Post op concern

User

Posted 13 Oct 2017 at 22:25

Hello,

I have had radical prostatectomy surgery In August and my Histology report showed a positive margin that I had a small spread to my bladder neck. My surgeon took away extra tissue in the affected area during my operation. I am just after getting the results of my psa and was told that it was undetectable which is fantastic but my urologist still wants me to see an Oncology team for discussion.

Does this s mean that there is still a risk that some of the cancer that had spread towards my bladder neck might still be there even though my psa score is good ?

User

Posted 31 Oct 2017 at 11:59

Hi Enda

Umm .. What was your PSA (6 week post op) and how many dec places. ? Have you had just the single PSA (post op) test ?

ColwickChris - summarises well - over treatment or not ? umm ?

Op in Aug - RT in Jan 5 months ? What about asking for PSA test now + plus early Jan then make decision ? (with subsequent quarterly tests ).

Say these were all < 0.001 (I don't know your value). I assume MDT advising RT and will target prostate bed ? From what I understand there is no 'capsule', easily defined/ delineated membrane around prostate and bladder neck area is especially difficult for surgeon. So effectively you could have clear margins (like myself) yet I was given T3c . I do ask the consultant a fair deal (my op was Feb 2015) however no idea exactly where the tumours/ lesions were all positioned within the gland. When he drew them for me, they were all very small, scattered randomly it seemed. Again not unusual from his reaction.

Hope this helps ..

Regards

Gordon

Edited by member 31 Oct 2017 at 12:11 | Reason: Not specified

User

Posted 15 Oct 2017 at 14:47

Hi Clare,

I had the standard biopsy 2 years ago and came back clear.

My psa kept creeping up to it was at 9.4 and my Oncologist rang me to say that he was getting a new piece of kit in to do the new transperineal biopsy which he wanted me to avail of. I had an mri scan done first then the biopsy which was under a general anaesthetic. The scan showed 3 shadows on my prostate which with the new biopsy were able to measure and take samples exactly where the shadows were. These turned out to be 3 small tumours which were all positive.

Only if or my urologist I would probably still be walking around not knowing that I had cancer so I have a lot to thank him for. As thev tumours weee small they thought that they were non aggressive and unlikely to have spread outside my prostate so I went for the operation in Cambridge. I was a bit surprised and disappointed that the Histology report said that it had spread slightly but my surgeon took extra tissue away during my operation so hopefully he got everything .

Just now have to wait until I see my oncologist now.

Hope this is a bit helpful to you and the best of luck.

User

Posted 15 Oct 2017 at 19:02

Edna

I had positive margins and an extraprostatic extension yet my PSA was only 0.03. Unlike Bri I was not offered adjunctive RT, Following a slow rise in my PSA my team kept saying it might level off below 0.1 but three years post op my PSA was 0.27 and I started 33 sessions of Salvage RT. At my histology meeting I was warned that there was a 30 percent chance of recurrence. My last PSA a couple of months ago post SRT was 0.08. There is an argument that adjunctive RT can be "over treatment" but in my case not having adjunctive RT could be classed as "under" treatment. A difficult choice to make.

Thanks Chris

User

Posted 16 Oct 2017 at 21:47

Thank you Enda,

Really appreciate the Intel, thank you for sharing..

Good luck for the oncologist meeting

Regards

Clare

User

Posted 31 Oct 2017 at 23:35

Gordon.

That is why following surgery the RT is often more scatter-gun rather than pin point in the hope that at least some of the dose hits the affected area.

Barry

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User

Posted 14 Oct 2017 at 08:28

Hi
Undetectable usually means a reading below 0.1. However, with a positive margin you will be classed as 'high risk'. There is a chance that there will be some remaining PCa cells but equally he may have got them all. The discussion with oncology will be about the probability of further treatment e.g. Adjuvant radiotherapy.
Usually in these circumstances they will monitor the PSA before deciding on further treatment. It may be helpful if you can share more information about your dx e.g. Gleason score, pre-op PSA, histology results.

Hopefully your PSA will remain stable.

You can read my profile by clicking on my avatar. I had follow up RT after my operation

Bri

User

Posted 14 Oct 2017 at 16:40

Thank you Brian for your feedback .

My Gleason Score went from a 6 (3+3) pre-op to a 7 (4+3) after Histology report.

My results were pT3a Nx Mx !

User

Posted 15 Oct 2017 at 09:21

Similar to me. I would discuss your histology report with the oncologist and seek their clinical opinion. I suspect the surgeon has suggested oncology due to the T3a following the op.

As I said in my previous post I had adjuvant RT as my PSA went from 0.06 to 0.087 in 4 months. Still small numbers but an increase. Others would have waited to see what the PSA did. My oncologist recommended RT so I followed her advice. I'm due my PSA test but 7 months ago it was 0.02 so the RT did something 👍

Let us know what the say.

Bri

User

Posted 15 Oct 2017 at 12:19

Hi Enda,

So sorry to hear about your regrade and apologies for jumping on your thread but do you mind me asking the diagnostic route that gave you the Gleason 6(3+3) diagnosis. Can I ask what sort of biopsies/ scans you had?

My husband is diagnosed at G6 and having not chosen a radical option of treatment the risk of a higher G grade/ spread like you is always a concern.

Seeing the urologist tomorrow so your story caught my attention.

Hope you don't mind me asking.

Clare

User

Posted 15 Oct 2017 at 14:47

Hi Clare,

I had the standard biopsy 2 years ago and came back clear.

Just now have to wait until I see my oncologist now.

Hope this is a bit helpful to you and the best of luck.

User

Posted 15 Oct 2017 at 19:02

Edna

Thanks Chris

User

Posted 16 Oct 2017 at 21:47

Thank you Enda,

Really appreciate the Intel, thank you for sharing..

Good luck for the oncologist meeting

Regards

Clare

User

Posted 31 Oct 2017 at 09:05

Hi Bri,

I have had my consultation with my Oncologist yesterday and have reached the conclusion that I would benefit from 6 weeks of RT which will start early January.

My consultant discussed all pros and cons which is what they have to do but I am slightly worried as they say that I could have a relapse of my side affects from my prostatectomy op of which I am recovering very well.

As you have went through the RT treatment could you let me know how you got on with it please Bri ?

Thanks

Enda

User

Posted 31 Oct 2017 at 11:59

Hi Enda

Umm .. What was your PSA (6 week post op) and how many dec places. ? Have you had just the single PSA (post op) test ?

ColwickChris - summarises well - over treatment or not ? umm ?

Op in Aug - RT in Jan 5 months ? What about asking for PSA test now + plus early Jan then make decision ? (with subsequent quarterly tests ).

Hope this helps ..

Regards

Gordon

Edited by member 31 Oct 2017 at 12:11 | Reason: Not specified

User

Posted 31 Oct 2017 at 23:35

Gordon.

That is why following surgery the RT is often more scatter-gun rather than pin point in the hope that at least some of the dose hits the affected area.

Barry

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