Unsure as to severity of diagnosis

Probbo,

In previous posts you have stated that your biopsy was 8 (4+4), but I don't see an initial staging as a result of your MRI, but given you were steered down the route of RP as opposed to RT, I'm guessing that it may have been T2b or T2c, this would have put you in CPG 4 and that would be consistent with you been told the cancer had not escaped the prostate capsule, however the T3a staging can be subjective for instance the person who originally looked at my MRI scan deemed it T2c however 2 MDT teams have since reviewed it and each had assessed it as T3a..

Unfortunately your post RP histology was upgraded to 9 (4+5) and staging confirmed as T3a with the capsule been breached, taking the forum as being fairly representative it would seem histology upgrades are not uncommon. The Gleason score alone would have placed you in CPG 5, the highest risk group.

I'm not sure whether you've had a PSMA scan before the HT which detected cancer, or if they are going to irradiate the pelvic bed, which your pattern of PSA increase and their experience is telling them that is where there stray cancer cells will be, but either way hopefully they will kill the cells and you will be in long term remission.

Adrian, I'm assuming they assessed the risk of recurrence as much less than 70% pre op?

Also as time goes by surely the chance of recurrence diminishes, either way, long may you continue to defy the odds

Adrian

I was intrigued by your comment that the chance of recurrence does  not go down the longer your PSA remains undetectable.

Could I ask what this is based on please as I have seen numerous research papers which seem to show the contrary - happy to post some links if that would be helpful.

Kevin

Have you had a recent biopsy or some scans and if so what were the results?

In your situation, without a prostate, the psa clearly suggests recurrence and the most likely source is the prostate bed but that's guesswork and it could be glands or maybe seminal vesicles.

Do you mind sharing your age here?

Jules

Probbo, Richard has covered it well. You could ask your oncologist exactly what they intend treating with RT; the prostate bed, the seminal vesicles and maybe some lymph glands? Basically, it would be good to know exactly what judgement on spread the oncologist is working on.

With a G9 it's not surprising that you had some extra-capsular extension but at the same time your psa was low at 5 and you're relatively young, so RP was an understandable choice . The "high grade" pretty much goes with the G9 rating, so it's not any more menacing than the G9 itself.

Jules