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

Posted by di341 @di341, Aug 13, 2023

Hello everyone, thank you for taking your precious time to help. I previously wrote about my partner and his information, trying to figure out what should be done. We came to the conclusion that a prostatectomy was our next step. It was a tough decision between the choices given by our surgeon of radical prostatectomy, radiation or continue to wait and watch (which in our mind was a no-go). He wanted it gone.

His pathology report has concerned us a bit but we really don’t know how concerned 😟 we should be. This is where the honesty on this board of experience is so very invaluable.

I will post the highlights and if more information is needed, please let me know:

FINAL PATH DX on 1 of 2 tumors

Acinar adenocarcinoma, Gleason score 4+3 with introductal carcinoma of the prostate (IDC-P), limited extraprostatic extension, negative margins. L and R seminal vesicles with no tumor. One lymph node and associated fibrodipose tissue, negative for tumor.

Grade group 3. Approximately 4 small additional foci of tumor (gleason score 3+3)

Type of Gleason Pattern 4 present (including cribiform) Fused gland and expansile cribiform types.

Extraprostatic Extension (EPE) present, limited

Urinary bladder neck invasion not identified.

Approximate percentage of Gleason pattern 4:60%
Approximate percentage of Gleason pattern 5: 0%

Lymphovascular invasion not present

Perineural invasion: present

Pathological Stage Classification (pTNM, AJCC 8TH EDITION): pT3aN0

Googling is just making us have some concerns. Can anyone lay this out for us? Is further treatment of any kind warranted? His clinical history listed was Gleason score 3+4 and a PSA of 4.56. We were told that treatment was elective but we chose to proceed. Now it seems it was a bit more serious than we thought? His follow up is weeks away. Catheter comes out tomorrow.

A million times 🙏.

Di

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

@melcanada

Ask if they took and lymph nodes to test

I was clear but they still put me on Cosodex for 30 days and then Zolodex shots every 3 mos for 18 months

Jump to this post

They checked one lymph node. He did have a PET scan before surgery and lymph nodes looked good, as well.

REPLY

Just a follow up note, after catheter removal at day 10, he has had no incontinence, leakage or difficulties. Went right back to normal and wearing his normal underwear. Guess I should give a shout-out to his excellent surgeon, Dr. Peter Carroll at UCSF.

REPLY
@di341

Just a follow up note, after catheter removal at day 10, he has had no incontinence, leakage or difficulties. Went right back to normal and wearing his normal underwear. Guess I should give a shout-out to his excellent surgeon, Dr. Peter Carroll at UCSF.

Jump to this post

Hi,
Dr. Carroll and staff will await the first PSA test which hopefully will be undetectable < 0.01
If that is the case, PSA tests every 3 months for a couple of years. You can request a Decipher test (which is sent out) to further investigate risk catagory based on his pathology.
Tom

REPLY
@di341

Just a follow up note, after catheter removal at day 10, he has had no incontinence, leakage or difficulties. Went right back to normal and wearing his normal underwear. Guess I should give a shout-out to his excellent surgeon, Dr. Peter Carroll at UCSF.

Jump to this post

As a fellow patient who had my Radical Prostatectomy performed on October 25, 2022, my experience is fairly recent.
Given the fact that your husband basically didn’t experience any incontinence at all is rather amazing. I’ve heard that kind of immediate result for only very few patients out of the hundreds I’ve read about.
I am assuming he had the nerve sparing surgery. If he is back to normal immediately without any signs or symptoms of ED he’s practically a medical miracle on the scale of Radical Prostatectomies.
Every patient is different. However, it sounds like your husband has had a much easier go if it than the majority of PC Patients. Surgery Lab results can be a bit complicated to read. However, if they removed 100% of all the detectable cancer and could not find any other detectable cancer outside the Prostate, in the nodules or anything else past the margins of the Prostate etc, your husband should be in great shape.
Secondly, if he doesn’t have to use any kind of ED medications for sexual inter course or other aids like a Penile Pump etc, he has been doubly blessed!
However, I would recommend that your husband speak with his surgeon or a Urologist who is knowledgeable and experienced in Penile Rehabilitation. Regardless of the great results, it’s usually a good idea to start some protocol for Penile Rehabilitation. Have his PSA and other blood markers checked every 3 months to establish his baseline numbers and stay current as he recovers and progresses. The best that any of us can do is stay in remission regarding our cancer. Hopefully, nether myself or your husband will have to revisit eradicating any if our PC in the future.
Best wishes,
Phil

REPLY
@di341

Thank you for more PSA info following surgery. I know it is the first clue to work off of. My next question is, how high would it need to be to be indicative of immediate follow up treatment or is it just how quickly it starts doubling between tests?

Jump to this post

Following closely and hoping for a speedy recovery and positive outcome for your husband. My husband, G8, PSA 8, is scheduled for RP in two weeks. Curious about your husband's age.

REPLY
@tom86

Hi,
Dr. Carroll and staff will await the first PSA test which hopefully will be undetectable < 0.01
If that is the case, PSA tests every 3 months for a couple of years. You can request a Decipher test (which is sent out) to further investigate risk catagory based on his pathology.
Tom

Jump to this post

Thank you for the additional information!

REPLY
@philipsnowdon

As a fellow patient who had my Radical Prostatectomy performed on October 25, 2022, my experience is fairly recent.
Given the fact that your husband basically didn’t experience any incontinence at all is rather amazing. I’ve heard that kind of immediate result for only very few patients out of the hundreds I’ve read about.
I am assuming he had the nerve sparing surgery. If he is back to normal immediately without any signs or symptoms of ED he’s practically a medical miracle on the scale of Radical Prostatectomies.
Every patient is different. However, it sounds like your husband has had a much easier go if it than the majority of PC Patients. Surgery Lab results can be a bit complicated to read. However, if they removed 100% of all the detectable cancer and could not find any other detectable cancer outside the Prostate, in the nodules or anything else past the margins of the Prostate etc, your husband should be in great shape.
Secondly, if he doesn’t have to use any kind of ED medications for sexual inter course or other aids like a Penile Pump etc, he has been doubly blessed!
However, I would recommend that your husband speak with his surgeon or a Urologist who is knowledgeable and experienced in Penile Rehabilitation. Regardless of the great results, it’s usually a good idea to start some protocol for Penile Rehabilitation. Have his PSA and other blood markers checked every 3 months to establish his baseline numbers and stay current as he recovers and progresses. The best that any of us can do is stay in remission regarding our cancer. Hopefully, nether myself or your husband will have to revisit eradicating any if our PC in the future.
Best wishes,
Phil

Jump to this post

Thank you so much, Phil, so very kind and helpful of you to respond. We both were very surprised and he was particularly delighted to bypass the incontinence. Yes, he had nerve sparing surgery and we were told that it went extremely well.

Too early to tell what his ED experience will be. I will let you know how it goes for him. So far, his recovery has been pretty easy over all. At two weeks he was taking long nature walks and practicing his putting at the driving range. I attribute this to his extremely active and healthy lifestyle (he is 100 times more disciplined than me 😉

Very best of luck with your journey!!

REPLY
@undetectable

Following closely and hoping for a speedy recovery and positive outcome for your husband. My husband, G8, PSA 8, is scheduled for RP in two weeks. Curious about your husband's age.

Jump to this post

He is a very “youthful” 74. His recovery has been as good as we could have hoped for. The first five days or so were a bit challenging, as I’m sure they are for everyone. At a week he seemed to turn the corner and started feeling better by the day.

Best of luck to your husband and you. Please keep us posted.

REPLY
@di341

Thank you so much, Phil, so very kind and helpful of you to respond. We both were very surprised and he was particularly delighted to bypass the incontinence. Yes, he had nerve sparing surgery and we were told that it went extremely well.

Too early to tell what his ED experience will be. I will let you know how it goes for him. So far, his recovery has been pretty easy over all. At two weeks he was taking long nature walks and practicing his putting at the driving range. I attribute this to his extremely active and healthy lifestyle (he is 100 times more disciplined than me 😉

Very best of luck with your journey!!

Jump to this post

I am so happy and thrilled for the recovery experience you and you husband have enjoyed up to this point. I can assure you that any and every PC Patient would be thrilled for the two you based on what your recovery experience has been to date. We would all love to have the same result and envy your husband’s recovery status.
As you may have already guessed, mist everybody on this site are happy to assist and or assist you and every other PC Patient in every way possible! Even though I was diagnosed about 1 year ago with my surgery on 10/25/22, I am still researching, learning and sharing information and questions wherever and whenever possible to give or receive valued assistance.
Once you personally contract and experience cancer it becomes a lifelong event. I hope that both your husband and myself will be so fortunate as to remain in remission for the rest of our lives. However, should that change, we will do and take advantage of whatever technologies exist at the time to treat us in the best way possible to obtain the very best results possible!
I may have shared the phrase I’ve personally coined for all CANCER!

CANCER is DUBIOUS at best, SINISTER at worse and VILLAINOUS during the interim.

It’s not a club that anybody wants to be a member of but is reluctantly added to the membership roster!

I am confident that your surgeon and other physicians affiliated with your husband’s case are overjoyed with his initial results and the trajectory he’s on for his continued recovery.

I am always interested in my the results of my fellow patients no matter what they are as a constant reminder and ability to share information in a discrete manner that could benefit the many who see it.

Best wishes and continued success in the months and years to come.
GODSPEED,
Phil

REPLY
@philipsnowdon

I am so happy and thrilled for the recovery experience you and you husband have enjoyed up to this point. I can assure you that any and every PC Patient would be thrilled for the two you based on what your recovery experience has been to date. We would all love to have the same result and envy your husband’s recovery status.
As you may have already guessed, mist everybody on this site are happy to assist and or assist you and every other PC Patient in every way possible! Even though I was diagnosed about 1 year ago with my surgery on 10/25/22, I am still researching, learning and sharing information and questions wherever and whenever possible to give or receive valued assistance.
Once you personally contract and experience cancer it becomes a lifelong event. I hope that both your husband and myself will be so fortunate as to remain in remission for the rest of our lives. However, should that change, we will do and take advantage of whatever technologies exist at the time to treat us in the best way possible to obtain the very best results possible!
I may have shared the phrase I’ve personally coined for all CANCER!

CANCER is DUBIOUS at best, SINISTER at worse and VILLAINOUS during the interim.

It’s not a club that anybody wants to be a member of but is reluctantly added to the membership roster!

I am confident that your surgeon and other physicians affiliated with your husband’s case are overjoyed with his initial results and the trajectory he’s on for his continued recovery.

I am always interested in my the results of my fellow patients no matter what they are as a constant reminder and ability to share information in a discrete manner that could benefit the many who see it.

Best wishes and continued success in the months and years to come.
GODSPEED,
Phil

Jump to this post

Thank you so much Phil. It seems that as we age, cancer starts taking advantage. I have Lynch Syndrome myself, so I am on high surveillance and have only experienced early melanomas (as if any melanoma is "only" ;).

I do believe that cancer is now treated as a chronic condition rather than a death sentence. Therapies continue to come along that make this more a reality. Immunotherapies are fascinating. My stepdaughter is in chemo for pancreatic and my sister is in radiation for breast, as we speak. I lost my former husband to leukemia and my father to colon cancer. Sadly, I have a lot of experience with this dance.

Our surgeon is pleased with his fast recovery. He is feeling great and mildly exercising everyday, at 3 weeks out.

Best wishes to you in your journey and thank you for contributions.

REPLY
Please sign in or register to post a reply.