Pathology interpretation help!

@johnnyz If decipher comes back high in my case and I choose surgery with indeterminate EPE, I might be facing a future with radiation and ADT and potentially major nerve sparing problems, ED and positive margins. But with radiation and a high decipher I would be facing ADT now but my indeterminate EPE might be addressed better without impacting nerve bundles. A lot of calculus!

@ezupcic yes there is lots to ponder and it is hard to move towards a decision. I have often swayed back and forth between radiation and surgery because of the simplicity of SBRT. They do say though that impacts from both become similar after a few years. So not hitting the nerves badly during RT seems like a good thing as they will not initially be impacted, but will diminish over time. The other part is possible need to get up and pee a few times during the night. Since you are 63, you have more time to recover and may be a good candidate for surgery. That said, it all depends how your follow-up meeting goes. I found it helpful to start a log in with ChatGPT where that AI archives your chats for recurring conversations. It all helps to provide context and lists of questions for you to ask the RO and surgeon. AI has become a companion which can accurately interpret your data. That said, your doctors know best. I like AI as it helps me to know that I am not leaving out questions that I forgot to ask. I recommend to not use google AI as those conversations are not archived, so you can’t have ongoing chats where the AI has your precious information.

I forgot to mention that I have 2 tumours; 1.0 and 1.9, bilateral with overall cancer of <10%. My surgeon says that he will do what he calls a high lift procedure with the nerves as he prepares to remove the prostate. I am hoping that this approach will assist in minimizing nerve damage. I was also hoping to hear some feedback regarding diets that minimize bladder irritation that in turn helps with leakage. Eg; can you still have coffee, or wine? Is there anything else that we commonly drink/eat that causes more leakage?

@johnnyz If it's true that statistically cancer control outcomes are statistically the same with either Radiation or Surgery , it does come down to side effects a person wants to manage and when. I'm definitely worried about nerve damage but also how I'll do on ADT. I exercise, try to eat healthy, feel great otherwise but who knows how I'll react to ADT if its recommended. I currently take tamsulosin, enjoy the occasional beer and glass of wine, coffee and have no issues (other than cancer) even with an enlarged prostate and some BPH/Prostatitis.

Yes I love the same drinks too. I ha read several stories where post surgery people have stopped pretty much any consumption of coffee, alcohol and bubbly drinks due to how they irritate the bladder causing more leakage. I am good to trade off alcohol as it is not healthy for us anyway ( won’t be easy though to stop). In the end, I want to do all I can to minimize or resolve post treatment impacts. Regarding ADT - I was pleased when my RO said he did not feel as though I needed it with the ADT. When I asked if it had any chance to help ensure the cancer does not grow or spread, he said, if you want some I am happy to prescribe some to you. Also, when I asked if I got recurrence down the road after SBRT, he said his plan was to give me Brachytherapy with ADT… The younger one is, the more they suggest surgery, and the older (past 70) then they push radiation. These are general statements since it really depends on pathology, if contained with in the prostate shell without EPE. And margins - even if the cancer is contained but close to the prostate shell or “ink” as they call it, then the margins are more positive. My surgeon says he thinks he may have to considered some positive margins in my bilateral case.

@johnnyz I also have bilateral disease and tumors near the capsule border but indeterminate EPE. With positive margins potentially does that mean they would start radiation and possibly ADT post surgery?

@ezupcic
Don’t know if your surgeon has the ability to have the tissue immediately inked by pathology during surgery so if there was positive margin he could continue getting more margin cut. That happened with me while in Surgery and my final pathology margin was negative. This is a reason for real time pathology as they only get the one shot and mine would have been positive if not for that.

Yes I love the same drinks too. I ha read several stories where post surgery people have stopped pretty much any consumption of coffee, alcohol and bubbly drinks due to how they irritate the bladder causing more leakage. I am good to trade off alcohol as it is not healthy for us anyway ( won’t be easy though to stop). In the end, I want to do all I can to minimize or resolve post treatment impacts. Regarding ADT - I was pleased when my RO said he did not feel as though I needed it with the ADT. When I asked if it had any chance to help ensure the cancer does not grow or spread, he said, if you want some I am happy to prescribe some to you. Also, when I asked if I got recurrence down the road after SBRT, he said his plan was to give me Brachytherapy with ADT… The younger one is, the more they suggest surgery, and the older (past 70) then they push radiation. These are general statements since it really depends on pathology, if contained with in the prostate shell without EPE. And margins - even if the cancer is contained but close to the prostate shell or “ink” as they call it, then the margins are more positive. My surgeon says he thinks he may have to considered some positive margins in my bilateral case.