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I am nine days past a ten hour Da Vinci removal, and I received my pathology report on Tuesday along with the catheter removal. My recovery so far has been unremarkable, except that my scrotal sack is still huge. Here are the pertinent findings;
21 lymph nodes all negative
Bladder neck and smooth muscle negative for cancer
Prostate 209 grams, size 7.8 centimeters
Primary pattern four 70%
Secondary pattern three 30%
Total Gleason 7
Extraoprostatic extension present non focal
Established EPE at right base, 1 mm breadth (E26); right posterior, 4 mm breadth (E34 and E36); and left posterior, 1 mm breadth (E75)
Urinary bladder neck invasion: not identified
Seminal vessal invasion: not identified
Lymphovascular invasion: not identified
Perineural invasion: present
Margins: Uninvolved by invasive carcinoma
Clinical stage classification pt3a
I received these results from the physician's assistant, I did not see the surgeon which has me a little distressed. The assistant told me I would see the doctor at the three month point, at the first PSA.
Since receiving the report I have been reading like crazy and I was hoping I could get some opinions here regarding the need for additional treatment and timing of that treatment. I am going to contact the surgeon in advance of three months and the more I know, the better questions I can ask.
Any comments or suggestions you can give are greatly appreciated.
I came out of my Da Vinci prostatectomy with a pT3b. You will have to get your PSA checked every month or perhaps every 3 months. If your PSA starts to go up and then hits 0.2 then you should probably get salvage treatment which is 6 months of ADT and 66 Greys over 33 sessions of external beam radiation treatment. This is when the PSA test is a perfect indicator of the state of your prostate cancer and is the only thing that the surgeon will really pay attention to. He doesn't really care what is in the pathology report as that is "old news".
I decided to get the salvage treatment a year after my prostatectomy as my PSA was definitely going up and had got to 0.18 and was going up every test. I was hopeful that I wouldn't need any salvage treatment as it hit a nadir (lowest point) of 0.02 three months after the operation but it just started going up after that.
In the end the ADT/radiation salvage treatment was no problem compared to the prostatectomy. If you do need salvage just make sure to get exercising, try not to be overweight and watch your diet as it is almost impossible to not put on weight on the ADT. Almost nine years later I still have an undetectable PSA.
Enock; I would say, do not borrow trouble before you need to. You have had enough already and just need to recover from that first before worrying about what might or might not be. By my layman's knowledge, your pathology reports look pretty good but as stated by others, your next couple PSA's will be the deciding factor. (A ten hour operation is remarkable! What explanation was given for such a lengthy procedure?) Until evidence suggests further action, just try to relax. Jon.
Thank you so much for your responses. One of the problems I have is being out of control. I want to double check everything or I can't relax. That's why a forum like this is invaluable.
The explanation given to me for the length of the procedure was the size of the prostate (209 grams), combined with my size (5'10'' 270 pounds) made for a very challenging work area. At one point they discontinued the procedure because they felt it was dangerous to keep me upside down for so long. I don't have to tell you, the day after the surgery I was pretty beat up. Amazingly though, they tell you to get up and walk, and somehow over the next few days you start to recover.
I hope you have read that being overweight will result in poorer outcomes for PC. I know how hard it is to drop a few pounds but you really need to put your focus on that area right now. For many people getting a cancer diagnosis is a big motivator to improve their overall health and may result in them living longer than they would have otherwise.
Thank you, Frank, for your comments. I know what you say is true. From diagnosis on June 30th to surgery on October 2nd, I lost approximately thirty pounds. I am continuing with the diet and have not varied even while recovering. I am hopeful that this will finally be the time that I take it off and keep it off.