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Posted 5/20/2014 12:03 AM (GMT 0)
Here we go.Please bear with me.
path results in front of me .<0.1 for one year post rrp.
0.1 for 2nd yr post op. 0.2 at 2.5 yrs post op.
4 of 12 cores left lateral mid9%
left lateral apex 25%
left apex 10%
right apex 4%
prostate size was3.0x3.6 3.5cm
40.0 grams
Gleason 6 before and after, seminal vesicles both negative.
Extracapsular extension-not identified , Bladder margin-negative,urethra margin -negative.
benign prostate at margin:present location:right posterior base
extent:focal ,angiolymphatic invasion neg.
Margin status-negative for carcinoma
perineural invasion present.( what is this)?Angiolymphatic invasion :absent
primary tumor pt2c stage IIb Rad onc says I can be cured with rads. Any thoughts
Posted 5/20/2014 12:33 AM (GMT 0)
your situation is weird. You have benign prostate at margin which means the surgeon cut through the prostate. You would seem to clearly have retained prostate. Your data suggests you should not have had a recurrence - particularly early. Just to clarify -what was pre-op PSA and what was your tumor volume? I am looking for anyhing to explain a BCR. I think I would get a second opinion before proceeding with radiation.
Posted 5/20/2014 12:47 AM (GMT 0)
tumor volume was 19.7
pre op psa was 4.2
Report reads as follows,
specimen received :
A-left neurovascular bundle
B-prostate and seminal vesicles
It consists of a prostate weighing 40.0 grams and measuring 3.0 cm to base ,3.6 cm to lateral to lateral,right seminal vesicle5.4cm and left sem ves 4.9cm.
Im confused because I,ve had two slow rises which I thought meant it was time to start rads.
Posted 5/20/2014 12:53 AM (GMT 0)
Maybe its the way I wrote it .
Here it is ,

Benign prostate at margin: Present
location: Right posterior base
Extent: focal
Posted 5/20/2014 10:57 AM (GMT 0)
I would likely get the more sensitive PSA and get a sense of the true value. If you are less than .2 (?standard test rounds up) I would wait and get second opinion. You have a verified G6 which is not felt to spread easily if at all. I would not panic. Savage radiotherapy is a "guess" that you have disease and it is still local. You have to "make a case for it" and I'm not sure you have done that. I am not however, your doctor and don't know all the facts. Second opinions never hurt in my opinion.
Posted 5/20/2014 1:13 PM (GMT 0)
Carpe,

Bearing in mind that I am just some random guy on the Internet and probably have no idea what I am saying, here is how I would read your pathology report.

When the prostate sample arrives at the lab the first thing they do is cover it with two coats of ink. First they color the right side one color and the left side another color (blue and green, I think) then they go back over the whole thing with black ink and then slice it. Anything on the slides that is colored by the ink was part of the "surgical margin" -- ie the outside of part the surgeon cut out. If the pathologist sees a slice where cancerous tissues were colored by the ink that is a "positive" margin. (The blue and green color helps him know which side he is looking at.) You didn't have any positive margins. That's good. The prostate is surrounded by a "capsule" and, ideally, only the capsule should show any ink. If there is a place where the actual prostate tissue is inked the pathologist will note that since it is a potential place where some prostate tissue may have been left behind. You have one of those on the posterior base of your prostate. But the pathologist remarked that it was "focal" which means not very big and usually those are nothing to worry about, especially with Gleason 6 cancer. What may be significant is the "perineural invasion". The pathologist found places where the cancer had grown close to the nerves. Cancer can grow along a nerve and that is one of the ways it can escape the prostate. It's usually not a big deal but it is a negative finding and something you could ask your doctor about given your rising PSA after surgery.

The good thing about Gleason 6 cancer is that for it to get somewhere it has to grow out to the affected area starting from your prostate. Higher Gleason cancers can go for a ride on your bloodstream and wind up in your bones or your lymph nodes or your lungs. But Gleason 6 mostly stays close to the prostate bed and is generally curable with radiation since you mostly know where it has to be.

You have lots of time for second opinions. Be sure you get some.
Posted 5/21/2014 12:37 AM (GMT 0)
Isnt it standard practice to start rad treatment after two rises in psa post rrp.
I went from >0.1 to 0.1 to 0.2 in two and half yrs.
rad onc seems to think I wont have any lasting side effects from treatment so my thoughts are why not get it just in case there is something there.
I certainly don't want to get rads but its in my thoughts all day everyday and don't want to regret not catching it in time for a cure.
just scared and worried right now.
Posted 5/21/2014 2:17 AM (GMT 0)
It all depends on who is paying for it...They get to define what "standard practice" is...A 70 Gray, 40 fraction SRT burns up $100K-$130K.....
Posted 5/21/2014 2:41 AM (GMT 0)
With you being a Gleason 6, and the fact that it even took that long to rise to .2, still wouldn't make me want to advise you to have SRT just because. Think you need a strong 2nd opinion from not a radiation oncologist (of course they would be eager for you to have SRT if you have good insurance). But there are risks with radiation (I am living proof of that), and with SRT, its just best guess if any remaining cancer is even in your prostate bed. And there is no guarantee (not from any doctor), that even if it is, you will be cured. Quite a few of us with failed SRT.

I would just want to me darn sure this was the next best move for you. It may well be, but get a stronger 2nd opinion before pulling the trigger.
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