13 days post RP op

User

Posted 17 Apr 2018 at 07:56

Hi, my OH had his op 13 days ago following a disgnosis in March. His PSA was 7.6 and is Gleason 3+4=7. The surgeon said the cancer had gone outside the capsule and removed one nerve bundle sparing the other side.

Catheter came out last Wednesday. He is still in quite a lot of pain where it came out but I suppose it’s still early days. He is dry during the night and wears a pad during the day but so far this is better than we’d hoped.

The prostate was removed and it was analysed by a pathologist while my husband was on the table by Neuro Safe. I don’t know if this is common but apparently it helps the surgeon to see where the cancer is and remove more tissue if required which is what they did in my husband’s case.

Obviously We are dreading the 6 week meeting with the surgeon regarding the histology of his prostate. What I would like to know is what determines whether or not he will require radiotherapy? I read somewhere that because the cancer has gone outside the prostate and was T3a that radiotherapy would be automatic but not 100% sure about this.

Any advice would be greatly appreciated.

Do as you would be done by

User

Posted 18 Apr 2018 at 12:55

Hi Sue,

You are right that the members who stay with this forum are largely those who have ongoing issues, so there are certainly those who do not need further treatment for quite a time if at all. One of the reasons why there is a greater risk of recurrence in the UK is that in many cases the PCa is not found early enough.

The jury is still out on whether RT it should be given early after Prostatectomy or later if rising PSA indicates the need, although there seems to be a move towards the former. However, there are cases where the surgeon, perhaps backed up by pathology, consider that in a given case early RT is advisable or can be reasonably left until such time as PSA and possibly further scans might show this could be beneficial.

As regards it possibly being considered barbaric to have treated PCa by surgery in the future, the same may be thought about radiation! There are a number of treatments being investigated including more advanced immunotherapy, http://www.dailymail.co.uk/health/article-5623197/Immunotherapy-treatment-game-changer-cancer.html
and alternatively one day men might just be vaccinated so they won't have this rotten disease, hopefully.
Meanwhile, whilst there is still a long way to go, men diagnosed recently have a greater chance of a better outcome, even with current treatment options.

Barry

User

Posted 17 Apr 2018 at 20:31

Sue

Similar stats to your OH except I was 4+3 not 3+4. I am just coming up to the 4th anniversary of my RARP.

Back then RT straight after surgery was not automatic but as in my case was more down to surgeon/urologists preference. Three years post RARP I started salvage RT. Based on other guys stats I did sometimes wonder why I had not had ART.

My surgeon said many men would be over treated by adjunctive radiation therapy. Equally many men would be under treated by not having ART.

I am sure some of our more knowledgeable members will explain your situation in more depth.

Thanks Chris

User

Posted 17 Apr 2018 at 23:24

Sue

Yes PSA took thirty four months to rise from 0.03 post to 0.27. Post surgery my hospitial does PSA at 6 weeks then three months for a year then six months for second year. I had three monthly tests throughout because of the rises and fluctuations. Our hospital uses the criteria that at 0.1 PSA post op you are referred back to the consultant some hospitials say 0.2 before being referred back to the consultant.

There does seem to be too many men having to have RT after surgery. As you say perhaps the guys who do well no longer post. A guy at my local support group had open surgery 18 years ago and did not need any follow up treatment for his cancer, he still suffers side effects but that was his choice not to have further intervention.

Not sure if you were advised to download the toolkit in previous posts, but well worth getting.

Thanks Chris

User

Posted 18 Apr 2018 at 07:51

I was t3a post surgery (T2B before)

My surgeon offered me the choice of a trial for t3a where half have ART and half don't, he said this trial was large and would definitely prove if ART saves or blights lives. Unfortunately it still has years to run so it is no use to you yet.

I actually declined the trial because of his advice that my tumour was "only just" a T3 and my Gleason was 3+3 so he thought SRT was the way to go if I ever need it (find out at the end of the month!!!)

User

Posted 18 Apr 2018 at 08:21

Hi Sue

I was T3a post opp. Gleeson 3+4. PSA 6.4. Extracapsular extension. Microscopic negative margins.

I asked my uro about RT just to make sure. He said they wouldnt do it unless PSA becomes detectable due to side effects and risks of side effects from opp being made worse.

So far PSA is undetectable after 14 months so fingers crossed hopefully the right decision for me.

Good luck to your OH with his recovery.

Cheers

Bill

Edited by member 18 Apr 2018 at 08:47 | Reason: Not specified

User

Posted 18 Apr 2018 at 09:27

Hi Sue, I was T3a after radical prostatectomy in July 2015 with intraductal cancer in addition to adenocarcinoma.

Negative margins, nerves preserved on one side.

I was also offered to participate in the radicals trial where half get ART and half don’t.

My surgeon explained that in his view my healing post op would stop if I had ART.

He spent a while explaining that it is very difficult to know where the cancer cells are when PSA starts to rise.

If it’s a local recurrence i.e. in the area where the Prostate used to be then radiotherapy has a good chance of curing any recurrence.

But if the recurrence is metastatic then why get all the side effects of radiotherapy for little or no gain.

I read somewhere that some men already have metastatic disease before they have a prostatectomy.

Unfortunately for me my PSA started rising rapidly a year or so after surgery. It went from 0.3 to 0.7 in around 10 weeks.

In this case my oncology team have told me there is a high chance I have metastatic disease but it isn’t at a point where imaging will pick it up.

If you read my profile you will see that I had SRT last year and am on HT.

This is an area that needs to be researched and worked on as too many of us have surgery and then need SRT plus HT.

Do I wish I had ART? Perhaps but until tests can tell us which man needs further intervention and which man doesn’t I think I would make the same decision again.

I wish you and your husband all the best and hope surgery will have done its job.

Ian

Ido4

User

Posted 18 Apr 2018 at 11:05

Contrary to Bill's experience, our hospital has been part of a trial where all men are offered RT straight after RP regardless of stage or pathology. The urologist told me that they are expecting to monitor these men and show that the recurrence rate at 10 years is much lower than with RP alone.

It does seem that there are more cases of biochemical recurrence - European data shows that recurrence is slightly more likely with robotic / keyhole than with open RP and at the national urological cancer conference in recent years the discussion has tended towards a belief that RP will eventually become archaic - that future generations will be shocked that we ever did this to men.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

Show Most Thanked Posts

User

Posted 17 Apr 2018 at 20:31

Sue

Similar stats to your OH except I was 4+3 not 3+4. I am just coming up to the 4th anniversary of my RARP.

My surgeon said many men would be over treated by adjunctive radiation therapy. Equally many men would be under treated by not having ART.

I am sure some of our more knowledgeable members will explain your situation in more depth.

Thanks Chris

User

Posted 17 Apr 2018 at 21:53

Thanks Chris

I presume your PSA started rising. Is that why you had SRT?

Is it the norm that the PSA is monitored and if it rises then SRT is recommended?

It just seems that a lot of people who have surgery end up having SRT at some point. Are there any members on here who haven’t had to have SRT or maybe they are ok so have left the forum.

Sorry, I find It all a bit confusing.