one..Good luck on your journey..
Posted 10/14/2011 5:45 PM (GMT 0)
Welcome Freedom

I also had SVI.

First thing to do is wait (as calmly as you can) for that first post-surgery PSA.
Mine was 0.1 which doc and I agreed was not ideal, but it's what happend next that matters.

If you have a higher PSA then maybe ART is the best option, if it's lower you need to repeat the test and then may find that like me it rises and so they send you for SRT (Which for me worked)
Key issue can be the fact that it is reckoned that RT will "freeze" your recovery from surgery in the continence and ED departments. So firstly well done for getting your incontinence sorted so soon. If you can get results with your penis too then you will find it easier to maek decisons about RT. (I know that was the case for me as I was okay in the continence and ED areas by the time the RT decision had to be taken)

Alf
Posted 10/14/2011 5:46 PM (GMT 0)
Everyone, Freedm is a fellow Alabamian and he and I have become friends over the phone since he was diagnosed in August. His biopsy DX Gleason was a 6. I pretty much talked him through his fears of having the RALP and he has done so well in the week after surgery.  He called me last night to give me his Pathology report and I asked him to post here today to get the help and opinions to where his journey goes from here.  This guy had a great surgeon, his catheter was removed yesterday morning and he was immediately dry, which is so rare in this forum. tongue On Wednesday he even took his 2 granddaughters to the Zoo wearing his catheter bag, and then wondered why the animals were always sniffing his way. smhair

 I really hope he can avoid any RT as it could have effects on his early continence.

Thanks in advance to all my PC brothers for any help you can give my buddy Freedm.

Terry TWG

Posted 10/15/2011 12:18 AM (GMT 0)
Freedom, welcome

i also am new to the forum. Just here to tell you the IMRT was not a big deal. While it did not do the trick for me, maybe it will for you. definitely wait until you get a PSA, but the staging is an indicator to do something more if its at all questionable

Posted 10/15/2011 2:19 AM (GMT 0)
Freedom,

I was one that was upgraded after RRP. I went in with a Gleason 8 and PCa confined to the Capsule. When pathology came back I had graduated to cancer in both margins, seminal vesicles, and my Gleason was bumped up to a 9. I always like to do well on tests!

Surgery for me was back on April 27th of this year. Prior to surgery I had three Provenge treatments, and one post surgery (July).

Somehow, I am still in the zero club (non-detectable) to the amazement of my medical team.

I have gone through all the due diligence of finding the best radiologists oncologist in the State and we are all geared up for HT and IMRT once the darn PCa comes back for its victory tour.

I am headed down to Las Vegas next week to meet with a medical oncologist to have him review everything from Dx to the present and get his thoughts on the next offensive Shock and Awe campaign to keep fighting this hideous disease.

I only have one grand daughter, but I want to live long enough to watch her grow up and be there to help raise her, just like you do.

Congrats on such a great surgery and outcome and getting to save by not buying Adult Depends and Pads by the cases.

My surgeon said, that based on my post surgery results, there are two possibilities, one is that he was able to take enough tissue on both margins to harvest all the cancer and by the time he cauterized the margins, it would have killed any remaining PCa left in the margins, or Provenge actually did go find, seek and destroyed the PCa or a combination of both.

I hope he is right and I hope you are going to be PCa free the rest of your life. Good luck.
Posted 10/15/2011 3:09 AM (GMT 0)
Hi Freedom,
I went in G-8 expecting to be either T2 or T3, I drew the long straw and ended up T3bNOMX. With a focal positive margin and SVI I'm still <0.04 as of 8-04-11, my next test is next week and we'll see.

Nothing is guaranteed in this disease, some people with G6 have immediate recurrences, some G-9 T3 guys never see a blip, try to stay calm and see what happens.

We're all wishing you the best.
Dave in Durango CO

07-06 PSA 2.5
01-08 PSA 5.5 (Dr never told me)
09-09 PSA 6.5 (age 55)
12-09 Biopsy, initial Gleason 9 (4+5) later reduced to 8 with tertiary 5
03-01-10 Age 55 RRP in Durango CO by Dr Sejal Quale and Dr Shandra Wilson
03-16-10 Path' G-8 (4+4+5) Bilateral involving 21% of left lobe, 3% of right lobe, SVI, Focal positive margin, pT3b NO MX

All PSA as of 8-04-11 <0.04
Posted 10/15/2011 5:25 AM (GMT 0)
If Gleason 6 was all they found, and your PSA drops to undetectable, they will probably recommend a wait a see approach before any further treatment...The best of luck to you...
Posted 10/15/2011 6:14 AM (GMT 0)
Hi Freedm,
I am a bonafide T1C at diagnosis and "upgraded" to pT3B at treatment guy. Joined the club just about five years ago at the age of 44. I added some therapies after RALP ~ adjuvant hormone therapy and radiation. I am due for another PSA test soon but I have been stringing zeros since March of 2007. So far so good.

You should try to stay positive about things. It's reasonable to be talking to a radiation oncologist. It's also reasonable to be talking about hormone therapy for a stint. I considered both after seeing great results with various studies showing that adjuvant therapies are beneficial for Stage 3 and 4 patients. I tolerated these therapies well and most of the guys do.

Stay well and keep us posted.

Tony
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