Prostate cancer, pathology report after RPR & Lymph nodes removed.

Posted by myboo2u @myboo2u, Jun 12 2:14pm

Hi. It's been awhile. My fiance had his surgery, RPR & Lymphendectomy.
The pathology results are so confusing.

We scheduled a PSA for 6 & 12weeks after surgery, per surgeons instructions.

We see the surgeons NP to discuss results but I think a medical oncologist would be very helpful.
The cancer included Cribriform-inside & outside of the prostate, IDC-P, no spread to lymph nodes, spread to bladder neck and other confusing pathology results.

I don't understand most of the acronyms or the doctor speak but we are trying to interpret each part of the report on Pubmed, Mayo, Prostate Cancer.org, etc..

1). I know that genomic testing is very important?
Can anyone explain this to me, in simple terms?

2). What is IDC-P, and what additional questions and tests should be asked for?

3). The surgeon started clear margins but I struggle with this due to the Cribriform outside the prostate, IDC-P and bladder neck spread.
4). PSA before surgery was only around 5.7. Highest Gleason was(3+4=7)-the Cribriform areas.

It's only been about 3 weeks since the surgery. I'm overwhelmed with fear for my boyfriend and lack of information, a very busy care "team", and I need to be equipped with the right information to help him during this life long journey..
I'm sure that I sound scattered but I'm really scared and the surgeon is very confident that, things went well and he should just have his PSA checked in 6 & 12weeks & every 6 months going forward.
This seems a bit simple for such a complex pathology report and from everything I have researched.
Any advice would be greatly appreciated. Please note that I'm just learning the terminology...
And don't get the acronyms very well...
Thanks in advance..

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

Profile picture for surftohealth88 @surftohealth88

@myboo2u
You have correct reasoning - one needs to establish relationship with RO and MO before problem arise.

We were actually denied access to MO just after surgery with explanation that MO works with metastatic patients only but we were insistent and we got app.

Oh yes, all appointments are always at least 6 to 8 weeks apart and that is maddening but it is like that unfortunately in most big centers. 😣 There is a "theory" that PC is slow growing and it takes time to spread and develop and yes, that is the case for most PC patients but for high risk patients it is different - it comes back without much warning and that it grows fast 😢.
My husband's uPSA started doubling every 4 weeks and only because we did tests every single month the trend was "proven" and obvious and even after that we had to wait for new PSMA scan for 6 weeks and we refused to wait. We scheduled PSMA scan in another local hospital to catch the window before uPSA reaches 0.25 . We were told that scan will not see anything at that level and guess what - couple of nodes were glowing !

They do all of those studies and than point blank ignore protocols and findings - just unbelievable *sigh. Also, if we did not have established contact with MO we would have waited for app. even longer. This way it was easier and faster since we were "his patients" already and he already knew our case and we had preliminary plan of action.

I am really sorry to hear that your urologist is so aloof and unpleasant, how disheartening : ((. Just be persistent - as many members told me here " a squeaky wheel gets all attention" and that is so true *sigh.

Thanks for asking - we are doing OK now. We finally did all scans and got all meds that I wanted for my husband (had to insist on those), and we have preliminary plan for RT that will happen mid July. Medications worked fast and well (*knock the wood) so we can relax somewhat. Hopefully you will never need anything done in the future, don't forget that that is VERY possible too ! 👍

May your fiancee heal fast and completely and be cancer free for life 💗

Jump to this post

@surftohealth88
Hi.
Your message means ALOT to me..
The information is paramount for quality of life & to simply not be so stressed from sun up to sundown.

Your understanding & compassion are so refreshing & much needed.🤗

I want to cry & hug you.❤️

Wishing you & your husband well.

REPLY
Profile picture for bikeman1 @bikeman1

@myboo2u
Hi Melinda,
Thanks for asking about how I am doing. I am feeling fine, 1.5 weeks on bicalutamide, one of the prostate drugs available. In fact, I had a great bike ride yesterday 🙂
I forgot to include in my last (unduly long) message, that surgeons are just that--surgeons. They are urologists too, but consider yours a surgeon, and other than questions related directly to the surgery (like issues with healing, incontinence, etc), you are pretty much done with him. I asked my surgeon if I needed ultra-sensitive testing and he told me no, so I delayed it for several months until reading postings by these and other folks convinced me I should do it.
Again, you are on the right track by getting appointments with a radiation oncologist and a medical oncologist to establish relationships with them (I have both). Don't be frustrated if it takes a while to see them; it is not an emergency that must happen right away.
I don't want to downplay your fiancé's (I guess I jumped the gun by calling him your husband) disease. It is serious, and you want to get things lined up. Also you have to remember that what applies to the "average" prostate cancer patient may not apply to him. But at this stage you don't want to drive yourself crazy by thinking everything must happen "right now".
PS, I found these abbreviations online and added a few myself. Hope it helps.
Take care and don't let this get in the way of your wedding planning :))

Jump to this post

@bikeman1
Hi..
Thank you for getting back. And for the abbreviation PDF...🙂

I hope you enjoyed your ride..
Me & my fiance ride..
But this summer we are talking a break-obviously.😟
Although I wish we could-it's just a few months..

I'm working on getting appts now..
So, fingers crossed..

Thank you for your input & sharing your story & the valuable information..

I hope to report back with positive news & multiple appointments...

Enjoy the ride & Be safe .
❤️Melinda

REPLY
Profile picture for surftohealth88 @surftohealth88

@jeffmarc
Yes, of course, for somebody with indolent cancer that will maybe cause BCR in 10 years seeking MO's advice is not urgent. However, as Melinda mentioned, for breast cancer or any other cancer MO is always involved from the beginning, busy or not. My advice was for Melinda since her husband has cribriform OUTSIDE of the gland, IDC and bladder neck invasion which all point to aggressive cancer.

As a perfectionist I always give my best and expect the same from other which is ridiculous, I am aware of that lol. BUT, wouldn't it be great if everybody gave their "best", and especially doctors ??? 😉 None of them works for free - right ? MO in any other oncology department is busy too.

Also, MO has the best knowledge about medications and medication interactions and most seniors are on MULTIPLE of them. His oversight is very important.

Jump to this post

@surftohealth88
It’s interesting that the biopsy that she supplied mentions nothing about cribriform Being outside the prostate. It could be the doctor told her that, but it sure isn’t clear from the biopsy.

REPLY
Profile picture for Jeff Marchi @jeffmarc

@surftohealth88
It’s interesting that the biopsy that she supplied mentions nothing about cribriform Being outside the prostate. It could be the doctor told her that, but it sure isn’t clear from the biopsy.

Jump to this post

@jeffmarc ,
@surftohealth88
Just to clarify.
The surgeon did tell me the cribriform was inside & on the outside lining of the prostate.

Sadly, our discussion about the report was just a Health Chart message & a 15 second voicemail.
Luckily, I have a transcript of the voicemail.
Because he must have been driving & I could only hear cars..
Odd...
But I guess odd & being extremely nonchalant are now common place..

But I will not be steam rolled by an overworked callous surgeon and will get the necessary appts & tests.

Sending love,
Melinda

REPLY
Profile picture for guybe @guybe

@myboo2u It is important to have a relationship with a Medical Oncologist, someone who is in a position to say "Hmm, wait a minute...." about decisions made by people whose roles are more circumscribed (ROs, surgeons) in your treatment. Placing treatment recommendations completely in the hands of an RO or surgeon is to eliminate consideration of other treatment paths or any critical review of what they want to do. That broader, more holistic view of your situation is needed and, to me at least, is the role of the MO. I sought one out on my own after I became uncomfortable with everything being in the hands of an RO. Having someone in the oversight role, a "go-to" person with whom I can ask any questions I want, knowing their responses are not limited by their particular technical specialty, gives me considerable reassurance.

Jump to this post

@guybe That is great advice, @guybe. You really do need someone outside the box when treatment can be complex.
Like the saying goes, “when all you have is a hammer, everything looks like a nail”
Phil

REPLY
Profile picture for guybe @guybe

@myboo2u It is important to have a relationship with a Medical Oncologist, someone who is in a position to say "Hmm, wait a minute...." about decisions made by people whose roles are more circumscribed (ROs, surgeons) in your treatment. Placing treatment recommendations completely in the hands of an RO or surgeon is to eliminate consideration of other treatment paths or any critical review of what they want to do. That broader, more holistic view of your situation is needed and, to me at least, is the role of the MO. I sought one out on my own after I became uncomfortable with everything being in the hands of an RO. Having someone in the oversight role, a "go-to" person with whom I can ask any questions I want, knowing their responses are not limited by their particular technical specialty, gives me considerable reassurance.

Jump to this post

@guybe
Thank you..
I've contacted 2 Med. Oncologists today.
I'll wait 48hours & call again..

If it wasn't for this site & doing our own research, we would be completely in the dark..

Wishing you well..❤️

Melinda

REPLY
Profile picture for myboo2u @myboo2u

@guybe
Thank you..
I've contacted 2 Med. Oncologists today.
I'll wait 48hours & call again..

If it wasn't for this site & doing our own research, we would be completely in the dark..

Wishing you well..❤️

Melinda

Jump to this post

@myboo2u Did you initiate the MO contacts on your own, or get a referral? It was in a meeting with my newly-assigned radiation guy that I asked for a referral to an MO within his organization (Johns Hopkins), and got one. Without that, I might have been at sea, and could have wound up in a situation prone to lack of coordination between RO and MO, if I ever found one at all. With the referral from a source within the COE, I was put on the MO's schedule immediately - though it did take a couple of weeks to meet with him.

Yeah, this site is pretty amazing. The level of detail and variety of experience among the comments are an enormous help. (Thanks, everyone!)

Best of luck in your search!

Guy

REPLY

Hi Guy,
How are you?
I don't have a referral for a Medical oncologist or Radiation oncologist.
But the surgeon, also the doctor(I guess), suggested prior to surgery, for us to review the entire "Care team" at the Cancer center & schedule accordingly..

I just called everyone.
And I'm hoping to get a callback.
But I will call again tomorrow, or next week, if no response.

The surgeon didn't take any time to discuss the pathology with us & with multiple red flags in the pathology report, we are not willing to take any chances.
I can't even get anyone from the surgeons office to respond to a health chart message. So-we will try to get things done without the surgeons help.

If things don't work out at the Cancer center or if everyone is just too busy, we will go somewhere else..
I'm slightly shocked, disturbed & angry that no one was able to spend 15minutes with us to discuss the Pathology report in detail.
Scary..

How is your care at Johns Hopkins?

Hope you are having a good day.
Melinda

REPLY
Please sign in or register to post a reply.