New Poster: Wife of Recently Diagnosed

Sephie · Regular Joined: 24 Apr 2008 Posts: 10

I'm new here but have been reading the posts on this board for a couple of weeks.

Here's our story: Hubbie is 57 and diagnosed on February 5 with a PSA of 6.4 (up from 4.7) . Had a TRUS with biopsy (10 samples taken). Dx came back PCa in left lobe with 2 out of 10 samples testing positive: sample one was 3+3 and sample two was 3+4. Perineural invasion was identified. Doctor called and told us the news and immediately said "don't panic ... we got this early." He ordered a CT scan and consultation within 2 weeks. At consult, told us that hubbie's PCa was a T1c with no lymph node or metastatic spread. Doctor said hubbie was excellent candidate for robot-assisted surgery which was scheduled for March 18. Surgery went off without a hitch (5 hours and 10 minutes - yikes!) and hubbie was released from the hospital 36 hours later. His biggest complaint was the catheter (which was removed 9 days later) and how much of an effort everything was. He "turned the corner" about 2 days after being released from the hospital, and his recovery has been very good to excellent.

The next shock came when we got a copy of the final path report. Up to that point, I wasn't aware that it's very common for the path report to upgrade the tumor stage which upgrades the overall stage. Here's the path report in a nutshell:

Invasive prostatic adenocarcinoma with GS of 7 (3+4). Gleason pattern 4 comprises 40% of invasive tumor present. Carcinoma confined to left lobe...pernineural tumor infiltration present with no blood vessel invasion identified. Tumor extension into capsule in multiple foci with solitary focus of extraprosdtatic tumor extension in posterior left. No tumor invasion of seminal vesicles present. Surgical resection lines of apex and bladder base free of tumor. High grade PIN in right lobe. Staging: T3a, NX, MX (Stage III).

Wow ... that's alot of words to describe what was taken out of my husband. Once again, I started to freak out over this report, and decided to speak with the urologist for a better understanding. Learned that upgrading is not uncommon at all and that is one of the reasons why an RP is so valuable. The tumor extension is miniscule and broke into the capsule not through it - an important distinction. Surgical margins and SV were clean - very good news here! So, the doctor said that he is very confident that he got it all but that he'll watch hubbie very carefully for the next 2 years (PSA test every 3-4 months). Should PSA go up, we'll resort to radiation but doctor again was confident that this won't be necessary.

First PSA 4 weeks post-op was 0.1 ... next PSA is scheduled 4 weeks later and the doctor is confident that hubbie's PSA will be down further (hopefully he'll get a zero on this test).

Sorry to burden you all with the gory details. I keep thinking about it all and worrying even though the doctors have told me not to. Hubbie is not the least bit worried - when he read the path report, he said "this tells me what was and confirms that surgery was the right choice for me."

Any words of wisdom from those of you who have been through this would be appreciated.

Thanks to everyone for your patience.

Replicant · Moderator Joined: 01 Nov 2006 Posts: 161

It's true that the surgical Gleason score is often different from the biopsy. 3+4 is better than 4+3. 3+4 behaves more like Gleason 6, and 4+3 behaves more like Gleason 8.

Negative margins--that's great!

I'd say your husband is justified in his statement. Those results are pretty good.

Everyone has to be vigilant after treatment; your husband is no exception.

Best wishes!
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1
http://pcabefore50.blogspot.com

sanjis · Regular Joined: 12 Oct 2007 Posts: 29

My husband is 55 and his PSA was 9.6. Gleason 6, then after surgery was updated to a 4 + 3. And report said High-grade prostatc inraepithelial neoplaplasia (PIN): Yes. No metastasis. pT2c Largest cancer dimension was 20mm. lymph nodes, none with metastasis. Adenocarcinoma is present at the Apex and Bladder base but not at the inked margin. (Asked and the doctor wasn't worried about this, but I am) There were also a couple of places that were a pattern 5 and rated 10%. Not a lot but still enough to worry. Hard to understand all of the report that is for sure. I know what you are going thru a lot of worry. Me too. So far the surgery was Dec. 13th and two PSA have come back undetectable. If any questions please ask and I will try to help.

Sephie · Regular Joined: 24 Apr 2008 Posts: 10

Thank you Replicant and Sanjis for your words of encouragement. I've actually started to calm down and have accepted that PCa is a chronic condition that requires monitoring and diligence. I have also begun to look at the positives in this (and there are always positives): the cancer has been removed, the surgical margins and seminal vesicles are clean, and we caught it before it broke through the capsule. Hubbie has his second - and I imagine definitive PSA - in about 3 weeks which puts him 9 weeks post-op. God willing, his PSA will be below 0.1 (his last reading) and this will be the baseline the doctor will use going forward.

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