Just diagnosed at 41

Thank you and that is encouraging.  I just scheduled my PET PSMA for May 1 which is the soonest they had available, but told them I'll drop everything and head over if they get an opening last minute.  While I'm not looking forward to the side effects of an RP, I was already mentally preparing myself for it and my focus is being around and healthy for my wife and two young boys so I'm at peace with that.  You can probably guess my career by the screen name and this will definitely impact that.  I guess this kind of things really gives one perspective.

On a side note, I had not been to the VA hospital since right after I got out of the military 13 years ago.  They have a pretty bad reputation for quality of care with the public.  I was shocked at how great their service has been.  It's the quickest, most communicative care I have ever received.  When I quizzed them on what equipment they have, they said it's the newest of everything (MRIs, Da Vinci machine, PET PSMA stuff, etc).  Since I served in Iraq, this will all be considered service connected and I shouldn't have to pay a dime.  So at least there's a little bit of a silver lining.

Just a small update. I spoke with one of the urologists yesterday morning and they said 11 of my 20 cores came back positive.  60% of the positive were +3, 35% were +4, and less then 5% were +5 but that was supposedly insignificant?  I asked if all that was the reason the other urologist expressed concern about it possibly being aggressive.  He said he wasn't as worried about that, but that my PSA of 12.6 and young age made him think it WAS aggressive.  He said he unless the PSMA scan indicates it's metastisized, he'd be pushing me for RP.  I said I totally agreed and he could sign me up for asap even before the scan results come back.  I also asked if poor results from the scan would preclude the RP.  He said normally yes, but they do sometimes still do it if they think it could help and somebody at my age and relative fitness would be exactly who they would consider it for.

If you were planning to have children (or to have more children) ask about having your sperm frozen before the op.

I have a very positive update; PSMA scan says no metastasis.  Nothing in lymph nodes, bones, seminal vesicles, or anything outside of the prostate from what they could observe.  I haven't gotten the official feedback yet, but the doc called me literally before I had even gotten home from the scan to briefly tell me the results looked good with no spread.  I then went in to my online records and snooped around until I found notes on the subject.  I did note that they referred to my diagnosis as "intermediate risk & high volume disease" for whatever that's worth.

The FAA pulled my medical as soon as they got the biopsy results, but I'm hopeful that after the latest PSMA scan, they will let me go back to yelling at pilots until it's time for the RP.  Then I'll be in the back shuffling papers until I'm pronounced cancer free.

Edited by member 03 May 2023 at 18:17  | Reason: Deleted doctor's name

I was not aware. Thank you and corrected!  

Exactly.  That's why I do it (when earned) 😉😆

Okay, RP completed on 13th.  Almost zero issues with controlling my bladder after removing catheter on 19th.  Things were actually great the day of removing the catheter but have gotten much more sore and flow is very slow.  I also feel like I have to go almost constantly but nothing much is there which I find disconcerting.  Maybe UTI or maybe just sore?  I hope I didn't pop a stitch or something.

So follow up is on there 30th but I have been checking my records and my pathology report just dropped (I don't think they intend me to be able to see it yet but I have found where I can).  I think maybe it's not catastrophic news but not very good either?  Help me decipher it if you could:

"DIAGNOSIS

 PROSTATE AND SEMINAL VESICLE, RADICAL PROSTATECTOMY:

 ADENOCARCINOMA, GLEASON GRADE 3+4 (SCORE = 7, 

 GRADE GROUP 3), INVOLVING APPROXIMATELY 15% OF 

 PROSTATE BY VOLUME.

 SEMINAL VESICLES AND VAS DEFERENS UNINVOLVED.

 RIGHT POSTERIOR AND RIGHT ANTERIOR MARGIN POSITIVE.

 PERINEURAL INVASION.

 SEE SYNOPTIC REPORT.

 PROSTATE GLAND: RADICAL PROSTATECTOMY

 Procedure: Radical prostatectomy

 Prostate size:

 Weight: 53 g.

 Prostate size: 5.4 x 5.2 x 2.8 cm.

 Histologic type: Acinar adenocarcinoma.

 Histologic grade: Grade group 2 (Gleason score 3+4 = 7).

 Percentage of pattern 4: 10%

 Cribriform glands: Not identified.

 Treatment effect: No known presurgical therapy

 Tumor quantification:

 Estimated percentage of prostate involved by tumor: 15- 20%

 Extraprostatic extension: Not identified.

 Urinary bladder neck invasion: Not identified.

 Seminal vesicle invasion: Not identified.

 Lymph vascular invasion: Not identified.

 Perineural invasion: Present/identified.

 Margin: Invasive carcinoma present at margin.

 Margins involved by invasive carcinoma: Right anterior 

 and right posterior.

 Regional lymph nodes: Not applicable

 Distant site: Not applicable

 Pathologic stage classification (pTNM, AJCC eighth edition)

 TNM

 pT2: Organ confined

pNx: Not assigned (no nodes submitted or found).

 pMx: Not applicable."

Edited by member 22 Jun 2023 at 23:22  | Reason: Not specified

The bit about it being organ confined, no extraprostatic extension, and pT2--is that a favorable finding from pathology, or was that an established fact going in to the RP based on my PSMA scan?  I'm just trying to reconcile organ confined with positive margins meaning something likely escaped.  I just started researching adjuvant RT and resulting reoccurrence rates.  Not super encouraging as I had hopes to be done with this forever 🫤

The organ confined / no EPE / T2 just confirms your diagnosis from the biopsy and scans. 

There are two kinds of positive margin - interior and exterior. An exterior positive margin means that the cancer had broken through the gland covering and can be seen touching or passing the inked / wax edge. An interior positive margin means the surgeon has accidentally left a bit of the prostate behind - a medical error.

Statistics for recurrence are different depending on whether it is an interior or exterior margin. A positive margin does not necessarily mean that some cancer has been left in your body or that you will need further treatment - your PSA results over the next couple of years will tell you.