thoughts on what I should do.

Posted by z1k @z1k, 2 days ago

48 years old , So How screwed am I. Dr. gave me two options radiation pellets or a Prostatectomy. Pet scan is next week. right now its panic and wait. was told if I did radiation then surgery was not an option after the fact as no dr would remove the prostate after I had received radiation first. but If I removed the Prostate and the cancer came back then I could get radiation afterword's.

SPECIMEN C: PROSTATE, LABELED AS "RIGHT APEX", CORE BIOPSY:
- ACINAR ADENOCARCINOMA, GRADE GROUP 3 (GLEASON SCORE 4+3=7)
- PERCENTAGE OF GLEASON PATTERN 4: 71-80%
- CRIBRIFORM GLANDS: NOT IDENTIFIED
- NUMBER OF POSITIVE CORES: 2 OF 2
- TOTAL CORE LENGTH INVOLVED: < 5%, 6-10%
- PIN4 MULTIPLEX IMMUNOHISTOCHEMICAL STAIN SHOWS THE ABSENCE OF BASAL
CELLS (p63 AND 34betaE12) AND IS POSITIVE FOR AMACR STAINING WITHIN
GLANDS OF INTEREST
- SEE COMMENT
Comment: The Gleason grade 4 tumor shows some nuclear stratification and
tufting suggestive of ductal features; however, the quantity of tumor
present precludes a more definitive diagnosis of ductal carcinoma.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

@heavyphil

I honestly don’t think a surgeon can “see” cancer in a lymph node or not- which is why most of the centers of excellence recommend removing at least six on each side.
Imagine them on a string running from your prostate and down toward the pelvis.
The pathologist examines them sequentially, first to last; if he sees cancer microscopically in the first, he then looks for it in the second and then down the line and so on until he hopefully finds none. If he does find cells then you are usually put on ADT and offered salvage therapy or surveillance.
Not removing a larger number of lymph glands is controversial. My surgeon, for instance, only removed the closest one to the gland ( I believe it was called the “bullseye node” in the path report) and I learned later that he was sued by some patients for doing just that.
Man, was I pissed!! But after going on various forums I discovered that a lot of surgeons do this for one reason or another.
I don’t agree with it or like it, but I am not a cancer surgeon so who am I to say?

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When I say "see", he did say that my lymph nodes were analyzed and no cancer was found, it was done in real-time as the surgery occurs, by a pathologist that attends the surgery. I can even see the detailed surgical bill where each of his tests had a line item.

My surgeon did indicate that it is his usual practice to remove all lymph nodes but the analysis indicated that was unnecessary and not done because that can lead to lymphedema.

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@survivor5280

When I say "see", he did say that my lymph nodes were analyzed and no cancer was found, it was done in real-time as the surgery occurs, by a pathologist that attends the surgery. I can even see the detailed surgical bill where each of his tests had a line item.

My surgeon did indicate that it is his usual practice to remove all lymph nodes but the analysis indicated that was unnecessary and not done because that can lead to lymphedema.

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I’m curious about how a pathologist can analyze a lymph node without it being removed first. I’d like to understand this process. Is it done by needle biopsy or similar?

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@ctl498

I’m curious about how a pathologist can analyze a lymph node without it being removed first. I’d like to understand this process. Is it done by needle biopsy or similar?

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Hey ctl, as in my case, he probably took out the first “bullseye” node, and finding it clear, made the call that if IT was clear, the others further down had to be.
I certainly understand the logic behind it and perhaps the custom of removing so many nodes is a throwback to an earlier protocol🤞

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@trusam1

Comment on DaVinci vs "by hand" ("open") prostatectomy. I'm a retired surgeon (not a urologist). Towards the end of my career, DaVinci robot became available @ my hospital. One of my younger colleagues jumped right in and trained on it. I did not, worrying that I might not have enough time left to get sufficiently skilled at it.

IMO from what I've seen and discussed with urologists, there's no question that the robot allows much more precision at the fine dissection needed to "tease" the nerves away from the prostate capsule. It takes longer, and requires the development of skill in technique. But if you can find a doc who's done at least 500 cases, you're better off with the robot.

That takes me to the risk of side effect of erectile dysfunction after surgery...a real problem for some men. Especially someone who has maybe 40 years of potential active sex life ahead of him.

There are many scare stories of ED, it does happen but I believe that it is much more preventable than commonly thought. Rather than go into a long discussion of how to manage that, I suggest searching on this forum and Google for penile rehabilitation after prostatectomy. Following a daily, multifaceted training program, I returned to full sexual function about 7 months after surgery @ age 74.

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How did you get back to sexual function in 7 month, boy am I jealous I’m 6 months out from surgery and finish radiation tomorrow. Then one more hormone shot so that’s another 3 months or more before I should try the different options. Are pills alone working or are you using jel or injection, thanks for giving the rest of us some hope , my oncologist told me my sex days are over but my surgeon disagrees, not fond of my oncologist as you can imagine

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