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    Old 09-22-2016, 10:10 AM   #1
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    Milos14 HB User
    Post Surgery Pathology

    I'm 3 weeks out from my prostate surgery, am 60 yrs old. My post surgery pathology report reads:
    Prostatic adenocarcinoma (3.2 cm), Gleason score 4 + 3=7 with tertiary pattern 5, extending into the left seminal vesicle (pT3b). All margins negative. Marked chronic inflammatory infiltrates.
    Bilateral pelvic lymph nodes, dissection:
    Metastatic in one of eight lymph nodes (1/8).
    My Urologist, who did the surgery is suggesting a hormone shot (Eligard), followed by high dose radiation in about 8 weeks.
    I guess I'm asking a couple of things:
    1) Does this sound like a reasonable treatment option given my results?
    2) Should I be seeing an Oncologist for determining my treatments rather than my Urologist?

    I had 2 opinions before surgery and both were relatively confident that surgery was my best option for a cure so this has come as a second gut shot (first being when I got the initial diagnosis).
    Any thoughts/comments are appreciated.

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    Old 09-24-2016, 09:09 AM   #2
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    Re: Post Surgery Pathology

    Hi Milos,

    Of course that report is not the news you wanted, but you seem to be looking with clear eyes and mind at what needs to be done next. That's good!

    The advice you got looks excellent to me for your situation; I hope to add some information soon if others do not cover it. I suppose the key issue is whether you will be healed well enough at 11 weeks from surgery, but the surgeon probably has a well-based view of that. A paper was just published that gives further support to the idea that early salvage radiation is wise for cases with risk factors such as yours, so having radiation shortly after you are judged sufficiently healed would seem to be the best course. It's not like one or two weeks, or likely even one or several months later will make a difference, but getting the radiation done when the PSA is very low (and the remaining cancer is small) is wise as demonstrated by research.

    You may feel that your choice of surgery was an unfortunate waste, but in your case it is easy to take a different view. Based on the pathology findings, it seems the radiation oncologist will want to radiate your pelvis as well as the prostate "bed" (which was done for me - prostate plus pelvis), and I'm thinking the choice would have been to radiate just the prostate (and a small margin) if you had gone straight to radiation, and that would have left at least the lymph node and perhaps other mets to spread an aggressive cancer you would not have known about since there would have been no removed prostate to biopsy. That prior radiation would also have made further salvage radiation problematic as the doctors do not want to over radiate healthy tissue.

    You will be soon working with a radiation oncology team, but, if you like the urologist and feel his team is good for follow-up care after radiation, he (or she) could be a good choice. Personally, I feel medical oncologists are usually in the best position for follow-up care (rather than urologists or radiation oncologists) because such care often involves drugs and knowing how to implement countermeasures for side effects of the drugs and treatments, and medical oncologists know a lot about those things while urologists and radiation oncologists often have less in-depth knowledge and less awareness of advances that do not involve surgery or radiation.

    Modern radiation, especially when backed by hormone therapy (probably for 18 months to 2 years - be sure to learn about countermeasures for side effects!) is often curative for cases like yours. Also, even if salvage radiation is not curative, it should knock the cancer way back and give you time to take advantage of the great advances that have recently been made and continue to be made with medications, some of which can eliminate certain kinds of metastases, and those metastases can be pin-pointed with modern imaging most of the time.

    Keep your spirits up!

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