I know I shouldnt be doing this to myself, but... my husband had nerve sparing robotic surgery this past Monday. He is doing well, and we have our follow up appointment in about five days to have catheter removed and get biopsy results. I was looking for information from other guys who have had the surgery .. has anyone found out after the surgery that their cancer was worse than the original biopsy indicated? I was so blindsided when my husband was diagnosed since he is only 48 and it was a fluke he found his cancer.. Thanks guys!
Glad to hear that your husband went through the surgery well...which is the typical and expected result. Tell him that the catheter will be a distant memory soon...!
The surgery pathology report is the next important piece of information about his case, and then in a couple of months his first post-surgical PSA test will be the next big event.
The biopsy that he had pre-surgery was simply a sampling of tissue—a small sampling—typically less that 1% of the total prostate tissue. His assigned Gleason score of 3+3=6 was based on the cells found in that sample. It is not uncommon that small amounts of more aggressive (higher Gleason) cells are found with the more thorough pathological examination which takes place post surgery. I've seen results of several studies (each reporting slightly different results) which show that somewhere between 20-30% of radical prostatectomy (RP) pathology reports end up with a higher Gleason score...with the most common being 3+3=6 going to 3+4=7...this is known as "upgrading". [This is exactly what happened in my case.]
This type of "upgrading" should bring little additional concern; the exception being the case of high initial PSA (your husband's was low; less than 3 ng/mL).
Surgical margins are a more relevant indicator of the long term success; negative margins being favorable, positive margins being unfavorable.
Thanks for the info KCON. Did your change in gleason from a 6 to a 7 change your treatment?
No...perhaps the way I worded my earlier reply was unclear. My biopsy Gleason result (which was, of course, before surgery) was 3+3. After surgery, Gleason was "upgraded" to 3+4 as a result of the pathological analysis of the removed prostate. There has been no need for any additional post-surgical treatment, and all functionality has been completely restored.
Welcome to the board! It's always good to hear that prostate surgery went well, and I'm glad for you both.
Kcon answered your question about the biopsy, but I wanted to respond to another aspect of post surgery care regarding the meeting on Tuesday that you mentioned:
Originally Posted by schaser40
KCON, yes, you answered my question. I really appreciate the info. I think I need to just take a deep breath, and wait for our appointment with the surgeon on Tuesday and stop freaking out.
The doctor will explain follow-up PSA testing to monitor for possible recurrence, though recurrence is unlikely. Many men still are monitored with a traditional PSA test that is sensitive only down to less than 0.1 (<0.1). However, "ultrasensitive" PSA tests are now available that can accurately and reliably measure PSA down to <0.01 in a normal clinical setting. In fact bwonka recently posted about his result of 0.008. These ultrasensitive tests are useful because they give early peace of mind or early warning of a recurrence. Typically, the early warning is a year or more earlier than the warning coming from monitoring with standard PSA tests.
Here is what some research has indicated, plus a grain of salt or two for considering these results. Ideally, the PSA after surgery should be <0.01, provided a brand of ultrasensitive test is used that is capable of getting that low, which is what the patient needs. A PSA of 0.01 is also excellent (also indicating an extremely low likelihood of a recurrence), and 0.02 is very good. A result of 0.03 is okay, and 0.04 is a concern, with 0.05 and higher indicating a likely recurrence. Sometimes a little healthy prostate tissue is left, and the first and subsequent PSAs will be higher, such as .08, for example, but steady. Therefore it's not just the result that's important but the trend in results, especially if the first one is on the worrisome side of the range. There can also be some very minor normal variation in results due to day to day patient variation in PSA production and to slight differences in lab processes, though those are usually tightly controlled.
The point of all this is that, if your husband's doctor does not explain that he regularly monitors patients with such ultrasensitive tests, you can ask the doctor to use an ultrasensitive test that is sensitive down to <0.01.
Sometimes I've heard doctors oppose such tests, asking "What's the point when the standard for a recurrence is a PSA of .2 or more that stands up on a retest?" The point is that there are mild lifestyle and mild medication tactics that you and your husband can use that are reported to be effective in preventing or slowing a rising PSA. A daily glass of quality pomegranate juice or equivalent supplement may be all that is needed, for example. Also, follow-up therapy, such as radiation - if needed, that comes on the early side is thought to be often better than later therapy. Finally, a superb early result, like the one Bwonka got, is wonderful for peace of mind.
Once again, congratulations on the successful surgery experience, and I wish you and your husband a smooth recovery.
That's great to hear! Excellent results...as expected!
Now, a little time for surgery & effects recovery, and then the really good part...he'll be getting regular PSA tests going forward but it is highly likely that he will never have to deal with Prostate Cancer again!