Newbie posting on behalf of Dad-stage 3

Hi. I've been reading your forum for the last week and have learned so much from all of you already. My father, age 67, was diagnosed recently after having a turp because his prostate was 3 times the normal size and his psa had risen to 7. Prior to the turp, he had 2 biopsies and both were negative. After the turp he was diagnosed with Prostate Cancer and given a Gleason score of 7. He had surgery this past Thursday to remove the Prostate. The cancer had spread to the seminal vesicles so those were removed also. Dr. said it is stage 3 and Gleason of 8 (4 + 4). The Dr. did not remove lymph nodes nor did he take a biopsy of them (which I don't understand).

My questions are:
1. What should we ask at his appointment with the Dr. next Monday concerning our next step? I've asked if we could do a bone scan and ct scan. Anything else?
2. How quickly should we act on additional tests? It seems to be growly fast.
3. Have any of you had a similar experience and could shed some light on how common his numbers are?

I want to thank you in advance for any info that you can share. I'm sure I will have more questions in the future.

Sandi

Welcome to the forum. You can put aside the size of his prostate in relation to the tumour. It is perfectly normal for the size of a man's prostate to begin to increase in size (sometimes quite dramatically) around the 50 mark ---- this often results in urination problems but is not normally related to the presence of tumour. A CT scan and bone scan are usually done as a matter of routine but often don't tell us too much even when they are. Your father is unlikely to have any evidence of spread to the bones or surrounding prostate bed tissue with a pre-op PSA of 7 ----- this doesn't mean it has not happened, it means if there were anything it would be too small to be visible. Did the post surgical report mention the status of the surgical margin? (it will be either negative which is good or positive which is not as good). The Gleason score of 8 puts him in the higher category of risk of spread but there would not be too much difference between a 7 (his initial grading) with say 90% grade 4 cells and 10% grade 3 cells present and having 100% grade 4 cells comprise the tumor. It is the normal protocol for the seminal vesicles to be removed along with the prostate as part of the surgical process. Some doctors do not remove any lymph nodes unless they see a need to do so. In hind sight, given the seminal vesicles were later found to have contained tumour, it would have been handy to have sampled at least a couple of local nodes for any evidence of spread. The next step would be to check the PSA at 6 weeks and see if the surgery has had the desired effect (PSA should drop to less than 0.01). At present he should be well on the road to recovery so I wish him well on that front and his upcoming PSA tests.
Bill

Thanks you, guys, for the info. It saddens me that this cancer has affected so many, but it does help to know that we aren't figuring this out on our own. I appreciate your time.

Sandi

Welcome to HW. Sorry you had to come here, but glad that you found us.

I am also a stage 3, which means the cancer has gone outside the capsule. I am a Gleason 9, which many group 8-10 together statistically.

I believe you should seek out an oncologist as has been suggested, which may also be a radiation oncologist. Most oncologists will most likely recommend radiation at some point. Some may recommend it be done now, some suggest you wait until PSA rises. Radiation can effect your dad's incontinence, so waiting may be advantageous if his PSA remains low.

Meanwhile, life goes on. Make sure your dad does the things he wants to do. He still has years of good living.

Good luck to your father.

Uro-doc will be happy to start you on his HT therapy program and less likely to use further tests that onco-docs may be using. You can monitor blood and urine testings, PAP and other things to see if early mets or micro mets may be happening. Scans can easily miss micro mets, scans are far from perfection in PCa, perhaps they won't mention that little reality. If you failed surgery you need opinions and especially from an onco-docs perspective as they deal with the biology of the disease and not in a hurry to over endorse SRT which may or may not be realistic for some scenarios. Seems all docs in PCa like to believe they know it all and are experts in all phases, far from the reality of it all. Best to you, learn to question about everything and you will see why.