Met with the uro today for post-surgical.  He recommended radiation
therapy in 3-4 months, when we asked about ADT he said that was
controversial.  I asked about why rad when we had pos lymph node and he
looked at the path, then said it was "tiny" and they probably got it
all.  (AFAIK, *any* positive lymph node means its not local.  Right or
wrong?) Also he said, "if you want to be very aggressive, we can give
you a shot of (depo) today to put it in stasis until the RT."  I wasn't
ready to do a shot because I knew we didn't have any baseline tests and
didn't know what we needed. (And as if I had seen depo in any of this
stuff I've been reading.)  When Steve was asking about RT (IMRT vs 3D,
I think), he said, "That's out of my area of expertise, you need to
talk to a Rad Onc about that."  He didn't say that when asked about
ADT.  (I am trying very hard but not very successfully not to interject
any editorial comments before y'all have a chance to speak.)  Steve
says the doc said it was Stage T3c, I vaguely remember that but at the
moment can't believe it.  That's not how I see it.  We recorded it.  He
was very positive when we asked, picked up the recorder and started the
"This is Dr. Bruce Klestcher and I am meeting with...." till he saw me
laughing, then we just put it on the table.  But, that reaction was a
big plus.  He may be a surgeon first and last, but he is not skittish.
He has always been respectful of our wishes, questions, whatever.
Anyway, here is the complete unedited path report. My earlier post
about "instant continence and mostly bad news" was a summary from
memory after reading.  Maybe I got it wrong?

SURGICAL PATHOLOGY REPORT
* * * TISSUE SOURCE * * *
A. Left pelvic lymph node.
B. Right pelvic lymph node.
C. Prostate.
* * * CLINICAL DIAGNOSIS * * *
Prostate cancer.
* * * GROSS DESCRIPTION * * *
Specimen A is received labeled "left" and consists of one fragment
of fatty tissue, measuring 4.6 cm in greatest dimension. Sectioning
reveals a 4.3 cm lymph node. It is sectioned and submitted entirely in
Al-A2.
Specimen B is received labeled "right" and consists of one fragment
of fatty tissue measuring 5.0 cm in greatest dimension. Dissection
reveals a 4.5 cm lymph node. It is sectioned and submitted entirely in
Bl-B3.
Specimen C consists of a prostate gland with attached seminal vesicies
and vas deferens. The specimen weighs 37 grams and is 4.0 cm superior
to inferior, 4.4 cm transversely and 2.9 cm anterior to posterior. The
right seminal vesicle is 1.5 cm long and 0.9 cm in diameter. The right
vas is 1.8 cm long and 0.5 cm in diameter. The left vas is 1.3 cm long
and 0.5 cm in diameter and the left seminal vesicle is 2.0 cm long and
1.0 cm in diameter. The right side is inked blue, the left side is
inked black, the anterior yellow and the posterior green. No distinct
masses are identified on cross section. Representative sections are
submitted per the prostate protocol, Cl-C22 as follows: Cl-C2) left and
right seminal vesicle and vas; C3-C4) left and right bladder neck
margin, radially sectioned and submitted entirely; C5-C6) left and
right distal urethral margin, radially sectioned and submitted
entirely; C7-Cl0) base section, quartered and submitted clockwise
beginning at left anterior; Cl1-C14) superior section, quartered and
submitted clockwise beginning at left anterior; Cl5-Cl8) mid section
quartered and submitted clockwise; C19-C20) left and right inferior
sections; C21-C22) left and right apex.
* * * MICROSCOPIC DESCRIPTION * * *
Sections of the specimen designated "right pelvic lymph node"
reveal a single lymph node which displays a microscopic subcapsular
focus of metastatic adenocarcinoma. The focus measures less than 1mm in
greatest dimension.
Sections of the specimen designated "left pelvic lymph node" reveal
a single lymph node, negative for tumor.
Sections of the prostate reveal extensive high grade adenocarcinoma.
The tumor involves both lobes, with the largest focus involving the
left prostate (approximately 2.0 cm). The tumor shows features of
Gleason pattern 4 and 5 with a few nests of cells and occasional single
infiltrating tumor cells identified. Tumor focally extends beyond the
prostate to involve soft tissue surrounding the left seminal vesicle,
though the muscular wall of the seminal vesicle is not involved. Focal
perineural invasion is present. The left and right bladder neck margins
are positive for tumor. The right seminal vesicle and distal urethral
margins are uninvolved.
* * * FINAL DIAGNOSIS * * *
Left pelvic lymph node (one)
Microscopic focus of metastatjc adenocarcinoma, less than 1 mm in
greatest dimension.
Right pelvic lymph node (one):
Negative for metastatic adenocarcinoma.
Prostate, radical prostatectomy:
Adenocarcinoma, Gleason score 9 (4+5) involving right and left prostate
lobes (largest focus 2.0 cm).
Focal involvement of soft tissue surrounding left seminal vesicle, with
perineural invasion noted.
Left and right bladder neck margins positive for tumor.
Right and left seminal vesicle and distal urethral margins negative for
tumor.