RARP Pathology report questions

Thyroid cancer is not uncommon. They just remove the thyroid and put you on a pill every day that replaces its function. This is pretty common, so don’t sweat it.

Urinary Bladder Neck Invasion Shows signs that the PSA Reoccurrence is more frequent.

Having intraductal means that while you do have a seven gleason your cancer is actually more aggressive than that. Recent seminar, I went to says that if you have intraductal you almost always have cribriform.

They point out that “Greatest Dimension of Dominant Nodule: 18 mm Extraprostatic Extension”. This means that the cancer has gotten out of the prostate, and that your chance of reoccurrence is much higher because of it. EPE is a significant predictor of recurrence and metastasis, and is an important factor in prostate cancer staging.

The report does say only one lymph node had cancer so that’s why they only removed one.

While this doesn’t sound real great. Your chance of surviving for many years is really great because of the drugs and treatments that are available.

Have they put you on ADT? This sounds like a case where you should be on ADT and maybe another drug to prevent your cancer from coming back.

Hi Jeff,

thanks very Much for your response and insight, its clear you have a good understanding of this disease and follow the medical advances.

There were a total of 19 lymph nodes removed I guess I should have included more of the pathology report for clarity, here it is. It references invasive carcinoma at the margin which seems to go along with the Metastic Prostate Carcinoma found in the one lymph node.

Our follow up appointment is on Feb 24 where presumably we will discuss ADT as well as radiation, we had discussed going on hormone therapy prior to surgery but only had about two weeks prior to surgery so decided to deal with the surgery first then look at the next steps. They did tell us that the normal follow up after surgery is three months later but because the cancer is more aggressive we are having it after two months. My understanding is that radiation generally needs to wait between four and six months post surgery to give area time to heal properly but the hormone therapy can be started anytime, not sure if I have that right or not or what others experience has been on how long they waited to do these other treatments after the surgery.

Thanks again for your thoughtful response it is very much appreciated, have a great rest of your weekend!

Margin Status
Invasive carcinoma present at margin
Linear length of margin(s) involved: Three foci, less than 1 mm each Margin(s) involved: Left posterior
REGIONAL LYMPH NODES
Regional Lymph Nodes Status Regional Lymph Nodes Present
Tumor Present in Regional Lymph Node(s) Number of Lymph Nodes with Tumor: 1 Number of Lymph Nodes Examined: 19
DISTANT METASTASIS
Distant Metastasis. Distant Site(s) Involved: Not applicable
pTNM Classification (AJCC, 8th edition)
Modified Classification: Not applicable
pT Category: pT3a: Extraprostatic extension or microscopic invasion of bladder neck
T Suffix: Not applicable
pN Category: pN1: Metastasis in regional nodes
pM Category: Not applicable - pM cannot be determined from the submitted specimen(s)
Representative Tumor Block: C10, C16, C18
Comment: Select slides seen in consultation with Dr. Jordan Reynolds.
The synoptic report incorporates information from all relevant surgical material and includes all required data elements of the current CAP Cancer Protocol.

Hey Albcan, jeffmarc gave you some pretty good advice there; and while your case is a bit more aggressive, it IS totally treatable from here on out as a chronic illness; no “one and done” but neither is diabetes, HBP, heart disease and many others which we all carry to the end.
Yes, you do have to heal before radiation, but ADT is a miracle drug for stopping the spread and vigor of your wayward cells. Getting on it ASAP is important. Advocate for Orgovyx - if applicable to your case - since it is oral and many of the nastier side effects of ADT are mitigated. It should put your mind at ease knowing that while you heal your cancer is being dealt with. Best
Phil

Your 90 day (or 60 day) PSA will tell the story and direct next step options.
Surgery Aug 2022. My 1st PSA was 90 days postop and .19 (retested 30 days later at .18) and called persistent PSA.
Postop pathology G 9, EPE; surgical margins, lymph nodes and seminal vesicules were clear; stage pT3aN0X0
Began Salvage Radiation Treatment to whole pelvic region together with pelvic lymph nodes and 4 mos ADT.
Began ADT in Feb 2023 and radiation in Mar; 37 IMRT txs 66.6 gy to prostate region (and 45 gy to lymph nodes).
ADT completed June 2023.
1st uPSA Nov 2023: undetectable at < .02
This may or may not be your future course. It was an unpleasant Feb - Nov, however my tx results were and have been as good as it gets, so far.
Have been doing well for last year +.
Wishing you an undetectable 1st postop PSA.

While you have not directly said it, it appears that you are prepared for having both surgery and radiation. I’ve heard of people having salvage radiation less than a month after surgery, I’m sure they can wait in your case If you get hormones after surgery, that will prevent your Cancer from growing. There would be no harm in starting hormone therapy immediately after surgery, ask your doctor, I’m sure he’s going to want you on hormones, try and get Orgovyx as previously recommended.

I had my PSA checked about seven weeks after surgery, it went from around 20 to undetectable. I’ve heard that three months is pretty much the standard however.

Even though you have a few negative things in your biopsies, You have a really good chance of living a long life as long as you follow the standard treatments. You are only a Gleason seven, that makes your cancer very treatable.

Thanks Very Much Phil,

Yes I've come to realize that this cancer isn't going away and will just become a part of life going forward and we will be dealing with it from here on out and appreciate the reference to heart disease diabetes ect and will use that as a reference point from here on out.

Thanks for the information re Orgovyx vs injections, we will discuss if that would work based on my situation and see how fast we can get that started and also find out the timeline for radiation and then research the different options pros cons ect of that, will keep you posted.

Thanks Again,

Have a Great Day!

Al

Thanks MichaelCharles,

Sounds like you had ADT about six months post surgery and radiation seven, seems like a common timeline, feb - nov 10 a month unpleasant period sounds pretty reasonable based on what we are all dealing with here, only question is when did the radiation stop ie June July just wondering if we need to be prepared for an additional X number of months to heal or feel better from the radiation side.

Glad to hear everything has been going well for the past year and wishing you many more of doing well ahead.

Thanks Again.

Al

Thanks Jeff,

Yes originally the doctors explained that the most aggresive approach would be to have the surgery first then look at the other treatments, he said that all though it was possible to do radiation first then have the surgery it was much more difficult for the surgeon because of the effects of the radiation to the region so we went ahead and did the surgery first.

We had also discussed starting hormone therapy before surgery but because it was so close time wise decided to do the surgery first and again that would make it easier for the surgeon to handle.

We will see what the PSA is and what they say at our upcoming follow up in about three weeks but assume we will be discussing getting on hormones right away and whatver else the next steps are.

Its very comforting to know there are so many treatments now and like everyone has said should be able to live normal (new normal) life going forward.

Thanks Again,

Will keep you posted...

Side effects from radiation disappeared about 2 - 3 weeks after final treatment on May 3; last Orgovyx pill June 13 (not that I was counting the days).

ADT Orgovyx 4 mos Feb 9 - June 13. Radiation 37 txs Mar 13 - May 3.

Felt pretty normal by October/November.

Best wishes.

After I had surgery, my PSA went to undetectable within less than two months. I only had a Gleason seven, So they didn’t even think about ADT. I don’t think the NCCN was recommending what they are today, back 15 years ago.

If your PSA after surgery shows up undetectable then they’ll probably put you on ADT and maybe a second drug, and wait until your PSA starts to rise before doing salvage radiation. In your case, ADT is recommend because of that high Gleason.