The positive note in the report is that the lymph nodes are clear,
important as they represent the traveling system for Pca, or any cancer
for that matter. Good that he started the Casodex first, as this will
prevent "flare", when the Luperon is administered. The bad part about
the Chemo drugs, is that they are cyto-toxic, kill the good cells as
well as the (:bad -guy's), many with nasty side effects..
With my limited knowledge these are the only comments i can make. My
prayers are with both of you. ~ Bob

Is this Daave481's path report?

(Standard disclaimer about not being a doctor.)

juniper pasted for Dave481:

Nice.  4/4 negative, that's a good sign.

The cancer travels along the nerves on its way out of the prostate,
that is the perineural invasion.  This is an indicator of extracapsular
extension, but not important because the rest of the report says there
is EE.

The cancer did not extend past the bottom edge of the prostate.

Your prostate was pretty much pure, aggressive cancer.  Good thing you
got it out.

According to Pagliano and Strum, "if the PC has spread to nerby tissues
outside the scope of the urologist's scalpel, PSA recurrance after RP
is virtually a certainty."

This report does not say how extensive the invasion is but if it were
minimal, just at the edges, it probably would state that.  (These
quotes are from various websites.)

"Adenocarcinoma of the prostate with seminal vesicle involvement
indicates a poor prognosis."

"Prostatic tumours with seminal vesicle invasion have a high risk of
progression after radical prostatectomy. A preoperative PSA level less
than 10 ng/ml, a Gleason score of the operative specimen less than 7
and effraction of the prostatic capsule can be used to identify a
subpopulation of patients with a better prognosis."

"Of 32 patients, 12 (37.5 %) had seminal vesicle involvement. Seven
patients had involvement of bilateral seminal vesicles and five had
unilateral involvement. Tumor cells invaded the muscle portion of
seminal vesicle from the adjacent prostatic tissues in all 12 patients.
Four of the seven patients with involvement of bilateral seminal
vesicles developed bony metastasis 7 to 12 months after operation. No
patient with unilateral involvement of seminal vesicle was found to
have disease progression to bony metastasis during follow-up for as
long as 39 months."

Lots of cancer still left at the edges of the excised tissue.

Again, the bottom side.

T3b means bilateral extracapsular extension.  However, they stated that
seminal vesicle invasion was present.  That would be stage T3c. Seminal
vesicle invasion is generally a worse sign than EE.  However, the
degree of your EE may have made it seem more important to the
pathologist.  N0 means no lymph nodes. MX means that the presence of
distant metastasis cannot be assessed.  I suspect that with the degree
of your pathology, they weren't able to say "no distant mets"--just
made it a "who knows".

Well, there's good news.  That tumor may have saved your life.

Its a good thing he gave you something, but I don't know much about all
this.  I do know the dosage is 84 days (12 weeks) and not 90.  It may
or may not matter to you, but if the manufacturer says "84" days then I
think that extra week might matter. I am suspicious of urologists
knowing a lot about HT, and prefer our situation, with an oncologist
prescribing.  The Zoladex causes an initial upsurge in testosterone,
presumably feeding all those cancer cells that like testosterone, but
the Casodex blocks the testosteron receptor sites so the cancer is
surrounded by food but can't eat.  When they do it with Casodex pills,
they start the pills a week before the Zoladex to give the Casodex time
to block all the receptors first.  I don't know how long it takes with
a shot.  The website for the manufacturer of both is at
http://zoladex.com/professionals/zoladex/.  In case you want to read up
on side effects or anything.

Who knows what this is.

Wow, you are a tough old cowboy.  Didn't even mention all this before.
Still think you got a good doctor.  You're healing from the surgery
fine?

If you don't think it important to see him, you could get your records
from him.  They would have the information about what drugs you got.
Also more information to see if any questions came up.  I would want to
see him for "closure", maybe to ask if he thinks you might get any more
tumors or what he thinks caused it, or if it makes you more likely to
get colon cancer in the future.  Just to put it to rest.

Yes, they like to give you plenty of time to heal, also get your
continence back.  It is clear beyond a doubt that RT (radiation
therapy) is far more effective with concurrent ADT (hormone, androgen
deprivation therapy.)  So even if you don't want to be on ADT for the
long haul, it would be good to bite the bullet and get another dose of
it to carry you through the RT.  (If you do RT.)

Your PSA goal is zero, undetectable.  Your goal is to (well, maybe not
*your* goal) have a testosterone <20 (depending on the test).   Our
doctor is taking testosterone, PSA, and PAP tests every 3 weeks to
watch the cancer.  (She is also doing blood tests every week, but that
is because of the chemo.)

The thing about ADT is that men can often do intermittant ADT.  Be on
it for a while then get off for months (or years, for some).  The
determining factor seems to be having an undetectable PSA for 12 full
months before stopping it.  Another important piece of information for
all this is your testosterone levels.  How fast they dropped, how low
they dropped.  So if your doctor is not testing your testosterone, then
you may be missing out on information you need to make decisions in the
future.

Dave, it sounds like radiation is the thing to do.  Since you know
there was a whole lot of cancer left in the area.  With a G9, it is
most likely that your cancer is spread beyond the prostate area,
somewhere else in your body.  To fight it aggressively, you would need
to look at systemic treatments.  Those would be hormone therapy of some
sort and/or chemotherapy.  Of course, in all of this you have to make
your choices based on a lot of factors.

I'm sorry for the awful news.  Just because it was expected from the
pre-treatment workup doesn't make it easier, I know.  Like Steve says,
used to be the archer and now he's the target.  What awful news is
going to come next, he asks.

It will be interesting to see what you decide to do about all this.
Just because radiation and hormone therapy are indicated, doesn't mean
you have to do it.  Plus, there are two valid sides to the hormone
question.  One side says to hit it fast and hard while it is weakened.
The other side says to wait until your PSA rises to a certain point
(various #s on that one) and then do HT.  Even though your Gleason is
so high, and the cancer was so prevalant, it is possible that it was a
cancer with a strong territorial sense, and stuck close to home, where
you can get it with radiation.  There's no doubt in my mind that you
have some cancer cells floating around your body, but short term ADT
could get rid of them if there's no major nests.  I read a study that
found prostate cancer cells in the bone marrow of a large percentage of
PC patients before RP, and after RP the % of patients who still had the
cells in their bone marrow was way down.  Maybe those 'child cells'
need a parent (testosterone), while they're still looking for a place
to settle.

Best wishes, don't let your self get too depressed.  Its just another
g'damned thing, you know?  When something like this hits, you think,
'why did it have to be that?  why couldn't i lose a leg, or something?'
 But there is that parable about the troubles tree.  Everyone could
hang their bag of troubles on the tree but they had to take someone
else's bag of troubles.  Basically, most people kept their own.   Also
it reminds me of that book I read, The Other Side of the Mountain.
This teen "had it all"--was going to be on the olympic ski team.  Then
she fell while skiiing and became paraplegic.  Or quad.  Anyway,
someone asked her how she could be happy in a wheelchair.  She said, "I
just remember that everyone's troubles are just as big to them as mine
are to me."  I didn't say this right, but it was a powerful concept for
me.  We are all just doing what we can with the hand we're dealt.

my highest regard,
laurel