Results of RALP pathology report

This really is an issue. The question is does the report say that the margins were clean? They can get all of it if they know where the proper margins are, since it has spread outside the prostate capsule. You still may have a high chance of reoccurrence. You should ask your doctor if you can get a decipher test to see if your cancer has a high chance of reoccurring.

You say your Gleason score is 7+3 did you mean 4+3 a 7 total?

The cribriform, neurovascular bundle and the EPE are the real concerns. The size of the cribriform is important, If over .25 mm then it is considered the same as having a five in your Gleason score. All three may require radiation to eradicate it. This is something you need to discuss with your doctor, If your first PSA comes back undetectable, then he may not want to do anything, yet.

The extent of your cancer would probably include ADT And maybe an ARSI (Zytiga or a lutamide). Something else to be prepared for when discussing with your doctor.

What you have is considered stage three since it has apparently not spread to distant parts (Like a lymph node).

I’m just giving you some information so you are informed when you go talk to the doctor.

Thanks so much. I corrected the Gleason score. Margins were clean. The surgeon would not discuss it much and I received results on a portal. Said he would decide if further treatment was necessary based on my next PSA. Originally, I was told Stage 1 after biopsy, so surprised at this.

As far as I can tell (as a non-expert), the cancer is stage 3, as you suspect. because of the perineural invasion: it's made it outside the prostate capsule, but not far away yet, like into the spine (which would be stage 4).

Since it's all close together, radiation might have a good chance of getting it all, or at least knocking it back enough for you to live out the rest of your normal life. But some oncologists might hesitate because of your age, even though you're a very healthy, active 77.

This is where it's important to be assertive. If you want to fight the cancer aggressively and are willing to deal with side-effects, tell them; if you'd rather just manage the symptoms for now and enjoy the next few years as fully as possible, tell them. They're both good choices, but never let the medical team decide for you what *they* think you want.

You're the CEO of your cancer treatment; the doctors are the experts who will figure out how to carry out your strategy.

A surgeon does surgery, Once it’s done, and you have no more urological issues you need to Move on to an Oncologist. Preferably a Genito urinary oncologist, The ones that specialize in prostate cancer. You should have your results of your surgery reviewed and find out what an expert thinks you should do.

I know too many people that relied on their urologist and ended up with extensive cases of prostate cancer, because their urologist didn’t know enough. You need to find what an expert in prostate cancer thinks about your situation. Hard to believe ADT would not be included. I could be wrong.

My surgeon is an oncologist and told me he will do all my follow up. He is the Director of Urologic Oncology at NYU Langone and in Newsweek as a Best Doctor for 2024.

It seems like you should be in good hands. Normally, radiation isn't performed after surgery for at least for a few months to allow the area to heal. I'm not sure about ADT therapy but that would be a great question to ask your Doctor. I always try to schedule my PSA blood work within a week of my appointment to see my Urologist in case the results aren't what I want when they post on the portal.