Had Radical Prostatectomy last week: What are next steps?

Posted by perrychristopher @perrychristopher, Aug 10 6:36pm

Hi, I just had a Radical Prostatectomy on 8/4/22 and made the unfortunate decision to look at my Pathology Report before my appointment with surgeon in 2 weeks. Actually, all data looked good except one margin notation. My Gleason was still a 7 as it was during the biopsy in May. No seminal vesicles, bladder neck, or lymphovascular invasion observed. 15 lymph nodes were removed with no sign of tumor and were given a rating of pN0. The tumor itself was diagnosed as a PT2. However, in two slides of the left lateral location of the removed prostate an invasive carcinoma was present at margin. The length of this carcinoma was 1mm. My last PSA taken in March 22 was 3.46. Now I am concerned what is the next step. I was really hoping I would not require Radiation after the surgery, but not so sure now. Any thoughts. Thank You. Perry Christopher

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Perry
You have options and time to consider what, if anything you want to do.

A positive margin may be sufficient clinical data to discuss adjuvant salvage radiation therapy with your team. If you have those discussions, include whether or not you should consider adding short term, six months ADT and whether or not to include the pelvic lymph nodes.

You can also consider waiting to you have clinical data supporting SRT, That could take the form of PSA tests, either standard or ultrasensitive, three months apart. If those show your PSA increasing you can determine doubling and velocity times as well as if your PSA hits .5 or higher, add imaging. Informed by definitive clinical data, PSA, PSADT and PSAV, imaging locating sites of PCa, you can make an informed decision about treatment.

If your PSA tests do not indicate PCa activity, you could do nothing but continue to monitor your PSA every three months, if it stays "undetectable" then after a year you could switch to labs every six months.

Kevin

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If you are under 75 and have a 10-year life prospect, I would do the radiation. It should kill remaining cancer. The proton radiation can zero in on cancerous cells and fry them.

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@ken1946

If you are under 75 and have a 10-year life prospect, I would do the radiation. It should kill remaining cancer. The proton radiation can zero in on cancerous cells and fry them.

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I am 60 years old. I will mention Proton beam to surgeon and Oncologist. Have you had this treatment?

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Hi Perry,
I had surgery on January 7, 2022. They also tested 8 lymph nodes. One came back with a Gleason score of 7. Ugh. I discussed this matter with radiation and oncology doctors. Their recommendation was 39 radiation treatments plus ADT shots, monthly, for two years. While this would most likely kill my cancer, the treatments come with a lots of negative side effects!
Therefore, I decided to do active surveillance and have my PSA tested every three months. In addition, I’ve adopted a Mediterranean diet and a vigorous exercise plan. My fist two PSA tests came back with undetectable results. I just had a follow up appointment with my oncologist. She was happy to see the results, and we’ll continue to closely monitor my PSA every three months.
Hope this helps you with your decision. It’s not easy and is unique for everyone. Jerry

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@jerryegge

Hi Perry,
I had surgery on January 7, 2022. They also tested 8 lymph nodes. One came back with a Gleason score of 7. Ugh. I discussed this matter with radiation and oncology doctors. Their recommendation was 39 radiation treatments plus ADT shots, monthly, for two years. While this would most likely kill my cancer, the treatments come with a lots of negative side effects!
Therefore, I decided to do active surveillance and have my PSA tested every three months. In addition, I’ve adopted a Mediterranean diet and a vigorous exercise plan. My fist two PSA tests came back with undetectable results. I just had a follow up appointment with my oncologist. She was happy to see the results, and we’ll continue to closely monitor my PSA every three months.
Hope this helps you with your decision. It’s not easy and is unique for everyone. Jerry

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That's great news Jerry
Congratulations. My surgeon/Urologist called me yesterday about my concern. He said margins were good and no cancer left behind. He had an explanation that I didn't fully grasp but I still have an in person consult in 2 weeks with him so I can ask him to explain again. My catheter came out today. Nice to walk around again without one.

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I did 44 photon radiation treatments. My cancer had jumped to the lymph nodes. I exercise 5 days a week and eat a healthy diet. The Lupron hormone is the worst. I had a Gleason of 7. It was a 4+3. The RP was not able to get all of cancer.

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@ken1946

I did 44 photon radiation treatments. My cancer had jumped to the lymph nodes. I exercise 5 days a week and eat a healthy diet. The Lupron hormone is the worst. I had a Gleason of 7. It was a 4+3. The RP was not able to get all of cancer.

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I hear the photon treatments are very precise and effective. They should kill anything in the lymph node. I too am a 3 to 4 day a week gym guy who is a non smoker. My wife is a great cook who rarely makes red meat. I was shocked too about the PCa. My Dad died of heart disease at 58 so I have no clue on his side about PCa. My mother did have breast cancer though. She was clear for 20 years before she passed of MS complications. No more coldcut sandwiches for me at lunch. I used to eat 2 per week on average. It seems there really aren't any specific causations to a PCa diagnosis. Just a lot of possibles which is frustrating. At least we live in a time where there are multiple treatment options to allow for a full lifespan.

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The photon radiation killed most of cancer cells. It does not get them all.
I was given hormone Lupron to kill my testosterone. The idea was to starve the remaining cancer cells. So far, it has worked along with exercise and diet. It destroyed my libido. I would like it back. So would my wife.

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@perrychristopher

That's great news Jerry
Congratulations. My surgeon/Urologist called me yesterday about my concern. He said margins were good and no cancer left behind. He had an explanation that I didn't fully grasp but I still have an in person consult in 2 weeks with him so I can ask him to explain again. My catheter came out today. Nice to walk around again without one.

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All the best with your upcoming consultation, Perry. I'll be interested to hear what next steps are recommended for you.

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Just had my prostate removed after diagnosed with Gleeson 9 aggressive cancer. Get staples and catheter out tomorrow. After more recuperation have to do PSA to see if any residual cancer. Will probably also have radiation to capture any micro-spread.
Anyone else out there going through this?

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Following. Just has my RALP 8/23 and am looking forward to hearing about the lab reports about the gland and a pair of lymph nodes. But the surgeon was very enthusiastic yesterday.

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@whytee

Just had my prostate removed after diagnosed with Gleeson 9 aggressive cancer. Get staples and catheter out tomorrow. After more recuperation have to do PSA to see if any residual cancer. Will probably also have radiation to capture any micro-spread.
Anyone else out there going through this?

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Welcome @whytee. Yes, there are many members who, like you, are going through prostate cancer and treatment. To help you connect with others, I moved your message to this existing discussion:
– Had Radical Prostatectomy last week: What are next steps? https://connect.mayoclinic.org/discussion/had-radical-prostatectomy-last-week/

I encourage you to browse the discussions and follow the Prostate Cancer group here: https://connect.mayoclinic.org/group/prostate-cancer/

Many members have talked about their radiation experiences and choices they made. Do you know what type of radiation you may be offered?

I bet you're looking forward to getting that catheter removed!

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