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

Posted by rlpostrp @rlpostrp, Aug 27 11:15am

I'd like feedback from folks who are diagnosed as a pT3b cancer, the definitive criteria being that you had cancer invade one or both seminal vesicles. Please offer the following:
1) How long ago was you RP your surgery?
2) Did you have "surgical margins" with cancerous tissue left in you?
3) How long was it after surgery that your PSA increased to 0.2 ng/ml or higher?
4) Knowing you were a pT3b, did you start radiation before or after your PSA hit 0.2 ng/ml or higher? If you started before an elevated PSA, what did your urologist say that justified to them to start radiation?
5) If diagnosed as such, how long after RP surgery did your urologist or RO tell you that your cancer has fully returned, if it did (first year post-op, second year, third year...???), since pT3b has a 30-50% recurrence within the first five years post-op?
6) Besides radiation, what else is your urologist doing to treat you?
Thank you

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Profile picture for Brettiquette
Brettiquette | @brettiquette | Aug 29 12:55pm
In reply to @rlpostrp "Brettiqutte - thanks for your reply. What may I ask is "n1" and "r1"? I have..." + (show)
Profile picture for rlpostrp @rlpostrp

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.

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Thanks for the reply, I believe they refer to the one of ten positive lymph nodes and seminal vesicle or bladder neck invasion. I regained continence 3 months after surgery but lost it final week of radiation, had it for 6 weeks lol. Had severe Ed since surgery but have used a pump to keep atrophy at bay. Also recently started using trimix injections and still finding dosages but was able to have the spicy sleep with my wife this last week so things are looking up. I’ve also noticed my incontinence has improved as well as my penis is not in hiding all day since the injections. Feel free to reach out with any questions.

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Profile picture for daveandoneita
daveandoneita | @daveandoneita | Aug 30 9:32am
In reply to @michaelcharles "pT3aN0Mx G 9 w/ EPE 1st 90 day post-op PSA .19 (persistent PSA). Prompt Salvage Radiation..." + (show)
Profile picture for michaelcharles @michaelcharles

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.

Jump to this post

been clean for 10yrs with radiation lest then .01 psa knock on wood. but my orgasm has gone.

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1 reply
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dpayton | @dpayton | Aug 30 10:10am
In reply to @jeffmarc "Thanks for the positive comments. Really appreciate it." + (show)
Profile picture for jeff Marchi @jeffmarc

Thanks for the positive comments. Really appreciate it.

Jump to this post

Everyone here loves what you have to offer. We're all very, VERY lucky to have you around and give advice on things that are difficult to wrap our heads around.

THANK YOU AGAIN!!!
Doug

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Profile picture for surftohealth88
surftohealth88 | @surftohealth88 | Sep 17 3:47pm
In reply to @michaelcharles "pT3aN0Mx G 9 w/ EPE 1st 90 day post-op PSA .19 (persistent PSA). Prompt Salvage Radiation..." + (show)
Profile picture for michaelcharles @michaelcharles

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.

Jump to this post

How long was your ADT and what were you using as ADT medication ?
Thanks so much in advance 😊

REPLY
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michaelcharles | @michaelcharles | Sep 17 5:23pm

My RO prescribed 4 mos of ADT and I chose Orgovyx.

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shalom7777777 | @shalom7777777 | Sep 17 7:32pm
In reply to @psychometric "I was T1C at my initial biopsy (3+4, 6/12 cores, Decipher 0.56) in January, then pT3b..." + (show)
Profile picture for psychometric @psychometric

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.

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Hi, thank you for sharing your story. you said "EPE, SVI, large cribriform, suspicion of IDC)." all present in post surgery pathology. Did your pre surgery biopsy also indicate these features? Thanks!

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2 replies
Profile picture for psychometric
psychometric | @psychometric | Sep 17 7:47pm
In reply to @shalom7777777 "Hi, thank you for sharing your story. you said "EPE, SVI, large cribriform, suspicion of IDC)."..." + (show)
Profile picture for shalom7777777 @shalom7777777

Hi, thank you for sharing your story. you said "EPE, SVI, large cribriform, suspicion of IDC)." all present in post surgery pathology. Did your pre surgery biopsy also indicate these features? Thanks!

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No, my original biopsy in January did not show any of those features. I have my first post-op PSA test on Monday - we'll see how it goes.

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rlpostrp | @rlpostrp | Sep 17 11:32pm

If you are asking "me" the originator of this new post, I have not had radiation or hormone or any other pharmaceutical treatment.

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rlpostrp | @rlpostrp | Sep 17 11:39pm
In reply to @shalom7777777 "Hi, thank you for sharing your story. you said "EPE, SVI, large cribriform, suspicion of IDC)."..." + (show)
Profile picture for shalom7777777 @shalom7777777

Hi, thank you for sharing your story. you said "EPE, SVI, large cribriform, suspicion of IDC)." all present in post surgery pathology. Did your pre surgery biopsy also indicate these features? Thanks!

Jump to this post

That is the limitation and fallacy of a biopsy...it can't tell your urologist anything beyond Gleason Score and perineurial invasion that nearly everyone has (my urologist wasn't concerned about it...he literally said "everyone has perineurial invasion.").
The only way you find out about all the rest of it is when they remove your prostate and do a gross- and micro-examination of all of the prostate and seminal vesicle tissue. That is when Extraprostatic Extension (EPE), seminal vesicle invasion, Cribriform glands, bladder neck involvement, surgical margins, etc., are discovered and change "everything."

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1 reply
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thmssllvn | @thmssllvn | Sep 18 9:04am

Let's not forget the value of PSMA PET CT scans in the process.

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