It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Cancer: Prostate Message Board

  • Post Radical Prostatectomy

  • Post New Thread   Reply Reply
    Thread Tools Search this Thread
    Old 06-18-2020, 06:32 AM   #1
    stephenwilliam
    Junior Member
    (male)
     
    Join Date: Dec 2019
    Posts: 11
    stephenwilliam HB User
    Post Radical Prostatectomy

    I am looking for some opinions on my situation Post Radical Prostatectomy.

    Results from the initial Pathology (this is what they removed from my body)

    I am a 65 year old male. Born June 1955.

    SPECIMEN(S) RECEIVED MARCH 11, 2020
    1 - Prostate: Prostatectomy, Radical PROSTATE AND SEMINAL VESICLES.
    2 - Lymph-Node: LEFT PELVIC LYMPH NODES.
    3 - Lymph-Node: RIGHT PELVIC LYMPH NODES.

    DIAGNOSIS
    1 - Prostate: Prostatectomy, Radical PROSTATE AND SEMINAL VESICLES, weight 38 gram:
    - Adenocarcinoma, Gleason score 7 (4 + 3) with a high grade component, comprising 60% of the carcinoma.
    - Positive for extraprostatic extension, negative for bladder neck invasion, positive for left seminal vesicle invasion (pT3b).

    - Surgical margins negative for malignancy.

    - About 20% of the prostate volume involved by carcinoma.

    2 - Lymph-Node: LEFT PELVIC LYMPH NODES.:
    - Metastatic prostatic adenocarcinoma in two of four (2 / 4) lymph nodes.

    3 - Lymph-Node: RIGHT PELVIC LYMPH NODES:
    - Two lymph nodes. Negative for malignancy.

    Subsequent Bone Scans and Cat Scans plus an experimental PSMA Pet Scan all showed no metastases anywhere in the abdomen, thorax, pelvis or bones and my lungs and all other areas were shown as clear.

    BUT there remained a 0.25 PSA...

    My Doctors are suggesting Hormone Replacement Therapy AND Radiation for 33 days and I am a little concerned because they tell me the 0.25 PSA means that something is still in me and it could spread so they want to get rid if it.

    Does anyone have an experienced opinion which could help me understand what this all means as far as my outlook. I am a very healthy man and maintain a plant based diet.

     
    Reply With Quote
    Sponsors Lightbulb
       
    Old 06-18-2020, 10:05 AM   #2
    Michael F
    Member
    (male)
     
    Join Date: Dec 2019
    Location: Greater Atlanta
    Posts: 63
    Michael F HB UserMichael F HB UserMichael F HB UserMichael F HB User
    Re: Post Radical Prostatectomy

    Hi & Welcome stephenwilliam! Following RP, most will demonstrate a PSA decline to <0.01 ng/ml

    A few questions:

    - What was your PSA at time of diagnosis?

    - What was the date of your RP?

    - What was the date(s) of your post RP PSAs? (and values if more than 1 PSA test) IMO, you should have at least 2 PSA values by now to confirm that the 0.25 is correct.

    Your current status contains 3 points of concern:

    - BUT there remained a 0.25 PSA...

    - Metastatic prostatic adenocarcinoma in two of four (2 / 4) lymph nodes

    - Positive for extraprostatic extension,...positive for left seminal vesicle invasion (pT3b)


    The AUA defines Biochemical Recurrence (BR) following RP as 2 consecutive PSA values > 0.20

    Now is the time to have consultations with expert URO Radiologists & Medical Oncologists who specialize in treating recurrent PCa to plot your course of action and treatment(s) moving forward. Discuss with them the importance of being certain that any and all sources of PSA will be well within the fields of radiation.

    The Good News(!) is:

    - RP is now behind you. (Your URO Surgeon's job is done)

    - There is high likelihood that complete CURE is still achievable!

    IMO, you should be monitoring your PSA with an ultrasensitive PSA methodology. (uPSA). This will allow the detection of very small increases and an estimation of the Rate of Rise. Be sure to Use The Same Lab and Same uPSA Methodolgy Each Time! Otherwise values can not be compared.

    Keep in mind that about 30% of men who undergo RP, require subsequent radiation therapy (can be with or without ADT). So you will not be walking the pathway of additional treatment alone!

    Certainly this is not the result that you had hoped for BUT it also is NOT a worst case scenario. Others who are better experienced will chime in. Meanwhile, we are here and with you every step of your continued Journey to Cure!

    MF
    __________________
    PSA: Oct '09 = 1.91, Oct '11 = 2.79, Dec '11 = 2.98 (PSA, Free =13%)
    Jan '12: Biopsy: 1/12 = G7 (3+4) & 5/12 = G6
    March '12: Robotic RP: Left: PM + EPE => MD excised additional adjacent tissues
    Pathology: Gleason (3+4) pT3a pNO pMX pRO c tertiary pattern 5 / Prostate Size = 32 grams / Tumor = Bilateral: 20% / PNI: present
    uPSA Range: 0.017 - 0.039 at 98 Months Post Op: Mean = 0.023 (n = 24)
    LabCorp: Ultrasensitive PSA: Roche ECLIA
    Continence = Very Good (≥ 99%) ED = present

     
    Reply With Quote
    Old 06-18-2020, 11:04 AM   #3
    stephenwilliam
    Junior Member
    (male)
     
    Join Date: Dec 2019
    Posts: 11
    stephenwilliam HB User
    Re: Post Radical Prostatectomy

    Hi MF,

    In May of 2019 I was found to have a PSA of 14, which by November 2019 had increased to 18 and I underwent an RP on March 3, 2020.

    PSA RESULTS AFTER RADICAL PROSTATETECTOMY

    - PSA on 14-Apr-2020 (Total PSA is 0.14 ug/L).

    - PSA on 27-Apr-2020 (Total PSA is 0.16 ug/L, Testosterone level is 19.5 nmol/L).

    - PSA on 3-June-2-2 was 0.25 ug/L.

    On June 22, 2020, I am scheduled for a CT SIM Planning Scan to plot a course of radiation treatment. My Radiation Oncologist has told me that even though all of the scans I have had done show no signs of any metastasis, they PSA from the bloodwork suggests there are remnants left and they want to begin a 33 day radiation treatment coupled with Hormone Replacement Therapy.

    Thank you for your comment.

    Steve

     
    Reply With Quote
    Old 06-18-2020, 11:49 AM   #4
    DjinTonic
    Senior Member
    (male)
     
    Join Date: Dec 2019
    Location: NC
    Posts: 266
    DjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB User
    Re: Post Radical Prostatectomy

    Hi Stephen. Treatment for your prostate cancer needs to be completed. Your cancer grew out from the prostate. You surgeon chose to remove only 4 lymph nodes. It's unfortunate that the PCa has spread to some pelvic nodes, but it's fortunate it was identified. Your adverse path findings (spread to a seminal vesicle and growth through the prostate capsule), coupled with the large volume of Gleason pattern 4 in your G7 (4+3) and your persistent PSA (PSA at detectable levels after surgery), would all point toward followup RT even if all your nodes had been negative

    One issue you can discuss with your radiologist is whether the RT will be limited to the prostate fossa (the area limited to where the prostate was -- this will encompass some pelvic lymph nodes) or, more likely, whole-pelvis (a wider field that will irradiate more pelvic nodes).

    Did your imaging include a bone scan either before or after your RP?

    ADT will usually halt the growth and spread of metastases, but it alone it would not be a potential cure for your PCa; however, the RT might be. Much depends on whether all your current metastases are currently limited to pelvic nodes.

    As Mike advised, after completion of your treatment, I would opt for the Labcorp ultrasensitive (3-decimal) PSA test to track your PSA in the future.

    A consult to get a second opinion is never a bad idea, as is your researching your treatment options, but given the results of your surgery, in your shoes I would opt for RT + ADT. Keep us posted!

    All the best,

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    11-10-17 Decipher 0.37 Low Risk; 5-yr met risk 2.4%, 10-yr PCa mortality 3.3%
    LabCorp uPSA: 0.010 (3 mo.)…0.015 (1 yr. 6 mo.)…0.015 (2 yr. 4 mo.)

     
    Reply With Quote
    Old 06-18-2020, 12:09 PM   #5
    stephenwilliam
    Junior Member
    (male)
     
    Join Date: Dec 2019
    Posts: 11
    stephenwilliam HB User
    Re: Post Radical Prostatectomy

    Thank you Djin. I appreciate you responding so quickly as I am scheduled for a Cat Scan Planning session next Monday.

    My Radiologist suggested that we treat the prostate area and the whole pelvic area, which I assume includes the surrounding lymph nodes.

    Since surgery, I have had two full body bone scans, two full body cat scans and a PSMA Pet Scan, which is when they inject a radioactive dye inside prior to the scan. ALL of these scans came back completely negative.

    My abdomen, pelvic area, bladder, liver and lungs were clear. No evidence of abdominal metastasis was detected. No evidence of intrathoracic metastatic disease was detected.

    RESULTS OF THE PSMA PET SCAN - May 22, 2020

    - There is no pathological uptake in the prostate bed.
    - There is no pathological PSMA uptake in pelvic or retroperitoneal lymph nodes.
    - There are no foci of pathological PSMA uptake suspicious for distant metastatic disease, including in the skeleton, lungs or liver.
    - There are no radiological findings suspicious for metastatic disease with low PSMA expression.

    CONCLUSION
    - The PSMA Pet Scan showed NO convincing evidence of PSMA-avid local recurrence or regional /distant metastatic disease. NO RECURRENCE.

    My Doctor says any remaining cancer is localized and possibly hiding within fat tissues.

    I will begin injections of Zoladex June 29 and radiation the following week for 33 days.

    I admit I am a little scared.

     
    Reply With Quote
    Old 06-18-2020, 12:17 PM   #6
    DjinTonic
    Senior Member
    (male)
     
    Join Date: Dec 2019
    Location: NC
    Posts: 266
    DjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB User
    Re: Post Radical Prostatectomy

    Excellent scan results! Regarding the psychology of it all, just anticipate the last day of your RT, when your cancer has been zapped away. Stay positive, take one day at a time, and let your medical team work for you.

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    11-10-17 Decipher 0.37 Low Risk; 5-yr met risk 2.4%, 10-yr PCa mortality 3.3%
    LabCorp uPSA: 0.010 (3 mo.)…0.015 (1 yr. 6 mo.)…0.015 (2 yr. 4 mo.)

     
    Reply With Quote
    The Following User Says Thank You to DjinTonic For This Useful Post:
    stephenwilliam (06-18-2020)
    Old 06-18-2020, 12:22 PM   #7
    stephenwilliam
    Junior Member
    (male)
     
    Join Date: Dec 2019
    Posts: 11
    stephenwilliam HB User
    Re: Post Radical Prostatectomy

    Djin - Thank you for your thoughtful and compassionate responses. I needed someone to tell me these things today...

     
    Reply With Quote
    Old 06-18-2020, 01:28 PM   #8
    Eonore
    Junior Member
    (male)
     
    Join Date: Jan 2020
    Location: Newington, CT
    Posts: 21
    Eonore HB User
    Re: Post Radical Prostatectomy

    Dear Stephen,

    I have been through both RP and RT with ADT, although my PSA was undetectable for ten months after surgery. Your doctors have presented you with the right plan for a cure, and your overall good health and habits will stand you in good stead. I do not want to say that the radiation and hormone therapy are a piece of cake, but they are doable and the ill effects tend to be temporary. In other words, you seem to be in good hands and in good shape and there is every reason to be optimistic.
    How have you been doing with your recovery from RP? How is your continence?

    Eric

     
    Reply With Quote
    Old 06-18-2020, 01:45 PM   #9
    stephenwilliam
    Junior Member
    (male)
     
    Join Date: Dec 2019
    Posts: 11
    stephenwilliam HB User
    Re: Post Radical Prostatectomy

    Hi Eric,

    Thanks for the optimistic note. It helps me to know that others have gone through the same thing and are thriving. I retired January 1, 2020 and this scared me as a way to start off retirement...

    My recovery from RP has been faster than the Doctors anticipated. Healthwise, I am strong and very healthy. My resting heart rate is between 50 - 60.

    I had absolutely no incontinence 30 days after surgery...

    Hearing from this forum helps :-)

     
    Reply With Quote
    Old 06-18-2020, 02:15 PM   #10
    OldTiredSailor
    Junior Member
    (male)
     
    Join Date: Dec 2019
    Location: Punta Gorda
    Posts: 33
    OldTiredSailor HB UserOldTiredSailor HB UserOldTiredSailor HB User
    Re: Post Radical Prostatectomy

    I want to echo what the others have told you. You could not get better advice and certainly are hearing from guys with a LOT of experience, both with their personal disease and helping all of we other PCa patients.

    I am 22-months post-RALP with a very small but inexorably increasing µPSA value. I have been resisting / aggressively battling against RT for about 18 of those 22-months. I am still hoping that my mid-July µPSA allows me to put off the RT decision for another 3-months.

    As the others may comment, I have been way over the top on research about RT followup to RALP and the indications/contra-indications and prognosis / long term statistics.

    BUT - the positive news I can offer you, based on an obsessive amount of research, is that modern/state of the art RT can be delivered with very low risk of significant long term side effects. I can recount many dozens of studies showing that Image Guided Radiation Therapy, even whole pelvis as you need, can be done with less than a 1 in 25 chance of significant side effects that last more than a month or two.

    I would have no hesitation, if I had your pathology, of starting RT as soon as my RO thought it appropriate. And, with your SV and LN involvement I would probably even accept the ADT, which, in my case, I have adamantly opposed and none of my RO or even MOs have suggested.

    I would be concerned about hypo-fractionation or the idea of a "COVID" RT schedule where you receive either 20 or even 5 RT treatments, each at a much higher dosage than the 1.8 Gy you would get with the "standard"39-treatments. Almost all the research I have seen shows the long term GI side effects for the higher dosage treatment schedule to be significantly greater than the 1.8 Gy/treatment.

    I am not sure avoiding increased COVID risk with fewer trips to the RT facility is worth the certainly higher risk of long term side effects.

    As DT said - you are in line for a cure, or at least a complete PCa knockdown so good luck and best wishes.
    __________________
    DOB: July 1947
    RALP 8/23/18 pT3a, G7 (3+4), 20% involvement, SM+ (Focal 2mm G6), EPE(Focal G6)+, PNI+, LNI-, SVI-, LVI-
    7g Tumor 20x size in MRI & biopsy report & in BOTH lobes not just L as biopsy reported
    Decipher RP = 0.47, which is .01 above a LOW risk

    Post-RP PSA
    10/3/18 0.021 01/4/19 0.018 04/03/19 0.022 06/26/19 0.028 10/1/19 0.035 3/14/20 0.050 4/16/20 0.055 7/8/20 0.060

     
    Reply With Quote
    The Following User Says Thank You to OldTiredSailor For This Useful Post:
    stephenwilliam (06-19-2020)
    Old 06-18-2020, 02:31 PM   #11
    OldTiredSailor
    Junior Member
    (male)
     
    Join Date: Dec 2019
    Location: Punta Gorda
    Posts: 33
    OldTiredSailor HB UserOldTiredSailor HB UserOldTiredSailor HB User
    Re: Post Radical Prostatectomy

    Vey current research has shown that even the most sophisticated PSMA/Pet scans have less than a 40% chance of finding mets when your serum PSA level is below 0.2 but 65% chance when PSA is between 0.2 and 0.5. It is encouraging your scan found no positive results

    Methods: We retrospectively analyzed a cohort of 66 consecutive patients who underwent a 68Ga-PSMA-11 PET/MRI for BR with a PSA value ≤ 0.5 ng/ml at our institution. Median PSA level was 0.23 ng/ml (range: 0.03 – 0.5 ng/ml). Detection of PSMA-positive lesions within the prostate fossa, local and distant lymph nodes, bones or visceral organs was recorded. In addition, all scans with 68Ga-PSMA-11 PET/MRI positive lesions were retrospectively assessed to analyze if lesions were detected inside or outside of a standard salvage radiotherapy volume.

    Results: Overall, in 36 of 66 patients (54.5%) PSMA-positive lesions were detected; in 26 of 40 (65%) patients with a PSA between 0.2 - 0.5 ng/ml and in 10 of 26 (38.5%) patients with a PSA < 0.2 ng/ml. Even at those low PSA values, only 8 of 66 (12.1%) patients had exclusive local recurrence. In 23 patients lymph nodes and in 5 patients bone metastases were detected on 68Ga-PSMA-11 PET/MRI. In 26 of 66 patients (39.4%) PSMA-positive lesions were located outside a standard salvage radiotherapy volume.

    Conclusion: Our data confirm that 68Ga-PSMA-11 PET/MRI has a high detection rate for recurrent prostate cancer, even at low PSA levels ≤ 0.5 ng/ml. In addition, we show that 68Ga-PSMA-11 PET/MRI detected PSMA-positive lesions outside a standard salvage radiotherapy volume in 39.4% of all patients.



    Detection rate and localization of prostate cancer recurrence using 68Ga-PSMA-11 PET/MRI in patients with low PSA values ≤ 0.5 ng/ml
    Benedikt Kranzbühler et. al.
    Journal of Nuclear Medicine 2019
    __________________
    DOB: July 1947
    RALP 8/23/18 pT3a, G7 (3+4), 20% involvement, SM+ (Focal 2mm G6), EPE(Focal G6)+, PNI+, LNI-, SVI-, LVI-
    7g Tumor 20x size in MRI & biopsy report & in BOTH lobes not just L as biopsy reported
    Decipher RP = 0.47, which is .01 above a LOW risk

    Post-RP PSA
    10/3/18 0.021 01/4/19 0.018 04/03/19 0.022 06/26/19 0.028 10/1/19 0.035 3/14/20 0.050 4/16/20 0.055 7/8/20 0.060

     
    Reply With Quote
    The Following User Says Thank You to OldTiredSailor For This Useful Post:
    stephenwilliam (06-19-2020)
    Old 06-19-2020, 11:42 AM   #12
    OldTiredSailor
    Junior Member
    (male)
     
    Join Date: Dec 2019
    Location: Punta Gorda
    Posts: 33
    OldTiredSailor HB UserOldTiredSailor HB UserOldTiredSailor HB User
    Re: Post Radical Prostatectomy

    Quote:
    Originally Posted by stephenwilliam View Post
    Hi Eric,

    Thanks for the optimistic note. It helps me to know that others have gone through the same thing and are thriving. I retired January 1, 2020 and this scared me as a way to start off retirement...

    My recovery from RP has been faster than the Doctors anticipated. Healthwise, I am strong and very healthy. My resting heart rate is between 50 - 60.

    I had absolutely no incontinence 30 days after surgery...

    Hearing from this forum helps :-)
    I am a bit older than you (73 next month) but can tell you that at this point, 22-months post-RALP, my life is unaffected by the procedure. I began hard bicycle riding four months post surgery and serious pickleball six-months after the surgery. I now play hard pickleball with a bunch of much younger guys for 3-hours a day six days a week. And, I ride my bicycle 20-miles several times a week.

    I have very minor urinary leakage when stressing my abdomen or after two beers late at night. Other than that - no adverse side effects of any kind.

    I seldom think about my recurrent PCa and just assume that sometime in the future I will need to take the last step and do a 39-day course of RT to finish off whatever small amount of cancer is still lurking.

    The rising PSA issue is just something that you learn to deal with and now that I understand the infrequency of side effects with Image Guided RT I can easily put the future decision out into the future where it belongs.

    I also did a post-RP Decipher test and received relatively positive genomic information about my PCa. It was reassuring to be told there is a 4% chance of metastasis within 5-years and less than a 5% chance of PCa specific death in 10-years based on my particular PCa genomics.

    Asking questions here is a great way to help yourself learn to deal with your ongoing PCa so ask away.
    __________________
    DOB: July 1947
    RALP 8/23/18 pT3a, G7 (3+4), 20% involvement, SM+ (Focal 2mm G6), EPE(Focal G6)+, PNI+, LNI-, SVI-, LVI-
    7g Tumor 20x size in MRI & biopsy report & in BOTH lobes not just L as biopsy reported
    Decipher RP = 0.47, which is .01 above a LOW risk

    Post-RP PSA
    10/3/18 0.021 01/4/19 0.018 04/03/19 0.022 06/26/19 0.028 10/1/19 0.035 3/14/20 0.050 4/16/20 0.055 7/8/20 0.060

     
    Reply With Quote
    Old 06-19-2020, 01:24 PM   #13
    stephenwilliam
    Junior Member
    (male)
     
    Join Date: Dec 2019
    Posts: 11
    stephenwilliam HB User
    Re: Post Radical Prostatectomy

    Thank you Sailor. You don't sound old or tired... I appreciate your detailed response and personal background. That helps. I also bike daily and jog 7 kilometres as well as lift weights and swim... and have resumed fully without any noticeable change.

     
    Reply With Quote
    Old 06-27-2020, 08:05 AM   #14
    JustBrandon
    Newbie
     
    Join Date: Jan 2020
    Posts: 7
    JustBrandon HB User
    Re: Post Radical Prostatectomy

    Well given that you had extracapsular extension and 2 nodes positive that probably explains the .25 PSA post op. Your imaging studies have not detected distant metastases in other parts of your body, so that's a good thing.

    Most likely scenario is there is some residual prostate cancer around the area where the prostate was, and that is probably causing the PSA to be detectable after surgery. You will probably need to consult with medical oncology and radiation oncology to determine your best course of action. You might be looking at hormonal therapy alone, radiation therapy alone, or a combination of both.

    The fact you seem to lack distant metastases means it's still very much curable and treatable. It's not the best situation obviously, as anyone wants all the cancer to be gone after surgery. But it is still a situation that can be managed and treated successfully.

     
    Reply With Quote
    The Following User Says Thank You to JustBrandon For This Useful Post:
    stephenwilliam (06-29-2020)
    Reply Reply




    Thread Tools Search this Thread
    Search this Thread:

    Advanced Search

    Posting Rules
    You may not post new threads
    You may not post replies
    You may not post attachments
    You may not edit your posts

    BB code is On
    Smilies are On
    [IMG] code is Off
    HTML code is Off
    Trackbacks are Off
    Pingbacks are Off
    Refbacks are Off




    Sign Up Today!

    Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation!

    I want my free account

    All times are GMT -7. The time now is 10:50 PM.





    © 2020 MH Sub I, LLC dba Internet Brands. All rights reserved.
    Do not copy or redistribute in any form!