Upstaging of PC after radical prostatectomy

User

Posted 09 Jun 2026 at 12:26

My husband was diagnosed in Nov 2025. Gleason 4 + 3, grade 3, T2c N0 MX with a PSA of 11.9.

MRI scan (Nov 2025) - showed as contained. CT scan in Dec 2025, showed there was a shadow outwith the prostate which prompted another scan in Jan 2026 - this time a PSMA-PET scan which showed contained.

He had his operation in February 2026. Cancer was outwith the prostate, in seminal vessels and in 2 lymph nodes. (27 in total were taken).

Cancer staging has now been upgraded to T3b N1 R0.

Surgeon said he never trusts scans!

Thankfully all margins are clear at the moment. Waiting for a blood test in the next few weeks.

User

Posted 10 Jun 2026 at 09:10

Hi, Ism1408.

Welcome to the forum. I'm sorry it has taken longer than usual for anyone to respond to your first post. That's probably due to it being exceptionally quiet on here recently.

It's quite common for the cancer grade and sometimes the staging to be upgraded following prostatectomy.

My post operation histology results were upgraded from T2, prostate confined, Gleason 8 (3+5) to T3a, extraprostatic extension, Gleason 9 (4+5)

Your case shows that no matter what scan is used they are not perfect at detecting the disease.

Like your husband, I had negative margins. T3 disease does increase the risk of biochemical recurrence, but fortunately, over three years after my surgery, my PSA is still undetectable.

I hope your post operative PSA test is favourable, and that your husband makes a full and speedy recovery.

Good luck. 👍

Edited by member 10 Jun 2026 at 09:15 | Reason: Typo

User

Posted 10 Jun 2026 at 13:22

That's one of the things with PCa, so many uncertainties. Biopsies can also miss tumors even the most aggressive ones, so clinicians can find it quite challenging. Having said that, advances in imaging coupled with better biopsies has led to improved diagnosis.

Hope surgeon got all the cancer.

Barry

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User

Posted 10 Jun 2026 at 09:10

Hi, Ism1408.

Welcome to the forum. I'm sorry it has taken longer than usual for anyone to respond to your first post. That's probably due to it being exceptionally quiet on here recently.

It's quite common for the cancer grade and sometimes the staging to be upgraded following prostatectomy.

My post operation histology results were upgraded from T2, prostate confined, Gleason 8 (3+5) to T3a, extraprostatic extension, Gleason 9 (4+5)

Your case shows that no matter what scan is used they are not perfect at detecting the disease.

Like your husband, I had negative margins. T3 disease does increase the risk of biochemical recurrence, but fortunately, over three years after my surgery, my PSA is still undetectable.

I hope your post operative PSA test is favourable, and that your husband makes a full and speedy recovery.

Good luck. 👍

Edited by member 10 Jun 2026 at 09:15 | Reason: Typo

User

Posted 10 Jun 2026 at 13:22

Hope surgeon got all the cancer.

Barry

User

Posted 11 Jun 2026 at 09:12

That was quite an advanced cancer so it was good the surgeon got the lymph nodes too.

Would be useful to know if the PSMA PET scan missed the lymph nodes because the cancer did not express PSMA OR because the infiltrated nodes were so close to the bladder / Prostate that they were obscured by the excreted PSMA tracer.

Fingers crossed for a "less than <) on his first post op PSA.

User

Posted 12 Jun 2026 at 16:25

Thank you for your replies.

Not sure why the PSMA PET scan missed the spread in January. It certainly was a rollercoaster of emotions! He’s only 56 and this all came out of the blue - only went to the doctors as he was feeling so tired all of the time.

His 6 week PSA check at the end of March was undetectable thankfully, going for another check at the end of this month.

The surgeon did say that he definitely made the right choice with surgery as he has “one more bullet” with RT if it makes an appearance again. He wouldn’t have that chance if he had opted straight for RT.

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