When should we follow up with Rad onc?

Posted by mimii24 @mimii24, 12 hours ago

My 64 year old husband had RALP in September 2024. ,
G- 9 (4+5) positive
+EPE , + cribiform, + margin at left posterior lateral neurovascular bundle and perineural invasion
27 lymph nodes removed - all negative
Post surgical complications due to abscessed lymphoceles bilaterally, resulting in sepsis, diverticulitis, bowel blockage, and subsequent MRSA in his drains. He was operated on and treated at Penn have since followed up with a different oncologist at Fox Chase. His 3 & 6 month PSA
were undetectable. Now 0.05 without the < . . NP said this is still undetectable. I am aware of his unfavorable pathology and we were told 80% chance for reoccurrence. He has never had a PSA. There was no genetic testing or decipher score and no one has told him to follow up with a radiation oncologist for a consult. I feel like his situation is not going to have the best outcome without being as proactive with an obvious aggressive situation. Please advise if I’m overthinking this or time to find a physician who will take him more serious. Thank you.

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mimii24 | @mimii24 | 12 hours ago

Sorry he has never had a PSMA/PET scan

jeff Marchi | @jeffmarc | 11 hours ago

The Cribriform and EPE both make it really aggressive. It’d be good to know if it was large or small cribriform. Having both means the cancer is aggressive and linked to a higher risk of adverse outcomes. If it’s large cribrifor, it’s much more aggressive.

Your being aggressive is really a good idea. It’s great to hear the PSA is not rising much yet. It took 3 1/2 years for my PSA to hit .2 after surgery. That’s the point at which they do salvage radiation.

I’m just wondering why with all of these issues and positive margins why they didn’t talk about radiating the area sooner rather than waiting till the PSA rises, which is almost inevitable. Fox Chase has some really good doctors so possibly they didn’t do the radiation because it wasn’t done soon enough, Or they’re worried about more complications due to your post surgical complications history.

Hopefully, your PSA bounces around rather than continuing to rise, that does happen.