Radical prostatectomy 9 days ago. Need help with the pathology PLEASE

Hi Di,
Just want to clarify, when my husband received his diagnosis, we were given a choice of radical prostatectomy or proton therapy. We opted for taking the prostate out completely and were very happy with that choice. The PSA tests were all negligible until the cancer recurred two years later, almost to the month. We then proceeded with 8 weeks of radiation.
Had we followed through with a Oncology consult right after surgery, as was our first instinct, who knows what they might have suggested? They could have opted for the "wait and watch" just like our surgeon, or decided on a round of radiation as a precaution. We'll never know. But, as I said, given a "do-over", we would run, not walk, to an oncologist for a consult! 🙂

God Bless you both!
Carla

One lymph node was tested, clear. Why were you treated?

Credi Valley Hospital Mississauga On Canada Excellent facility and oncologists and radiologists

Webinar "Rising PSA after treatment "
Prostate Cancer Foundation
Go to:
pcf.org
Top right menu
Patient Resources
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Patient Webinars
Jan 17 2023
Also, the free Patient Guide- download or hard copy - is very informative.
Best wishes for an undetectable PSA

Thank you so very much. Going to watch it!!

To summarize up front, my input is to relax, focus on recovery from the surgery, and all this will come into better focus in due time. But here's a little more detail....
Your focus now is on recovering from surgery. Learning more about the cancer is an optional adjunct. However, I understand that you want to fully understand the pathology report. I felt the same way.
Given the situation you went in with, this report is actually pretty great--from what I imagine a practitioner's perspective would be, which I am not, although I look at myself as perhaps cut from the same cloth as MD was one of the two most common career paths among my undergraduate peers.
So here is some lay reflection on what you shared from your report. 1) It does confirm your choice of RP as a good one, since the other options are not generally recommended for this stage/grade cancer. 2) It appears that the timing was good, as the cancer has (perhaps) not spread yet. 3) There is always the possibility with "intermediate unfavorable" prostate cancer that it will spread, however the survival rate in years is still way out there, and so is the likely time to biochemical recurrence (estimated by PSA levels).
One way of looking at treatment is that we will always have cancer unless we die from something else, so the question is one of timing. Right now there is no indication in what you have shared that it is time to seek further treatment. You may need those options in due time--it's usually best to enjoy life without further impairment in "quality of life" with those options still in reserve.
The reason that PSA is not tested immediately is that it takes time to settle after the surgery. You and your medical team will be looking for the nadir (low point) which might be around 6 months, not right now. In my case the first PSA was at 4 months, but it was not "ultrasensitive." The first ultrasensitive PSA [uPSA] was at 6 months. I have now had 4 uPSA's and am out about 18 months. They have been low and variable, but the most recent one at 16 months was actually undetectable. This does not mean I am not living with cancer, but it is the best possible result from that test. (Because of the grade of my cancer and also one spot of positive margins, I have been tested more frequently early on.)
For comparison, my pathology grading was quite similar, although I had more nodules of concern.
So, lets set aside the pathology, which your MD will go over with you in due time. (It is weird that we now get the results before the assessment, but I'd rather know sooner than not, given my analytic mentality.) What is in front of you right now?
Right now are the big three for quality of life--pooping, peeing, and penile rehabilitation. The first is pooping, and that requires drinking lots of water as those intestinal muscles seek to regain their natural rhythms. The second is peeing, and that requires rebuilding the pelvic floor muscles that have been so disturbed by the abdominal surgery in the depths of their generally private and unnoticed being. (It also requires relearning how to start and stop without a prostate.) The third is penile rehabilitation, and that requires two things--recovery of the traumatized nerves, even though they have hopefully mostly been spared, and sustenance and reconditioning of the smooth muscles in the penile cavities, which requires blood flow and tension. I have presented them in order in which they are likely to be your focus.
Given the level of detail in your reporting thus far, I suspect you are getting great coaching on all these things. I got great help with the first two from a physical therapist, although I have been disappointed at just how long it takes the pelvic floor to recover--in my case not for continence, which has been great, but for biking :-). The third I have slowly gotten more information about over the months, but the most thorough thing I've found (more recently) is "Saving your sex life" by John R Mulhall. I wish I had started reading this about one month after surgery. I have also used a mechanical exercise device from restorex dot com which is not really established protocol. My urologist's response was, "You try it if you want, and you'll be the first in my practice." If you read Mulhall, you'll be able to put the use of this device in context. The recommended timing of its use is approximately during the 6 weeks to 9 months after surgery. I don't really know if it works, but it made sense to me, especially since the pills did not work for me.

Brilliant, Spino! Thank you for your time and energy to write that out for us. I, much like you, have a desire for knowledge and understanding. I worked in the medical field myself so I know just enough to be dangerous 😉 I do not have experience with prostate, so I am on a fast track program!

He is healing really well and very quickly. Although older, he is in superior health and is an athlete. His doctor told him, "you're not the gold standard, you're the platinum standard", so he's got that going for him. Both of his parents lived to their mid 90's and his siblings are healthy.

At our first meeting with his surgeon, he laid out his objectives in order of importance, to live another 15 years to see all of his grandchildren graduate college, to regain full continence and to regain an erection. I imagine that pertains to most men. I know he will order that book, thank you for the suggestion.

I will be interested in following along on your journey. Sharing is so educational.

Di

Dang, @gkm. It looks like your message keeps getting cut off. I thought this bug was fixed by the tech team a while back. I'll have to investigate.

Did you use a symbol followed by a number without a space between the symbol and number? Such as > 0.3?
Try again and add a space after the symbol. (If you don't mind.)

I didn't. When I gave my initial PSA reading I did not have a space between the
< 0.008 The only problem is I can't remember exactly what I said. However I will resend when I get back from the lake, That must be a common problem when one is quoting PSA numbers which often have the < symbol.

We've received a message from our surgeon addressing that the tumor was more aggressive than the biopsy showed. He remarked that our decision to go forward with treatment and choosing a RP was absolutely the right choice. As we know, we follow the sensitive PSA's closely going forward.

It makes me wonder if it is really the better choice in most cases, to begin with a RP. With radiation and no complete pathology, it seems a patient doesn't really know what he is dealing with, as in our case.