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Significance of tertiary Gleason pattern 5

Prostate Cancer | Last Active: Dec 18, 2023 | Replies (11)

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@tstump12

Clear margins is a wonderful pathology report. My margins were not clear. Not sure how this can happen. My sense is I am in trouble but my oncologist will not admit it or give me a sense of next steps. Anyone else facing this dilemma?

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Replies to "Clear margins is a wonderful pathology report. My margins were not clear. Not sure how this..."

tstump12:
RP Aug 22; clean margins, lymph nodes and seminal vesicules.
But nonfocal EPE and Gleason score 9 foretold 1st postop PSA .19.
Referred to Radiation Oncology for evaluation for salvage radiation with ADT.
See SPPORT trial.
Completed treatment May/June '23; 6 mos post PSA < .02.
My Gleason score together with EPE foretold biochemical recurrence (BCR) and the need for additional treatment.
Hopefully your PSA will remain < .1 forever.

The primary score for becoming an oncologist is not patient communication. And then no one else wants to venture in where the MD does not. However, I'm a little confused because normally a urologist/surgeon does the operation, then refers you to an oncologist if needed for followup. Perhaps your experience was different. The labels are rather arbitrary as each MD has specific experience. My urologist has a specialty in prostate cancer, but his main expertise is robotic laproscopic surgery. I assume though if I need radiation I'll be referred to a "radioactive oncologist." Of course, that person wouldn't run the machines or pour the cocktails, just write the orders.
Anyway, as others have said and you already knew, while your report was not good, it was also not definitive. "Extraprostatic extension cannot be ruled out." Even if they thought it could, you could still have it, but your presentation is of concern. (MD code for "bad news.")
In my experience, oncologists are among the most optimistic, hopeful people on the planet. I guess you have to be to choose a career where all your clients are dying faster than usual and all your treatments are more likely to cause delay in death than outright cure.

@tstump12, that's not a great feeling to think your oncologist isn't being straight with you for fear of sharing bad news. I would want the bare truth too so that I know what I'm dealing with and can mentally prepare. As for next steps, I make sure I never leave an appointment without my being clear on next steps - clear to me. Sometimes the next steps are clear to the doctor, but not necessarily to me. So I repeat back what I understand next steps to be. That's gives the doc the opportunity to confirm I got it right or to correct my understanding, without being challenging.

Have you told him your preference and that you want clear and open communication, no matter the news?