Post Robotic Prostate Removal: My Husband

Posted by cgonsalves @cgonsalves, Jun 18 9:19am

My husband is 65 years old and had robotic prostate removal at MSK in Manhattan on 6/9. He is doing well. We received results and are going to see Nurse Practitioner tomorrow, his surgeon is away. From Original MRI: * Prostate size: 6.9 x 7.3 x 5.8 cm (History of Large Prostate)
* Prostate volume: 146 cc
* Membranous urethral length: 1.9 cm
* PI-RADS v2.1 Score: 5
* Size: 1.7 x 0.9 cm
* Location: Left, anterior and posterior, mid-gland to apex, peripheral zone
* Extracapsular extension: Probably present
* Seminal vesicle invasion: None.
* Adjacent organ invasion: None.
Lymph nodes looked clear etc.

High Decipher: 0.86 Gleason Score 3+4

After Surgery Results today: Final Diagnosis
View trends
1. Pelvic lymph nodes; Right; Excision/Resection:
Benign lymph nodes
Number of lymph nodes examined: 11

2. Pelvic lymph nodes; Left; Excision/Resection:
Benign lymph nodes
Number of lymph nodes examined: 9

3. Periprostatic fat; Excision/Resection:
Benign fibroadipose tissue

4. Bladder neck; Posterior; Excision/Resection:
Benign fibromuscular tissue, no prostatic glands seen

5. Bladder neck; Anterior; Excision/Resection:
Benign fibromuscular tissue, no prostatic glands seen

6. Neurovascular bundle; Left; Excision/Resection:
Benign fibrovascular and adipose tissue and nerves, no prostatic glands seen

7. Prostate and Seminal Vesicles; Excision/Resection:
Prostatic adenocarcinoma, Grade group 2 (Gleason score 3+4=7), pT3aN0

Procedure: Radical prostatectomy

TUMOR

Histologic Type: Acinar adenocarcinoma, conventional (usual)

Histologic Grade:

Grade: Grade group 2 (Gleason Score 3 + 4 = 7)

Percentage of Pattern 4: 10 %

Intraductal Carcinoma (IDC): Not identified

Cribriform Glands: Not identified

Treatment Effect: No known presurgical therapy

TUMOR QUANTITATION:

Estimated Percentage of Prostate Involved by Tumor: 11 - 20%

Location of Dominant Nodule: Left anterior, apex to mid

Extraprostatic Extension (EPE): Present, nonfocal

Location of Extraprostatic Extension: Left anterior

Urinary Bladder Neck Invasion: Not identified

Seminal Vesicle Invasion: Not identified

Lymphatic and / or Vascular Invasion: Not Identified

Perineural Invasion: Present

MARGINS

Margin Status: Invasive carcinoma present at margin

Linear Length of Margin(s) Involved by Carcinoma: Less than 3 mm (limited)

Margin(s) Involved by Invasive Carcinoma: Left apical

Margin(s) Involved by Invasive Carcinoma: Left anterior

Margin Comment: Supported by CK-PAN immunostain

REGIONAL LYMPH NODES

Regional Lymph Node Status:

: All regional lymph nodes negative for tumor

Number of Lymph Nodes Examined: 20

pTNM CLASSIFICATION (AJCC 8th Edition)

Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the time the report is issued. As per the AJCC (Chapter 1, 8th Ed.) it is the managing physician's responsibility to establish the final pathologic stage based upon all pertinent information, including but potentially not limited to this pathology report.

pT Category: pT3a

pN Category: pN0

ADDITIONAL FINDINGS

Additional Findings: High-grade prostatic intraepithelial neoplasia (PIN)

Additional Findings: Nodular prostatic hyperplasia
Intraoperative Consultation
View trends
4. Bladder; posterior bladder neck
Benign fibromuscular tissue, no prostatic glands seen

Intraoperative consultation reported to, read back and acknowledged by Dr. Spaliviero on 06/09/26 at 10:35 AM by Sarah Chiang, MD.

Note: The diagnoses given in this section pertain only to the tissue sample examined at the time of the intraoperative consultation.

5. Bladder; anterior bladder neck
Benign fibromuscular tissue, no prostatic glands seen

Intraoperative consultation reported to, read back and acknowledged by Dr. Spaliviero on 06/09/26 at 10:36 AM by Sarah Chiang, MD.

Note: The diagnoses given in this section pertain only to the tissue sample examined at the time of the intraoperative consultation.

6. Pelvis; left neurovascular bundle
Benign fibrovascular tissue, no prostatic glands seen

Intraoperative consultation reported to, read back and acknowledged by Dr. Spaliviero on 06/09/26 at 11:55 AM by Sarah Chiang, MD.

Note: The diagnoses given in this section pertain only to the tissue sample examined at the time of the intraoperative consultation.

Gross Description
View trends
1. Pelvis; right pelvic lymph nodes
The specimen is received fresh, labeled "Right pelvic lymph nodes", and consists of a portion of yellow lobulated adipose tissue measuring 6.0 x 3.0 x 1.5 cm which is dissected to reveal 9 tan-pink, fatty lymph nodes, ranging from 0.5 to 2.4 cm in greatest dimension. The specimen is entirely submitted.

Summary of sections:
LN – whole lymph nodes (7 nodes)
BLN – bisected lymph node
TLN – trisected lymph node
RT – remaining tissue

Allison Michelle Owens, PA

2. Pelvis; left pelvic lymph nodes
The specimen is received fresh, labeled "Left pelvic lymph nodes", and consists of a portion of yellow lobulated adipose tissue measuring 6.0 x 4.5 x 1.0 cm which is dissected to reveal 7 tan-pink, fatty lymph nodes, ranging from 0.4 to 5.0 cm in greatest dimension. The specimen is entirely submitted.

Summary of sections:
LN – whole lymph nodes (4 nodes)
BLN – bisected lymph node
SLN - sectioned lymph node
RT – remaining tissue

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Colleen Young, Connect Director | @colleenyoung | 2 days ago

@cgonsalves, how did the follow-up appointment go? What is next step for your husband?

cgonsalves | @cgonsalves | 2 days ago

In reply to @colleenyoung "@cgonsalves, how did the follow-up appointment go? What is next step for your husband?" + (show)

@colleenyoung The follow-up appointment went well and we have appointment for the first PSA test on 7/20. Thank you.

dhasper | @dhasper | 2 days ago

In reply to @cgonsalves "@colleenyoung The follow-up appointment went well and we have appointment for the first PSA test on..." + (show)

@cgonsalves What input did you get on the positive margin?

cgonsalves | @cgonsalves | 1 day ago

In reply to @dhasper "@cgonsalves What input did you get on the positive margin?" + (show)

@dhasper The doctor was away when results came in but called from Europe. He said that we will do the PSA 7/20, but from his point of view, historically, he feels positive feels the margin is very limited and that frozen samples sent out during surgery were clear and all 20 lymph nodes etc. clear, but we have to see what test brings. Just waiting and hoping at this point. I understand it will always be this way. I have been down this road before unfortunately, my daughter was diagnosed at 24 years with melanoma, which spread to her lymph node. She was also cared for at Sloan and because of her age we agreed to do watch and wait, Brain scans all kinds of test for 7 years every couple of months. Just reached the point tests once a year. Thankfully she has been cancer free. We can only hope and pray....

retireddoc | @retireddoc | 1 day ago

Wonderful news about your daughter! Of course, hope all stays well.

I was diagnosed at age 68 with G8. Unfortunately, I had seminal vesicle invasion and ultimately very limited metastatic disease (termed oligo metastatic-3 or less metastatic lesions). I was treated aggressively at Johns Hopkins and Emory 3-4 years ago and I am doing well. The treatment options available today are effective and increasing yearly.

Although it is hard to be diagnosed with any type of cancer it sounds as like your husband is in a good place. Reasonably favorable G score, no extensive local spread, node negative., no known mets. A lot to be thankful for. I would assume your physician will discuss the option of prophylactic radiation therapy with / without short term ADT therapy. If the PSA is undetectable and remains that way he might avoid this treatment.

I am not trying to get too personal regarding your husband's situation but there are a few issues that were not discussed in detail with me and I wanted to briefly share:

Incontinence. Virtually all men experience some incontinence, at least initially. Most regain full continence, especially those younger. If your husband is experiencing this problem my urologist suggested a book which I found invaluable in regaining continence- "Life after Prostatectomy ..." by Vanita Gaglani. Wonderful, well written book by very experienced pelvic floor PT. Available on Amazon. Spoiler: regaining continence involves a lot more than just kegels.

Erectile dysfunction. Very personal. It became an issue with me and my marriage. Not talked about much. If a man becomes impotent post surgery there are steps that can be taken to ameliorate the side effects. Too much to go into. Glad to elaborate if requested / needed. A website that discusses this issue in detail (actual men going through various problems related to ED ) is Franktalk.org

Good luck to you and your husband (daughter too)!

cgonsalves | @cgonsalves | 1 day ago

In reply to @retireddoc "Wonderful news about your daughter! Of course, hope all stays well. I was diagnosed at age..." + (show)

@retireddoc

Wonderful news about your daughter! Of course, hope all stays well.

I am not trying to get too personal regarding your husband's situation but there are a few issues that were not discussed in detail with me and I wanted to briefly share:

Good luck to you and your husband (daughter too)!

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@retireddoc Thank you. he is a little over 3 weeks post op. He has minor stress leaks, so that's pretty good from what I hear. At this point they just put him on Cealis 5 mg I believe and a challange dose 20 mg on day 7. Just did the day 7 dose. I appreciate your suggestion and will absolutely pass it on to him. I suppose time will tell...Thank you.