Hi Allen,
Thanks for your reply. I talked to the doctor last Friday regarding extended lymph node dissection. He said this is not necessary given my father's condition at present. Surrounding lymph nodes are clean and seminal vesicle invasion is equally dangerous as lymph nodes invasion. That's why he immediately gave my Dad Lupron shots for 4 months (which i think is a lot, causing a lot of side affects...). He also mentioned if there's occurrence of cancer most likely would be elsewhere other than prostate bed. He thinks the cancer is all out from the prostate area. An adjuvant radiation helps some but not necessary from my feeling out of his words... My dad has complications with catheters, still not removed (removed twice and twice got retention...). He has some leakage around the catheter this time and it seems not a big deal according to the doctor unless he progresses with retention symptoms which he doesn't. I think he should be ok to get catheter removed this time (scheduled this friday) since he already has leakage around the catheter meaning his bladder starts to function? ( he was put back with smaller catheter this time).
Tall Allen said...
I'm sorry to hear about the pathology report. Sadly, that, and not the surgeon's notes, is what is definitive. The 1 cm and 6 mm positive margins, and the T3b, are serious and if he is going to act, he should act quickly, as his RO suggests. (BTW, I'm surprised his surgeon did not do an extended lymph node dissection, but it's good he found nothing in the 4 lymph nodes he did remove.) Three months should allow the anastomosis to heal, and the Lupron to kick in. There will be nothing further to be learned at 3 or 4 months as long as the Lupron drives his PSA down, which it probably will. However, if he is going to have adjuvant radiation, doing it earlier has better outcomes than waiting.
On whether to have adjuvant radiation... You make a good point that it may already be systemic, in which case adjuvant radiation serves no purpose. On the other hand, the 4 clear lymph nodes indicate the cancer possibly has not spread in that direction, and the negative bone scan shows there are no obvious mets yet. And you know for sure that there are significant amounts of cancer left behind in the local area by the surgery. If that's all the cancer there is, the radiation can cure him.
- Allen