Hi Jim, - It would have been very unusual to find, metastases on the bone scan with a PSA of 6.9. Less than 2% of men with PSA levels under 10 ng/ml are found to have such advanced Prostate Cancer (PCa) on Bone Scans.. However, your post-surgical Pathology Report is certainly not encouraging and you may well have "systemic" disease rather than "localized" disease, which may POSSIBLY explain your continuing elevated PSA, following what appears to likely be failed aggressive localized treatment (surgery). If systemic disease is the cause of your continuing PSA elevation, you undoubtedly had it at the time of surgery.
The post-surgical (p) Pathology Report, where the entire Prostate is available for direct examination, is far more accurate, informative and reliable than the (c=clinical)) Biopsy Pathology which only has SAMPLES of tissue to examine. These may, or may not, be accurately representative of the true status of the disease present in the entire Prostate. So, from what you Posted, you evidently have Gleason SCORE p(4+3)= 7 disease, upgraded from the LESS aggressive c(3+4)=7 found in your Biopsy samples. Gleason GRADE 4 is now the predominant (primary) number in the formula and although the tumor percentage seems relatively modest at 7% of the total Prostate, the fact that it had already invaded the Lymph System with 1 node positive, supports the POSSIBILITY of Systemic disease.
Further support for the systemic possibility, taken from your pPathology results, are the combined positive findings of extraprostatic extension (EPE), Seminal Vesicle involvement (SVI) and Perineural Invasion (PNI). Although having negative margins, normally, would be an encouraging finding, the likely involvement of all these natural avenues for malignant cells to escape into the blood/lymph systems and to circulate within the body, would seem to outweigh that benefit.
Your first post-op PSA was exactly 8 weeks after the surgery which should, normally, be adequate to eliminate any residual PSA from the body, although many schedule it for 3 months (12 weeks) just to be assured that they obtain a reliable result. Yours was confirmed at 10 weeks and that again infers NO impact on your former PSA pre-treatment PSA of 6.7ng/ml, from your localized treatment.
My layman's educated GUESS is that you have systemic disease and that some form of Hormone Therapy (HT) will likely be your next form of treatment. IF so, I would suggest that you find a competent Medical Oncologist to provide your guidance in this respect, preferably one with experience in Prostate Cancer treatment.
Although,systemic disease is thought to be incurable, that does NOT mean untreatable, and men can live many years with the disease that is now considered "chronic" rather than transient. The treatment goal, realistically, changes from one of cure to one of attempting to effectively "control" the symptoms and side effects (morbidity) while slowing, or even temporarily stopping the advance of the disease (remission).
I sincerely wish you the best and hope the logic supporting my conclusions is understandable, although I would be happy to see your situation be an anomaly, and have you remain with treatable localized disease. Although I consider myself a well informed layman, I am NOT a Physician and suggest you discuss the "probable" conclusions that I have reached, with your professional advisors. Good luck! -
[email protected] (aka) az4peaks
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Post Edited (az4peaks) : 12/5/2011 9:33:03 PM (GMT-7)