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Gleason 6 with positive margin at bladder neck

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Posted 4/25/2019 12:59 AM (GMT 0)
Hey folks, you may remember me from earlier this year... the whole journey from worrying my husband might have prostate cancer, to him being diagnosed with low risk Pca to now post RALP.
A recap-
Husband is 44 years old. No significant family history
PSA 1.9
Biopsy results 1 out of 15 cores had 15% gleason 6 (3 were targeted)
MRI showed a Pirads 4 lesion with no suspicion for extracapsular extension
Oncotype DX was very low risk- score 12- 8% chance of adverse findings at pathology

We decided to be overly cautious and do the RALP anyways

The doctors were all very confident that this would be a slam dunk one and done deal...

Post pathology

A very large 3cm Gleason 6 tumor in the TZ with positive margin at the bladder neck.
We are very confused and not sure what to make of it... Gleason 6 is confirmed. Supposedly GL 6 doesn't metastasize... But we still need to be worried? Is SRT in the near future? The doctor said my husband won't die of prostate cancer ; If someone thinks that is BS, please don't tell me... I don't need the extra worry.

On a brighter note- My husband has recovered from the surgery very well, he practically had full erections with the catheter still in. Incontinence has been minor.
Posted 4/25/2019 2:31 AM (GMT 0)
Leah, I think your husbands dr is right. Especially with not only a G6 surgical pathology, but also a stellar Decipher score.
As far as SRT, I’d wait until the PSA tells you to do it.
My positive margin, in a intraoperative frozen section, was a G6. My Decipher score was 37. I started SRT with a PSA of .08, 3 years and 9 months after surgery. If I had a Decipher score of 12, I might have waited.

Hang in there and see if the PSA starts to rise. Unless the Dr says different, then maybe speak to an RO / get a second opinion.
But again, I think the Dr is right. Your husband isn’t going anywhere, at least not as a result of PCa. Try not to worry (yeah, right)
Posted 4/25/2019 2:38 AM (GMT 0)
What is in your near future is a PSA test to confirm that life is good. You shouldn't even be thinking SRT.

Have a party, go somewhere. PC is likely in the rearview mirror.

Andrew
Posted 4/25/2019 4:30 AM (GMT 0)
Thanks guys...
We are taking a break from all this mess.... Andrew , yep... we are leaving in June for 2 weeks in Italy... It will be nice to escape!
I am doing my very best not to worry... I am sick of worrying and honestly it is so counterproductive. What a shame it would be to ruin years of our precious lives worrying about something that may never happen.
The future is a mystery, the past is history.... so live for today! I am working on getting this down.

Pratoman, what is the difference between oncotype dx and decipher?

Honestly, I am not sure how much I trust the oncotype. It gave him an 8% chance of adverse pathology post prostatectomy. Isn't positive margin at the bladder neck adverse?
Posted 4/25/2019 10:00 AM (GMT 0)
Leah, at this point the diagnostic statistics are meaningless. Really. You have real post surgery data. Now, the next thing is a PSA test at 3 months post surgery. There is no reason to believe he won't be in the zero club (a number with at "<" in front of it. Then, another PSA test 6 months after that. And another one after that. For the rest of his life. So, you'll have plenty to be anxious about for a week before each test--and no, that never really goes away.

I diagnosed at G6 with 3 positive cores, all on one side. My post surgery was G7 in all 4 quadrants of the gland, so a definite upgrade. I've been non-detectable since, 4 years now. If that changes, I'll deal with it. But, 90+% chance I won't have to.
Posted 4/25/2019 1:41 PM (GMT 0)

Leah77 said...
What a shame it would be to ruin years of our precious lives worrying about something that may never happen.
The future is a mystery, the past is history.... so live for today! I am working on getting this down.

Very well said and spot on. It took me a while to get to the point where I could practice that philosophy, good that you are thinking that way

[quote] Pratoman, what is the difference between oncotype dx and decipher?

Sorry, I misread in your post, OncotypeDx for Decipher. As far as I know they are extremely similar, they both test the genetics of the tumor and draw conclusions as to chances of adverse pathology/chance of metastatic disease in 5 years.
They both show results on a scale of 0-100.
These genetics tests are not foolproof, the calculate odds, rather than make predictions .
Posted 4/25/2019 11:11 PM (GMT 0)
Pratoman, it sounds like Oncotype and decipher scoring is very similar. 1-100 are the scores... I am hoping the oncotype 12 score means any GL6 remaining at the bladder neck will just hang out and take its sweet time before it causes any problems.
I just wonder how the heck a 44 year old had a large GL 6 tumor? The darn thing started to grow when he was a teenager???
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