Pathology report is in post RALP; waiting 90 days for PSA test normal?

@clevelandguy
"It seems kinda odd that both the MRI and PET scans were negative."
Huh? OP's surgical pathology shows no EPE, no SVI, no BNI, no lymph node involvement. There's nothing in that report that would show on an MRI or PSMA PET. The LVI would not show up on either, and the positive margins are an artifact of surgery and not something that pre-surgical imaging would show or predict. The pathology fully validates why both the MRI and PET were negative.

Not only was there nothing unusual about the decision to recommend surgery for OP, but there's also no grounds yet to say there's been extra-prostatic spread. Neither positive margins nor LVI guarantee spread.

You've now written that "the pathology report showed that his cancer had spread outside of his Prostate and into his lymph glands" and that is 100% false. The report does not show any such thing.

"Didn’t know we needed a PHD to comment on this forum."
Nobody said that. But would you agree that spreading misinformation or incorrectly interpreting someone else's medical records is bad?

I apologize for the unnecessary "peanut gallery" comment. But when someone has already had surgery, what does saying "I'm surprised you had surgery?" accomplish besides making that person feel lousy about their decision? And in this case the statement doesn't even make sense given OP's excellent pre-surgery profile.

"I really don’t care what you think"
Noted.

@notpetecrowarmstrong
Am I reading this wrong from his post surgical finding” Lymphatic and / or Vascular Invasion:
Present
Perineural Invasion:
Present”. That means to me there was cancer in lymphatic and or vascular invasion and more cancer intertwined within his nerve bundles on the Prostate. The I”m surprised you had surgery comment was not making him feel bad but just stating my opinion. I’m not spreading false information or incorrectly interpreting his medical records. I’m commenting on them, if you don’t know the difference that’s your problem. I’m very surprised that nothing showed up on the scans he had, especially with the lymphatic issue. But how medical finding are analyzed by trained professionals differ from doctor to doctor/ hospital to hospital.

Dave3+4

@clevelandguy
In this particular query, no one has said they had an MRI or a PET scan.

Are you responding to something besides what the original person at the top was talking about?

It’s like somebody forgot to reply to someone else and just responded to the original message in this message stream.

I don’t see any follow up message by @thig350, So everything people are talking about just doesn’t seem to make a lot of sense. Is somebody answering a message in another message thread without bringing up that specific information?

Very confusing.

Yeah I think you need to read thig 350 original message at the top of this thread. Thig did say” Note: Pre surgery MRI and PET scan did not show spread.”. Thig wanted to know if he should wait 3 months for a followup PSA test. A lot of opinions by myself and notpetcrowarmstrong on his post surgical report. To summarize I stated to get another PSA test in 2-3 months which is kind of normal after surgery. Thig seemed concerned he needed one sooner. The rest of the several posts were me and notpetcrowarmstrong word smithing each other.

Dave 3+4

@clevelandguy

I understand why there's confusion, and you're far from the only person to read those terms in that way, but no, neither lymphovascular invasion nor preineural invasion mean spread was seen *outside* the prostate.

Those are both findings *inside* the prostate tissue that was examined after surgery. Lymphovascular invasion means that cancer cells were observed inside blood vessels or lymphatic channels within the removed prostate tissue. Perineural invasion means that cancer cells were seen inside or along nerve fibers within the prostate.

Neither of those findings indicates that cancer was actually seen outside the prostate, and neither is a guarantee that cancer has escaped the prostate. Both increase the risk of future recurrence, but do not provide evidence of spread having already occurred.

Nothing else in the OP's pathology report indicates spread outside the prostate. The fact that lymph nodes were negative and he was staged as T2 is good news. He has multiple risk factors that raise the odds of recurrence, but he's got a real shot still at escaping further treatment. I'm sure we all wish him good luck in that regard.

I know you mean well and I'm sorry again for getting testy. I reacted too sharply because I didn't want OP mistakenly thinking his report shows that his cancer has already spread.

You seem to be the one playing doctor/oncologist team and predicting his future. It’s not a good thing to find cancerous cells leading to the lymph nodes. Did you talk to the people who generated the reports, I doubt it. Do you know what his outlook is, I doubt it. You don’t know anything about this case other than what he wrote so you and I can just guess what is really is going on. So all the above stuff you said is just speculation. I wish him the best, but as I said and you don’t seem to get is we are both just commenting and not acting as his doctor team. I see no further reason to discuss this as we will never agree.
Dave 3+4

@clevelandguy

What a disappointing response. I held out the olive branch and you write this nonsense.

You wrote "I know the pathology report showed that his cancer had spread outside of his Prostate and into his lymph glands." His report does not show that. That's not a matter of opinion. The terms used in the report have standard meanings and I've explained what they mean. That's not playing doctor, that's just reading comprehension. One minute of research or one minute asking your doctor would confirm it, but instead you've doubled-down on your incorrect assertion.

None of us can know if his cancer may have spread microscopically outside the prostate without yet being detected. But the report definitely does not say or confirm that it has. There are no present signs of *detectable* spread outside the prostate. You're wrong for telling OP otherwise, and that's the only dangerous comment being made in this thread.

@clevelandguy
Oops. I searched for PSMA and didn’t find it. Should’ve searched for MRI and pet. Will do that next time.

Thanks

There's a PSA "half life" of like 4 days (check that ?) So depending on what your PSA was before surgery it can take that long to drop to undetectable,

@adoptedtomato

Every 3 days, cording to my husband's RO