Results not so good

User

Posted 17 Dec 2024 at 22:15

Hi, my husband was diagnosed with prostate cancer in September.

MRI one PIRADS 5 and two PIRADS 4

PSA, 7.6

Biopsy, Gleason 4+3=7

PMSA No spread

Robotic surgery 2 weeks ago no lab results yet.

Was advised that as the prostate was full of cancer surgery was the best way to go. They tried to save the nerve bundles but said that it was too risky and took both out due to bulging on one side.

My question is with both bundles gone will he ever regain continence.

He is pretty dry at night and at first was only leaking occasionally but over the last few days a bit more leakage.

Thanks in advance.

Edited by member 15 Jan 2025 at 19:06 | Reason: Not specified

User

Posted 16 Jan 2025 at 08:44

Hi Casey,

While your husband's histology results aren't the best news, his cancerous prostate has been removed and his latest PSA result is undetectable. This is good news. He'll be having regular PSA tests so I don't think you will need to make a decision about salvage treatment just yet (if ever). Adrian makes a good point that his PSA is still undetectable two years after a G9 T3A.

My post op histology showed a positive margin and my PSA was undetectable for a good 18 months before it started to rise. I had SRT in 2022 and my PSA is now undetectable.

At least for now, you and your husband can focus on his post op recovery and address the challenges that brings. If his PSA does start to rise at some point in the future, then you can and ask for a referral to oncology.

Good luck,

Kev.

User

Posted 18 Dec 2024 at 08:16

Thanks very much for the welcome, I am pleased to hear it is possible. Dr Google says its unlikely with the bundles removed.

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User

Posted 18 Dec 2024 at 00:20

Casey , nerve bundles are more related to erections rather than continence. I was non nerve sparing but 4 days after catheter removal I was 99 percent dry.

Thanks Chris

User

Posted 18 Dec 2024 at 05:55

Hi Casey.

Sorry that you've had to join our club, but welcome to the forum.

As Chris said the lost nerve bundles affect your husband's ability to get a natural erection rather than effecting recovery from incontinence.

He must have only very recently had his catheter removed and appears to be doing very well.

I had non nerve sparing surgery two years ago. It took about 6/7 months to regain full continence, which I believe is about average.

Unfortunately however, I am unable to get an natural erection anymore and have to use erection dysfunction drug injections.

I wish you both well and hope that you continue to update us on your husband's recovery.

Best of luck.👍

User

Posted 18 Dec 2024 at 08:16

Thanks very much for the welcome, I am pleased to hear it is possible. Dr Google says its unlikely with the bundles removed.

User

Posted 15 Jan 2025 at 05:59

Well we got the histology results today.

Not so good.

Has been upgraded from gleason 7 to 9 and has breached the prostate so T3a.

There was also a small focal point on the margin not clear. Not sure what this means for now apart from 3 monthly psa checks.

Would it be better to get radiation now or wait for the psa to rise?

Thanks

User

Posted 15 Jan 2025 at 21:10

Casey, have you actually been offered immediate radiation treatment?

I believe there is an ongoing trial comparing those two approaches, but it probably is one that will look at ten year outcomes.

(I know, because I was offered entry to the trial after my histology showed a small area with a positive margin. I didn't join the trial because I had made the difficult decision over treatment on the basis of the risk of long term radiation effects, but in the event I needed salvage radiotherapy anyway after 6 years).

User

Posted 15 Jan 2025 at 21:25

Hi, no he hasn't been offered radiation as we are just seeing the surgeon. He hasn't referred us to an oncologist as yet.

I just wonder if it is better to ask him to refer us and maybe start treatment earlier rather that later. It a good point that radiation can cause issues down the line and thats why he chose surgery instead.

Thanks

User

Posted 15 Jan 2025 at 21:46

Hi Casey.

I had a very similar post op histology showing, Gleason 9 (4+5) and T3a with extraprostatic extension I was fortunate to have negative margins. Although your husband has a positive margin, I'd have thought that they'd wait for a first PSA check prior to any further treatment, but I might be wrong.

I had my op two years ago and my PSA checks (every three months) have all been undetectable.

Edited by member 15 Jan 2025 at 23:29 | Reason: Spelling

User

Posted 15 Jan 2025 at 22:42

Hi Adrian

They have done a PSA this week before the appointment which is undetectable. I have done some research on the focal margin and it says less than 3mm. I am not sure whether its Gleason 4+5 or 5+4 they both seem not so good.

Fingers crossed the PSA stays this way for a while.

I was under the impression that if he had a positive margin they would do radiotherapy as a salvage treatment but he never mentioned it at the appointment.

Thanks

User

Posted 15 Jan 2025 at 23:15

Originally Posted by: Online Community Member

It a good point that radiation can cause issues down the line

True, but statistically the chances are quite low. Sorry I can't give you any figures but Lyn did post them here a while back.

Jules

User

Posted 16 Jan 2025 at 08:44

Hi Casey,

My post op histology showed a positive margin and my PSA was undetectable for a good 18 months before it started to rise. I had SRT in 2022 and my PSA is now undetectable.

Good luck,

Kev.

User

Posted 16 Jan 2025 at 09:21

Hi Kev

Thanks so much for your positive reply. We were knocked over by the results and it feels like life has changed forever.

We will wait to see what the next PSA result is and try to get used to a new normal.

Cheers Casey

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