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Thread: Ductal Cancer Question

  1. #1
    Regular User FredS's Avatar
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    Ductal Cancer Question

    I've been wondering if I should have more tests since the pathology exam after surgery indicates ductal adenocarcinaoma. I'm reading online articles that appear to say that ductal cancer is worse than other cancers.

    When should they give me a CT scan or other type test for spread of cancer? I'm grateful that my first PSA after surgery is 0 but still worried. Thanks for any help. Fred
    Age 71
    Robotic Surgery Nov 28, 2012

    Post surgery report 11/30/12:
    Sections show extensive mixed pattern adenocarcinoma (Gleasons 4+4) present in all four quadrants of the prostate. The tumor is comprised primarily of acinar-type glands that exhibit a gleasons 4+3 pattern. Some areas of ductal adenocarcinoma (Gleasons's 4+4) are also identified. Adenocarcinoma is seen focally at the apex margin and focally on the right capsular margin. Tumor is fairly extensively present at the bladder neck margins. Seminal vesicles are negative. Lymphovascular invasion and perineural invasion is not identified.

    PSA Numbers:
    1/14/2013 0.00
    9/19/2012 8.15
    1/23/2012 4.45
    11/18/2011 5.70

  2. #2
    Moderator Top User HighlanderCFH's Avatar
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    Hi,

    I can't say for certain since I'm not a doctor, but could be that they will keep a close watch on your PSA. Sounds like they are doing this now since your first post-op PSA test was about 6 weeks instead of the usual 3 months. The zero reading, of course, is what you want to see. They may suggest watching the PSA now to see if it begins to rise and, if so, the doubling time, etc.

    I could be wrong, but any potential local spreading at this early juncture might be too microscopic for a CT scan to pick up. That's why regular, frequent PSA tests are so valuable. They can be the leading indicator.

    It is still very possible that you are cured, but keeping on top of those PSAs every 3 months (I'm sure they'll recommend this) is the way to keep ahead of things just in case.

    Good luck!
    Chuck
    July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA 9/ 2011 = 5.7.
    Local uro DRE revealed significant BPH, no lumps.
    PCa Dx Aug. 2011 age of 61.
    Biopsy DXd adenocarcinoma in 3/20 cores (one 5%, two 20%). T2C.
    Gleason 3+3=6. CT abdomen, bone scan negative.
    DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
    Surgeon was Dr. Matthew Tollefson, who I highly recommend.
    Final pathology shows tumor confined to prostate.
    5 lymph nodes, seminal vesicules, extraprostatic soft tissue all negative.
    1.0 x 0.6 x 0.6 cm mass involving right posterior inferior, right posterior apex & left
    mid posterior prostate. Right posterior apex margin involved by tumor over 0.2 cm length,
    doctor says this is insignificant.
    Prostate 98 grams, tumor 2 grams.
    Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
    Post-op exams 2/13/12, 9/10/12, 9/9/13 PSA <0.1
    Semi-erections with continued improvement.

  3. #3
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    Quote Originally Posted by FredS View Post
    I've been wondering if I should have more tests since the pathology exam after surgery indicates ductal adenocarcinaoma. I'm reading online articles that appear to say that ductal cancer is worse than other cancers.

    Thanks for any help. Fred
    First of all, congratulations for an undetectable first post op PSA reading. Hopefully, your surgeon was able to remove all of the prostate cancers from your body.

    Second, I don't think you should worry too much at this stage. From the medical journal articles I read, the overall survivals of ductal prostate cancer were no different from the "garden variety". The pathology community does as a matter of policy, assign a Gleason grade 4 to ductal cancer and as a g4 it is no different in aggressiveness than the garden variety adenocarcinoma grade 4.

    Third, if it spreads, whatever treatments that work for adenocarcinoma also work for ductal.

    I do want to mention that since it is quite rare, there are conflicting articles, some said ductal are more aggressive, others actually said they found longer survival. However, a number of articles did say that if they metastasized, they sometimes went to organs like lung and liver instead of bones. So, monitor your situation carefully and hope for the best.

    Good luck and welcome to the zero club and hope you stay there a long time.

    Please note that I am just a layperson and my opinions are not from any formal healthcare trainings.
    PCa Dx at 65. PSA 2.5 in 2000, 8.4 in 6/09. Three negative biopsies in between. 6/10 PSA 10.7, biopsy 1 of 12 cores 5% cancer, Gleason 3+3
    CT, bone scans & MRI all negative
    Da Vinci 8/10; nerve sparing, catheter out in 7 days; no incontinence, no ED
    Post Op Pathology pT2N0Mx: organ confined; negative margins; lymph nodes & seminal vesicle not involved but PNI present; cancer extensive within prostate, multifocal G 3+3 and tertiary G 4+
    9/10, 12/10, 3/11, 6/11, 6/12, 6/13, 12/13 PSA <.1

  4. #4
    Regular User FredS's Avatar
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    Thank you both for your feedback. I think I'm supposed to have a PSA test every 6 weeks so you must be right about the doctor following my PSA closely. If I can get several more zeros under my belt, I'll feel a lot better. But if the number goes up, I'll do whatever is necessary.

    I appreciate your being willing to give your opinion. It helps. I'll keep you updated. My next PSA test is March 8.

    Fred
    Age 71
    Robotic Surgery Nov 28, 2012

    Post surgery report 11/30/12:
    Sections show extensive mixed pattern adenocarcinoma (Gleasons 4+4) present in all four quadrants of the prostate. The tumor is comprised primarily of acinar-type glands that exhibit a gleasons 4+3 pattern. Some areas of ductal adenocarcinoma (Gleasons's 4+4) are also identified. Adenocarcinoma is seen focally at the apex margin and focally on the right capsular margin. Tumor is fairly extensively present at the bladder neck margins. Seminal vesicles are negative. Lymphovascular invasion and perineural invasion is not identified.

    PSA Numbers:
    1/14/2013 0.00
    9/19/2012 8.15
    1/23/2012 4.45
    11/18/2011 5.70

  5. #5
    Moderator Top User HighlanderCFH's Avatar
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    Nov 2011
    Location
    Highland, Indiana
    Posts
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    Here's wishing for another great test on March 8!

    Chuck
    July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA 9/ 2011 = 5.7.
    Local uro DRE revealed significant BPH, no lumps.
    PCa Dx Aug. 2011 age of 61.
    Biopsy DXd adenocarcinoma in 3/20 cores (one 5%, two 20%). T2C.
    Gleason 3+3=6. CT abdomen, bone scan negative.
    DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
    Surgeon was Dr. Matthew Tollefson, who I highly recommend.
    Final pathology shows tumor confined to prostate.
    5 lymph nodes, seminal vesicules, extraprostatic soft tissue all negative.
    1.0 x 0.6 x 0.6 cm mass involving right posterior inferior, right posterior apex & left
    mid posterior prostate. Right posterior apex margin involved by tumor over 0.2 cm length,
    doctor says this is insignificant.
    Prostate 98 grams, tumor 2 grams.
    Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
    Post-op exams 2/13/12, 9/10/12, 9/9/13 PSA <0.1
    Semi-erections with continued improvement.

 
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