Update from Clinic Visit Today

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Jim - 11 Feb 2008 22:34 GMT

This morning I went back for a scheduled visit to the urology clinic at
Henry Ford Hospital in Detroit after they decided not to remove my catheter
last week. The urethra-bladder connection was still leaking then. Today,
the bladder x-ray was good and they pulled my little friend to my great
relief after 19 LONG days in place! I'm on my fourth pad in the last five
hours but I'm SOOOO glad I won't be tethered to the bed by my penis tonight!
Can you tell I'm grinning from ear-to-ear?

The difficulty with the anastamosis was limited access for the robotic tools
due to my deformed pelvis (childhood disease, arthritis and weight (220's).
That made putting me back together difficult.

I also got to talk to my surgeon. We weren't scheduled to get together for
a couple of weeks but the nurse said he was in clinic today and she would
save us a trip back. I got much better info from the doctor than I did from
the PA last week when I was really down due to positive margins on the path
report. Folks on this newsgroup suggested a lot of excellent questions
which I posed to the surgeon.

- The Gleason score was still 7 as in pre-op pathology
- Tumor is T3a versus T1c (I think) before surgery
- The seminal vessicles were not involved
- Lymph nodes were negative; they took nodes from near the prostate
and farther away
- There were three small areas where the tumor approached the capsule;
these were the positive margins
- During surgery, the doctor sampled tissue outside the prostate (that
he intended to leave) but near one of these areas and had it biopsied - it
was negative
- He recommends no additional treatment (other than penile
rehabilitation) unless the PSA's start to climb.
- Finally, he commented on the anastamosis and said I made him wish he
was in accounting. Fortunately, he claims he's the best in their group at
that step and got it done.

So, the next point of anxiety is the post-op PSA. He said to wait another
month or so to do that. Anuway, I feel so much better emotionally and ready
to work on regaining continence.

Regards,
Jim

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I.P. Freely - 12 Feb 2008 01:18 GMT

> Today, they pulled my little friend to my great
> relief after 19 LONG days

Now THAT's my kind of hospital. Man, the VA wouldn't even wash mine, let
alone pull it for me. ;-)

> [My surgeon] recommends no additional treatment other than penile
> rehabilitation

And my kind of surgeon.

I.P.

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Steve Kramer - 12 Feb 2008 13:33 GMT

> - The Gleason score was still 7 as in pre-op pathology
> - Tumor is T3a versus T1c (I think) before surgery
[quoted text clipped - 8 lines]
> - He recommends no additional treatment (other than penile
> rehabilitation) unless the PSA's start to climb.

Good news, Jim! I'm confused by they 'everything negative outside the
prostate' and the 'T3a' Staging. Based on his detailed description of what
he found and didn't find, it's actually a T2a (or c) Staging.

In any case, that which he details is all good news.

Signature

PSA 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

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Steve Kramer - 12 Feb 2008 13:42 GMT

> Based on his detailed description of what he found and didn't find, it's
> actually a T2a (or c) Staging.

I did not intend for that to be an assertion -- more of a probability.

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Leonard Evens - 12 Feb 2008 21:29 GMT

> This morning I went back for a scheduled visit to the urology clinic at
> Henry Ford Hospital in Detroit after they decided not to remove my catheter
[quoted text clipped - 17 lines]
> - The Gleason score was still 7 as in pre-op pathology
> - Tumor is T3a versus T1c (I think) before surgery

T1c before surgery means that the doctor couldn't feel anything on
digital rectal examination. The only way you could have a T1 staging
after surgery is if it turned out no cancer was found in the any of the
tissue removed. That would indicate a real botch of the pre-surgical
pathology or a remission of the cancer before surgery. Such things
happen but they are pretty rare. Otherwise a post-surgical pathology
staging is going to be at least T2. T3 means it has extended beyond the
prostate, and the a means just on one side. That would be a pretty
serious pre-surgical diagnosis because it would mean the extension was
clear on DRE. In such a case, many surgeons wouldn't even try surgery.
But as a post-surgical diagnosis, it may not mean that much,
particularly since your surgeon described the possible extension as
minimal. It wasn't even clear the tumor penetrated the capsule from your
description. I would take his advice and not worry specially about it.

> - The seminal vessicles were not involved
> - Lymph nodes were negative; they took nodes from near the prostate
[quoted text clipped - 12 lines]
> So, the next point of anxiety is the post-op PSA. He said to wait another
> month or so to do that.

It can take a while for the PSA level in the blood to decline even if
nothing is producing new PSA, so a wait of a month is not unusual.

> Anuway, I feel so much better emotionally and ready
> to work on regaining continence.
>
> Regards,
> Jim

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