Can anyone offer any input here? I recognise my case isn't as advanced or aggressive as it might be, and that I am in a better boat than many others - so I really appreciate anyone’s time spent reading or responding.
53 yrs. PSA 5.66 (Jan). MRI (Feb) PI-RADs 5, left side, T2a N0 M0. Biopsy (March), 9/10 cores G7(3+4), Grade 2. More in my profile.
Seven weeks after robotic RP (1st June), feeling good, recovered well. Had brief phonecall with Consultant after chasing them up for an appointment - histology has upgraded to 7(4+3), have a “touching margin” at nerve sparing area but “might be a tear”. “Get a first PSA, will monitor 3 monthly”, “Will speak in 6wks”, “Oh and I’ll send a letter to your GP and prescribe sildenafil”. He’s reasonably happy, nothing to be overly concerned about. Great.
Have now received my report and need some help interpreting. Main points below (with my thoughts bracketed)…
Surgical incisions: Absent (Good?)
Site: Right lobe, left lobe, multifocal. (Worse than previously understood?)
Dominant on left 19mm, 20% (No news)
Gleason: 4 + 3 = 7 with tertiary 5 (Gulp!)
High grade PIN: Yes (past that point?)
Confined to prostate: Yes (Good!)
Extraprostatic extension: No (Good!)
Invasion of seminal ves: No (Good!)
Involvement bladder neck detrusor: No (Good!)
Circumferential margin involved: Yes, left lobe posteriorly and laterally, Intraprostatic, <3mm (assume NOT good ??? Why is this one specifically called out as Intra, and next one not?)
Apical margin involved: Yes, <3mm (assume also NOT good ???)
Base margin involved: No (Must be good, got enough to worry about!)
Vascular invasion: Not identified (So…??)
Nodal status: No nodes sent (OK)
Additional info: extends into prostatic urethra (good that it’s out then, but does that hint at a potential for later bladder-based recurrence??)
So glad to have got it out, given the new grading and staging. Little to celebrate though as we move to the next step. I’ve been doing some research and am interpreting this report as…
a) mentioned margins are ‘positive margins’
b) because there’s 2, that’s ‘multiple’
c) based on several studies, presence of tertiary Grade 5 is significant to likelihood of recurrence
d) with multiple margins and a sprinkle of 5, my 15 year survival % and recurrence-free survival % just dropped significantly
e) Gleason 4+3 with 5, coupled with T2c should surely be considered more like Gleason 8 and/or T3, to be sure ?
If I’m over (or under!) thinking this please shout. Am back to the usual un-nerved anxiety that comes between receiving daunting information and either getting clarification or making an active decision.
Obviously first PSA is key (bloods this coming Wednesday) and there’s nothing to be doing until I get that. At this point am praying that it will be undetectable, obviously.