pT3b Prostate Cancer - where are you now post-op?

I was T1C at my initial biopsy (3+4, 6/12 cores, Decipher 0.56) in January, then pT3b after RARP at the Cleveland Clinic on June 18th (3+4, surgical margins and 15 lymph nodes all negative, EPE, SVI, large cribriform, suspicion of IDC).

My first post-op PSA test is scheduled for 9/22. The surgeon's office has been adamant that I don't need to do anything if PSA is undetectable (or below 0.2) but I've requested an appointment with a local RO and, based on several recent threads on this site, will once again request an appointment with an RO at CC. I seem to be on the borderline between adjuvant vs. early salvage radiation.

Thanks for the reply. You remind of something confusing in my surgical pathology report: It said:
1) Histological Grade 2 (Gleason 3+4 = 7). That was in agreement with the biopsy four months prior.
2) Tumor "involving" left seminal vesicle (my " " quotation marks). A couple sentences later however, it says...
3) Left seminal vesicle "invasion" (a little more serious sounding). But then...
4) Serial sectioning of vas deferens and seminal vesicles reveals "no distinct mass lesions or nodules" (my " " quotation marks). And...
5) Linear length of Surgical Margins >3mm and Gleason Pattern at margin involved with carcinoma = 3.
So my confusion is obvious. In two areas it says that my left seminal vesicle is "involved" and has been "invaded," thus the pT3b category, yet a few sentences later it says "no distinct mass lesions or nodules" in the left seminal vesicle. That implies to me that the left seminal vesicle is barely involved...likely at the microscopic cellular level, but not present enough to have formed a mass lesion or nodule. And the good news being that the Gleason cellularity was only a "3."
I have a clinical background having spent 40 years in the hospital, clinical environment. I can discern clinical information well, but this report leaves me baffled. It is like they "must" report the seminal vesicle invasion because it was seen, but they also tell me it was only a Gleason level 3 cellularity (the minimum for it to be called "cancer"), and go on to say there are no lesions or nodules. In my experience, a "lesion" is the presence of pathological tissue of concern, yet the surgical pathology report seems to want to try to minimize the description of that seminal vesicle invasion. I guess the clear line of demarcation in writing a surgical pathology report, is that "seminal vesicle invasion of any sort must be reported as a "pT3b", but the pathologist can back off that category by minimizing the seriousness, saying it was (only) Gleason 3 cellularity and there were no lesions or nodules. Massively confusing to me. Any physicians out there that want to weigh-in on this?

What knowledge do you have of the BAT treatment?

As well as, PTEN, and both generic variations of TP53, therapies?

Proton therapy vs photon?

Have you had any blood transfusions for your anemia?

Would love to hear your thoughts on these...

You probably know that BAT treatment is designed to allow your body to work correctly with an ARSI after it has failed. In my case since I have BRCA2, I am not a candidate for BAT.

They essentially stop treatment and give you testosterone injections, which in some cases can result in your ability to have those drugs work again.

PTEN and TP53 are genetic problems. BRCA2 is a genetic problem, but there is actually a drug (PARP inhibitor) that works with BRCA but is not really a treatment for any other genetic issues. If you have PTEN or TP53 it is resistant to Pluvicto a Oh my God,nd does not work well with it. There really is no treatment for those two genetic issues.

Proton radiation is much more controlled and only affects the tissue it is directed at. It has been extremely difficult to build proton radiation machines, in the past, it required whole buildings to be built to fit it. They have recently reduced the construction needs down to one or two rooms, so it will be much more commonly used as the cost comes down. It will probably replace photon radiation in the future. Photon radiation, of course has a wider spread and affects more tissue, While the incident of cancers caused by, it are quite low there is a risk.

While my red blood cell count and hemoglobin have been a lot below the minimum I have not felt any effects of anemia at all, and as a result I have not had any blood transfusions.

Yes, I suspect that several of us are members of the Jeff Marchi fan club!
His nearly-constant presence here, with his calm, informed voice, is such a balm for us.

Hi Jeff, I guess you are one of the few who don't use a pseudonym in this forum. And so I found the podcast with you https://connect.mayoclinic.org/discussion/pt3b-prostate-cancer-where-are-you-now-post-op/?pg=2 as the featured speaker. I second @tuckerp 's commdent: "I think your advice and knowledge has been marvelous."

pT3aN0Mx

G 9 w/ EPE
1st 90 day post-op PSA .19 (persistent PSA).

Prompt Salvage Radiation Treatment:
IMRT 37 txs (WPRT) 66.6 gy total prostate region; 25 of the txs included pelvic lymph nodes 45 gy

Difficult radiation proctitis last 4 wks of radiation
Short term ADT

No residual effects from radiation (routine colonoscopy; no radiation damage)

2+ yrs post Salvage Treatment; all uPSA tests have been undetectable < .02

In my opinion, you are fortunate to have undetectable PSA postop.

If, and when, your PSA becomes detectable, and a PSMA Pet does not identify any specific lesions elsewhere, Salvage Radiation Treatment is the next step.

The low dose per session/many sessions would be my choice vs fewer sessions and higher doses of radiation.

Short term ADT (SPORRT trial). Or no ADT, seems to be a developing trend.

What I believe that I have learned is that we are all the same; and all different.

There is no precision in prediction.

Either you receive SRT as quasi-adjuvant therapy currently or when/if PSA becomes detectable.

For me, I know that I have PCa and that it is highly probable that I will have recurrence in LESS than 10 yrs. Every uPSA test is worrisome. And that's the way it is.

Does not make it easier to accept. I have 2 friends who also are undetectable 2 yrs post tx following SRT at the same time as me (and no, I do not know all of their numbers).

A cancer diagnosis is a challenge to accept and live with peacefully, and I hope for all of us to be able to find that place of acceptence of our disease, and turn our energy toward recovery and disease management, including the mental aspect.

Best wishes to you and to all of us.

I too am pT3b n1 r1,
My PSA was 9.4 six weeks after surgery so got radiation and lupron pretty quickly and am now “undetectable” a year later. Good luck in your journey.

Thanks for the positive comments. Really appreciate it.

Brettiqutte - thanks for your reply. What may I ask is "n1" and "r1"? I have not seen that terminology with or without relation to the pT3b status. Nice to hear you are undetectable one year later, especially after a 9.4 ng/ml PSA six weeks post-op. Have you recovered full urinary continence and sexual function one year later, or still a battle?
Thank you.