While I was out today of course the Dr. called with Franks pathology results and now I have a question I hope someone will be able to answer for us.
Here is what our doctor said: Margins were clear, pattern was 3 + 4 has now changed to 4+3, 16% of left side of gland had cancer. Lymph node from left side OK.
Now the original pre op biopsy said:
Right apex Negative for malignancy,
Right middle, focal atypical small acinar proliferation,
Right base, focal atypical small acinar proliferation. Doctor called it ASAP.
Left apex, Invasive adenocarcinoma (Gleason 7/10 .. 3+4. 1 of 2 cores and less than 5% of the combined total of those two cores involved no extraprostatic extenstion, seminal vesicle involvement, or perineural invasion identified.
Left middle, Invasive adenocarcinoma (Gleason 7/10... 3+4. 2 of 2 cores and approximately 10 to 15% of the combined total of those two cores involved no extraprostatic extension, seminal vesicle involvement or perineural invasion identified.
left base, Focal atypical small acinar proliferation.
Doctor told Frank that he was T1c, PSA 8.8, told it was low volume intermediate prostate cancer.
My question is, do we have to worry that the cancer has spread because the lymph nodes on the right side were not removed for testing?
We do not see the doctor for two months for Franks first post op PSA test.
Hopefully I'm just a worry wort. I know many of you have more serious results to deal with, but I would appreciate all your input to easy my mind.
Judy
That's quite a good post surgery report! While you would rather have a Gleason 6 or lower, on balance the clear margins, low stage, relatively low PSA in the context of a Gleason 7 cancer, negative node check, and other favorable indicators are encouraging!
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Doctor told Frank that he was T1c, PSA 8.8, told it was low volume intermediate prostate cancer.
My question is, do we have to worry that the cancer has spread because the lymph nodes on the right side were not removed for testing?
Current guidelines from the American Urological Association are not enthusiastic about sampling the nodes, actually recommending against it for men with Gleasons up to 6 who also have a PSA under 10. Your husband had a higher Gleason, but checking nodes is a sampling effort in any event. My layman's understanding is that just checking an additional node or so on the right would likely have added little information.
We do not see the doctor for two months for Franks first post op PSA test.
For post surgery monitoring, I'm personally a big fan of ultrasensitive PSA tests with reliable capability down to <0.01. Such tests are far, far more sensitive than conventional tests that typically have a lower limit of <0.1. The ultrasensitive test can give much earlier piece of mind (especially if the result is <0.01 or in that neighborhood), or it can give an early warning that there may be a recurrence. Forewarning is powerfully motivating for lifestyle changes that appear to be able to halt minimal recurrences in their tracks before they build momentum. If you are interested in that kind of testing, it would be wise to check with the doctor now to see what he has in mind. If he does not already use ultrasensitive monitoring, checking in advance would allow you and your husband to try to negotiate its use.
Hopefully I'm just a worry wort. I know many of you have more serious results to deal with, but I would appreciate all your input to easy my mind.
Judy
There's an old definition of a serious problem: a problem that you have is not serious; one that I have is serious. I think you are doing exactly the right thing by preparing for the future.
It is very improbable that the cancer has spread to the lympnodes. The low psa and absence of seminal vessicle invasion are two good indicators as is the Gleason 7. A high psa and or a Gleason 8-10 would have a much higher probability of lymphnode involvement.
I think you are doing exactly the right thing by preparing for the future.
