I've been wondering about this.  Best I can figure, no one knows the
exact mechanism that the cancer uses to get loose.

I've seen two descriptions.  Both remind me of weeds.

The cancer creeps out, cell by cell, kinda like kudzu.  The docs talk
about margins, micro-tendrals, getting to the seminal vesicles.  That
speaks for slash (surgery) and burn (radiation) as a treatment.

They don't like to talk about distance metastasis, where colonies of
the cancer take up in distant bones or lymph nodes.  The docs send us
for radioactive bone scans, which usually do not show cancer.
Apparently, there's a speading mechanism that's like dandelion seeds.

Given that blood flows in and out of the prostate, these dandelion
seeds are always spreading.

I guess that's the 35%.  Maybe the seeds don't usually take root but in
35% of guys,over a long period of time, they do.

This suggests that environmental changes and good gardening techniques
should help over the long term.  By that I mean, the vitamin-D, the
soy, tomatoes, the juices, and other supplements.

If that lets me skew the 35% to 20%, then it's worth trying.  

-kh

I had similar results in May of 2002 when I had my RP.  3+3 on biopsy, PSA
in the 5's (my age then was 64), and a  competent uro who felt that
prospects looked good.  After surgery (with one nerve spared), Gleason was
3+4, possible penetration of the capsule, and some cancer cells found in
adipose tissue outside the prostate.  I was really down.

A veterenarian whose SO had similar results used to post in this forum.  She
was really helpful to me.  Not only did she assure me that escaped cancer
cells are not a death sentence, especially when our immune system is good.
What sticks in my mind was her saying that probably every time our skin is
exposed to the sun for any length of time, some cancer cells may be
produced, but our body usually takes care of them.  But what was particular
helpful is that she wrote that even with the alarming results in her SO's
post surgical report, several years later his PSA was still undetectable,
and everything was going well.

I am now 4 1/2 years post RP.  PSA is still undetectable (<0.05), I am
basically continent, and have erectile function normal, I believe, for my
age.  I still get nervous at PSA check time (and given the positive margins,
I will have to go 10 years before I am declared "cured"), but really don't
worry about it much anymore. I don't know if this is helpful to you, but the
good lady's encouragement to me after my post-surgical bad news, helped me
get through a difficult stretch.  Don't let the negative statistics dominate
your thoughts.

gary.miller12@comcast.net wrote:...snip...

Part of the prostate is just "hanging out" there in space in side your
body, it is not physically attached to any other anatomical structures
(other than the rest of the prostate).  The remainder of the prostate
is physically attached to other parts of your anatomy.  When the
surgeon removes the prostate he/she need only cut through the part that
is physically attached to other structures.  That area where the
surgeon cut is called the margin.  If cancer cells are found at the
margin, then there is the possibility that some cancer cells remain in
your body on the other side of the margin or excision, the part that
remains in your body.

The part of the prostate that is not physically attached to your body,
the part that is just "hanging out" is covered with a thin membrane,
the capsule.  Cancer can also grow through this membrane and exist on
the outer surface of the prostate (extra-capsular extension).  From the
prostate surface it can then migrate to the seminal vesicles and so on.

So there are at least two pathways for the escape of cancerous cells,
1) through the physically attached portion of the prostate and 2) from
the surface of the prostate.  The best pathological prognosis would be
negative margins and no ECE.  This would indicate that both of these
pathways were not operative...Best wishes and good health, ron

That sounds pretty good to me.

You would feel better if that hadn't happened, but it is not at all unusual.

That is good.

T1c is a diagnosis before surgery based primarily on what the doctor can
feel under DRE.  After surgery, presuming any cancer at all is found in
the prostate that was removed, you can't have T1c anymore.  It has to be
at least T2-something.  The T3 in your case means it penetrated the
capusule, which you already knew.

The Sloan Kettering nomogram puts it a bit lower at around 28 percent,
but that seems the right ballpark.

I think others have addressed this issue.  The pathology report after
surgery only tells you what the pathologist found when examining the
prostate.  He can't be sure some small amount of cancer hasn't managed
to escape, and clearly he can't say anything definite about parts of
your body he can't examine.  Estimates of this kind are based on follow
up studies of other patients with similar post-surgical pathology.

The most likely prognosis is that you will never have a recurrence.
After all, the odds seem to be at least 2 to 1 against it.  But even if
you do, most likely it won't be for a while, and it will first show up
as an increase in PSA.   At that point, if the recurrence is local, it
still may be possible to destroy the remaining cancer through radiation.
  Even if the cancer has escaped to distant sites,  it often takes many
years before a PSA rise is followed by clinical symptoms.   At that
point, hormone therapy is still available, or perhaps some miracle cure
developed in the next several years.

I know it is difficult, but for the moment assume the best, not the
worst, and concentrate on recovering from the surgery.  Most likely, you
will do fine, and worrying about what will happen otherwise won't do any
good.

Sorry to hear about your urinating problem, but it is quite common and
should fix itself quickly.

T3a means that it penetrated the wall of the prostate or is in the seminal
vesicles.  That's where I started my journey.

Hello Gary--

This will probably make me an outcast here but I have concluded that in
terms of  QOL after pca treatment  it is the "overexamined life that is
"not worth living". (Socrates: "the unexamined life is not worth
living"). You need to review the information that you must know in
terms of your treatment but with everything you come across here you
could drown in info and also become more depressed and nervous.  That's
what happened to me initially.

I have to say I love this group but some here are so obsessed with data
relating to this illness that in order to remain here I have to skip
through most of the specific stats and numbers because if not I would
go crazy.  And anyway,  after J's surgery, I didn't really care about
knowing every particular detail of his tumor and what his prospects
were in aggravated detail.  Some of thatinfo  was too late to be of any
use, anyway..  What really chills my bones is the nomogram, just the
idea that somebody would actually want to sit down and placidly try to
predict their own life expectancy to a T. It  makes me freak out just
to think about it.

This relates to the stat you mentioned: the 35% recurrence rate.   It
had been somewhere in my consciousness before I read it here (time and
again) but none of the doctors had mentioned it explicitly and as far
as my husband was concerned, I had discouraged him from to reading too
much about future outcomes, at least not until after his RP.

I wanted to bring up some issues with Jon  and so I mentioned this 35%
stat to him the other day and he was like a deer staring into the
headlights. He just had had no idea.  If you must know I felt like a
murderer afterwards, he was so down for a couple of days and I thought
maybe telling him had served no purpose.

I suggested to J.that there were a couple of things  that he might
want to try in terms of diet.   Hence, why i had been urging him to
drink  pom juice.  He was very eager to comply and we also decided he
would  eat 3 tbs of tomato sauce a day and also have a V-8. (Thank you,
Alan for that). A  can of V-8 juice  has a day's  MDR of vegetables and
it comes in bought the low- sodium.  You can only help yourself by
eating more fruits and vegetables and, as a matter of fact,  I am going
to have a v-8 myself every day.And I thought there was some reliable
evidence in existgence about the pom juice.

Afterwards  we talked about him doing other things that can always help
with illness such as trying to lead a less stressful life, going to the
gym and doing more enjoyable things. And, In his case, J. already prays
every day  so I told him to do it double-hard!  (BTW I think prayer is
a healing exercise and you don't even have to be relig. to get
something out of it.  For example: I enjoy reading Psalm book even
though my religious practice is now mostly vestigial).

You know there are some people in this group who are clearly obsessive.
In your case, the worst thing you can do for yourself is to dwell on
this statistic (and others) in my opinion. It is already bad enough
that you have that 3-mo psa test to cope with.

I would add that there are some types who might  want to know
everything but this is not the right approach for a lot of people.
Personalities vary.

Also, even if every  bit of info were valuable some people are just not
capable of acquiring it before or during illness.  For ex. after my
husband was initially dx he was so paralyzed by fear and depression
that it was enough work for me just to keep him going.  And there
wasn't any time to waste in treating him, acc. to the docs, so I
simply did not time to read the whole encyclopedia britannica  Some
people don't have a research ass't  (like J. has me) and there are
limits to what they themselves can do.

Hope this helps.

Best of luck,

Leah

All it takes is for one cancerous microfiber to enter the bloodstream and at
some point there is a re-occurrence.\ And how many blood networks are within
the prostate capsule?

gourd dancer