Husband's prostate cancer story

Posted by dory20 @dory20, Sep 7, 2023

My 64 yr old husband was having urination frequency and enlarged prostrate. Visited the urologist for at least two years. His PSA was around 4, and she blamed it on the enlarged prostrate. Jan 2022 he went through REZUM and third hernia mesh repair. PSA went up to almost 8, and blamed it on the REZUM. Around April it went down to 5.6. June 22 had an MRI. Showed no lesions and 10% chance of cancer. Had rectal biopsy because that's all they did, and we didn't know any better.

Biopsy results:
Left base, had Grade Group 3, Gleason 4+3, 60% pattern 4.
2 cores positive, tumor 3mm. 12% prostatic tissue involved. Lymphovascular and perineural invasion not identified. Other tissue benign.

We had a Polaris test done. Risk of metastasis 2.7% with active treatment.

Bone scan negative.

September 22 had Pet CT F 18 PYL PSMA. Negative.

Had robotic surgery Sept 22.

Pathology results:
10 nodes tested all negative.
Grade 2(3+4), 68 gram prostrate. 45% grade 4.
Cribiforms glands present. 30% prostrate was tumor. No EPE, No urinary bladder neck invasion, no seminal invasion, no lymphoma secular identified. PERINEURAL INVASION. 0.3 mm positive margin, Grade 3. PT:2 N:0 M: Not applicable. HGPIN.

Then in April 23, sent everything to Dr. Epstein at Johns Hopkins.
He changed the biopsy to Gleason 3+4=7 (Grade Group 2) involving 2 cores (10%, 10%). 10% Gleason pattern 4.
Small focus of prostatic adenocarcinoma, Gleason score 3+3=6 (Grade Group 1)

Pathology reviewed:
All 10 lymph nodes negative.
Dominant nodule 3+4=7. Grade Group 2: 20% pattern 4.
Secondary nodule, 3+3=6, Grade Group 1.
Tumor extension max 13 mm.
Positive margin < 1mm, 3+3 grade at margin.
No seminal vehicle invasion, no lymphatic invasion, all nodes negative.
PT2x, pNO. Positive margin. HPIN

The biopsy, pathology and Dr. Epstein are all different. I understand the biopsy can be different, just shocked the pathology is different after Dr. Epstein review.

The pathology states cribiform, but Epstein doesn't. Epstein also doesn't mention perineural invasion.

I am confused if he doesn't have those findings, or Dr. Epstein just didn't include it. Also been getting PSA every 3 months, < 0.01 so far.

Should we be concerned about the positive margin, less then 1mm, and 3+3? Any comments about his results would be appreciated. We went with surgery because he has other conditions that may have been affected. Still incontinent, about 3 pads a day but he doesn't want any more surgery.

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proftom2 | @proftom2 | Sep 8, 2023

First you're doing the right thing, getting help. Second, stay the course, numbers may vary, that's normal. This thing, prostate cancer, fluctuates, stay vigilant.

spino | @spino | Sep 8, 2023

While it's disappointing to have positive margins, as I do, hopefully there will be a long interval before it reaches a level where further treatment is recommended. While you're living with known uncertainty now, in truth you had uncertainty before as well, even if you didn't know it. May you find peace in the journey.
Since it takes months for the post-surgery PSA to reach its lowest point, it will be even more months before that provides any guidance as to whether the cancer is actively spreading, and then even if it is, it will be a judgment call as to when the best time is to add further treatment--probably radiation.

wellness100 | @wellness100 | Sep 9, 2023

Understable that you lost confidence with your doctor because she did not catch the cancer early. However, that is not uncommon. Still you caught it early enough. It seems the surgery went well, with the PSA < 0,01. It is when it doesnt go below 0.1 that you need to worry about. The general medical opnion seems that below 0.1, you will stay cancer free for many years. Even if it recurs, there are many treatments to deal with it, radiation, homone etc. That said, your husband is in good hands. Just stay with Johns.
Dont mind me. I am just another layman trying to make some sense out of the whole thing.

perrychristopher | @perrychristopher | Sep 9, 2023

I've read online that a single positive margin less than 3mm has relatively the same chance of bcr as no margins. My pathology after surgery was all clear except for a 1mm at the margin. My urologist and surgeon who also leads up R and D at their practice did not recommend radiation. My surgery was in Aug 22. I was 4 + 3. My surgeon says I have a 30% chance of BCR in 15 years. Age at surgery was 60. It seems like your husband had a very good pathology report.

gkm | @gkm | Sep 9, 2023

At this stage I would not be unduly worried as your husband's PSA is less than .010. Keep on monitoring his quarterly PSA. One of the members in our Support Group had positive margins but his PSA was less than .008 for 4 years and it has only started to increase marginally in the last year and is now at .027. I had surgery at the same time as this member in 2018 and my margins were clear and my PSA was at .008 for my first two readings but then began to increase and I finally had salvage radiation in conjunction with 2 shots of Zoladex in July 2022 after my PSA had reached .370. My 4 post radiation PSA's have been less than .008 which is very gratifying but it is a long journey with many twists and turns along the way. I am 81 and have to deal with ongoing incontinence but I still golf, ski, exercise and keep active. Everyone's journey is different and your husband's journey is just beginning. Keep yourselves informed and be positive.

dpcarriere | @dpcarriere | Sep 11, 2023

That low PSA is your magic number. My oncologist would love that number and so would anyone. That's where my PSA is now. Relax, take a deep breath and go into monitor mode. A rising PSA will indicate cancer activity. This cancer is generally slow moving and doesn't advance overnight. You will have time to act. I don't blame him not wanting another surgery. Surgery was NOT my choice. I treated my Gleason 10 with Proton Beam Therapy. As I've told others - its a piece-of-cake. There's no anesthesia needed and you don't feel a thing. You don't even know it's happening. 15 minutes later you get up and walk out, smiling at the nurses on your way home.

perrychristopher | @perrychristopher | Sep 15, 2023

I had the same finding of Present on my pathology report under the heading of Cribriform gland. Nothing else with regards to this. Anyone know what this means. My surgeon said my pathology report was excellent last August. Now I am concerned. My cancer was 4 + 3 stage PT2N0. No letter after the 2 (2a, 2b etc).