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Medical Forum / Diseases and Disorders / Prostate Cancer / February 2008Update
I'm now 12 days post-op on my RLRP. I went down to Detroit to have them check the healing on my urethra-bladder connection needed for catheter removal. Unfortunately, the connection is leaking so they decided to leave the catheter in place for at least another week. Worse news is the pathology on my removed prostate. There are three small locations where the cancer reached the edge of the prostate. As I understand it, that may mean that the cancer was not organ-contained at the time of surgery. I don't get to talk with the surgeon for another three weeks so I don't know what that means regarding future treatment. Also, I don't get a post-op PSA for a couple of more weeks and realize that may be key input. Can anyone discuss likely options with this much information? It's getting a little harder to maintain a positive attitude. Regards, Jim _____________________________________ Age: 65 Sep, 2007: PSA = 7.0 Oct, 2007: DRE unremarkable; Biopsy positive on 3 of 12 cores - Gleason 6 (3+3); T1 Nov, 2007: Negative for methasases on the usual bone scan, abdominal CT, chest x-ray Dec, 2007: Gleason 7 (3+4) reading on the same biopsy slides by different pathologist Jan 23, 2008: RLRP at Henry Ford Hospital in Detroit Feb 4,2008 Path report-T3, Gleason 7, negative nodes, positive margins > I'm now 12 days post-op on my RLRP. I went down to Detroit to have them > check the healing on my urethra-bladder connection needed for catheter [quoted text clipped - 11 lines] > > It's getting a little harder to maintain a positive attitude. "Reached the edge" and "surpassed the edge" are two different concepts and the exactitude of terms is extremely important. Can you quote the pathological report? Another thing, Jim. What Stage did they attribute to your disease? Originally, it was probably stated as T1a, or T2b, or something like that. Your path report probably has a T2c or T3c or something like that. It might look like T2cN0M0. With this designation, we can tell you a lot more about what they think your disease is. You may note by my signature, I was orginally classified as T2c which means the cancer was palpable (the doc felt it during a DRE) and both lobes of the prostate are involved. After surgery, cancer was found in my seminal vesicles, so I was reclassified as T3c. The N0 means none was found in my nodes. The M0 means no mets are known to be present. You probably did not get a T4 designation. If it says T3, your next step is probably radiation in the hopes of burning the rest of the cancer that is probably on the prostate bed. But, they might wait awhile to see what your PSA does. You'll note they waited on mine until my PSA went up to 0.37, 1½ years after the surgery. At this point, you might wish to also note that I was almost 20 years younger than you when diagnosed and, therefore, my cancer was probably a lot more aggressive. Furthermore, note that I am still alive some 8 or 9 years after my cancer was likely a Gleason 7 and PSA was 8.11 (it was not diagnosed until I was a 16.0). Finally, note the final line in my signature. This is not a passive event. You have to fight the bastard!  SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 PSAD .056 years Lupron 07/03 (1 mo) 8/03 and every 4 months there after PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years Casodex added daily 07/06 PSA <0.04, <0.05, <0.04, <0.04 10/11/07 Non Illegitimi Carborundum > It's getting a little harder to maintain a positive attitude. A positive attitude, to me, means an aggressive, take-charge, fact-driven, priorities-based, direct response to PC, not an "Oh, it'll be fine" self-deception. The latter will crumble if the disease progresses, but the former will keep us going right up to our last gasp. PC may (or may not) shorten our lives, but it usually takes many years to do it and seldom dictates its quality until many years past diagnosis. Study it, analyze your priorities, treat it accordingly, and keep talking about it without obsessing on it. Before, during, and after medical science has done its best, Attitude is Everything. I.P. As Steve said, "reached the edge" may or may not be important. I had a "well-focused 2-mm tumor" located at the inked margin of my removed prostate resulting in a "positive margin" and I opted for no additional treatment. So far, knock on wood as they say, my PSA's are still undetectable almost five years out. A positive margin that is the result of the surgeon slicing through a piece of cancer leaving a chunk behind can be quite serious but simply growing up to the margin is often much less so. Even if a small amount of cancer is left behind it often dies off because of lack of nutrients due to surrounding scar tissue that restricts blood supply to the area. Though the odds of recurrence are greater for guys with positive margins, there are also lots of positive margins that turn out to mean nothing. I can't and won't recommend any treatment or no treatment since I'm not a doctor and more specifically not your doctor. I can only relate what I went through along with my results but at least you may have some ease of mind knowing that "three small locations" need not always be bad. You and your doctor will have to decide what to do about them, if anything. That decision will be influenced by your Gleason, your PSA velocity before surgery and finally, and most importantly, that first PSA result you'll get in about six weeks. Good luck, Dave Perry > I'm now 12 days post-op on my RLRP. I went down to Detroit to have them > check the healing on my urethra-bladder connection needed for catheter [quoted text clipped - 28 lines] > > Feb 4,2008 Path report-T3, Gleason 7, negative nodes, positive margins > I'm now 12 days post-op on my RLRP. I went down to Detroit to have them > check the healing on my urethra-bladder connection needed for catheter [quoted text clipped - 28 lines] > > Feb 4,2008 Path report-T3, Gleason 7, negative nodes, positive margins I echo what the others have said. Read Wlash's book to see what he says about margins. Wait until you can talk to your surgeon about the significance of the pathology report and don't jump to any conclusions. >> I'm now 12 days post-op on my RLRP. I went down to Detroit to have >> them check the healing on my urethra-bladder connection needed for [quoted text clipped - 33 lines] > about margins. Wait until you can talk to your surgeon about the > significance of the pathology report and don't jump to any conclusions. Better still give the surgeon a call. Surely the surgeons at Henry Ford Hospital, a hospital that isn't shy to promote itself as patient centered, will be happy to address your concerns if you don't want to wait the full three weeks until your scheduled appointment. What happened to the proverbial American self-confidence? |
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