My Pathology Post RALP - originally PSA 135

It’s definitely better to wait to see if your PSA rises before doing anything. Since you are a Gleason seven, it could be a very long time before it comes back. You did have seminal vesicle invasion, which can be a problem, but they probably got rid of it all in surgery.

I know people with Gleason nine that went decades after surgery.

Yes, you could get adjunct radiation instead of waiting for salvage radiation but with a 4+3 it doesn’t make sense. I was a 4+3 and I’m still around after 16 years even though I have BRCA2. The treatments today work.

Here are some info on adjunct radiation in case you’re interested in what a well respected doctor has to say about it. You do have two of the risk factors, but other people in this forum have looked at this, considered this and decided to wait.

Adjunct radiation
Dr. Efstathiou concluded as follows:b
* Early salvage radiotherapy is favored over adjuvant radiotherapy in most patients
* Consider adjuvant radiotherapy in otherwise fit, motivated, very high-risk patients with ≥2 of the following risk factors:
* pT3b-4
* Gleason score 8-10
* pN+ Lymph node Metz
* Decipher score >0.6
* In high-risk patients, use lower thresholds to initiate ‘ultra-early salvage or adjuvant-plus’ radiotherapy
* If giving adjuvant radiotherapy, it implies high-risk disease. Thus, Dr. Efstathiou would recommend treating the prostate bed and pelvic lymph nodes, in addition to short-term versus long-term ADT, depending on risk factors
* May consider genomic classifiers or artificial intelligence tools to help with informed decision-making
* The goal is to avoid (or delay) radiotherapy in those who we can, without missing a window to cure patients who are guaranteed to recur

Here is a link to the article supplied by @surftohealth88 originally
https://www.urotoday.com/conference-highlights/apccc-2024/151546-apccc-2024-debate-how-to-best-manage-a-fit-patient-with-high-risk-localised-and-locally-advanced-prostate-cancer-how-to-select-patients-for-adjuvant-therapy-after-radical-prostatectomy-and-how-to-treat-them.html

It’s definitely better to wait to see if your PSA rises before doing anything. Since you are a Gleason seven, it could be a very long time before it comes back. You did have seminal vesicle invasion, which can be a problem, but they probably got rid of it all in surgery.

I know people with Gleason nine that went decades after surgery.

Yes, you could get adjunct radiation instead of waiting for salvage radiation but with a 4+3 it doesn’t make sense. I was a 4+3 and I’m still around after 16 years even though I have BRCA2. The treatments today work.

Here are some info on adjunct radiation in case you’re interested in what a well respected doctor has to say about it. You do have two of the risk factors, but other people in this forum have looked at this, considered this and decided to wait.

Adjunct radiation
Dr. Efstathiou concluded as follows:b
* Early salvage radiotherapy is favored over adjuvant radiotherapy in most patients
* Consider adjuvant radiotherapy in otherwise fit, motivated, very high-risk patients with ≥2 of the following risk factors:
* pT3b-4
* Gleason score 8-10
* pN+ Lymph node Metz
* Decipher score >0.6
* In high-risk patients, use lower thresholds to initiate ‘ultra-early salvage or adjuvant-plus’ radiotherapy
* If giving adjuvant radiotherapy, it implies high-risk disease. Thus, Dr. Efstathiou would recommend treating the prostate bed and pelvic lymph nodes, in addition to short-term versus long-term ADT, depending on risk factors
* May consider genomic classifiers or artificial intelligence tools to help with informed decision-making
* The goal is to avoid (or delay) radiotherapy in those who we can, without missing a window to cure patients who are guaranteed to recur

Here is a link to the article supplied by @surftohealth88 originally
https://www.urotoday.com/conference-highlights/apccc-2024/151546-apccc-2024-debate-how-to-best-manage-a-fit-patient-with-high-risk-localised-and-locally-advanced-prostate-cancer-how-to-select-patients-for-adjuvant-therapy-after-radical-prostatectomy-and-how-to-treat-them.html

@jeffmarc Jeff, Does the administration of ADT + lutamide lower the Gleason score when given pre-surgically?
If someone is a G8 at biopsy (with a majority of cores showing G8), is a lower Gleason score from surgical biopsy a ‘true’ Gleason score? I mean, months of ADT lower PSA so a lower Gleason score may only reflect this temporary finding.
And since Gleason is quantitative vs qualitative, aggressiveness is really not decreased …right??
All I mean is that when a Gleason is downgraded on surgical pathology, that is wonderful news; but is that downgrade the same if ADT + lutzmide was involved? Thanks,
Phil

@heavyphil
After surgery, they are able to look at the whole prostate. Dr. Epstein said, in The latest PCRI conference, 30% of the cases have a change in Gleason score 50-50 up or down.

You are correct for sure, About the fact that what you do can’t change the Gleason score. It doesn’t go down as a result of any drugs. The changes are due to being able to see more of the prostate and in some cases, I suspect, are due to getting a better pathologist. It was mentioned during the conference that you should check the expertise of the pathologist that looked at your after surgery prostate. Was that doctor a specialist in prostate cancer or were they a specialist in breasts or other cancer analysis?. That can make a big difference in what the results show.

@jeffmarc wrote "Yes, you could get adjunct radiation instead of waiting for salvage radiation"

For the benefit of others who might want to research further, the term in question is "adjuvant" radiation, not "adjunct". The distinction between adjuvant and salvage RT is primarily that adjuvant is preemptive whereas salvage waits for evidence of BCR, typically in the form of detectable and rising PSA.

@heavyphil
After surgery, they are able to look at the whole prostate. Dr. Epstein said, in The latest PCRI conference, 30% of the cases have a change in Gleason score 50-50 up or down.

You are correct for sure, About the fact that what you do can’t change the Gleason score. It doesn’t go down as a result of any drugs. The changes are due to being able to see more of the prostate and in some cases, I suspect, are due to getting a better pathologist. It was mentioned during the conference that you should check the expertise of the pathologist that looked at your after surgery prostate. Was that doctor a specialist in prostate cancer or were they a specialist in breasts or other cancer analysis?. That can make a big difference in what the results show.