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Thread: Post Op 9 months Gleason 9

  1. #21
    Senior User
    Join Date
    Aug 2017
    Posts
    164
    Cajun, I am higher risk, with a 9, but I started out with an 8, pre-surgery! And my RALP surgeon, even at GS8, said to plan on ADT and RT.

    Following surgery and the upgrade to 9, it was a no-brainer to him to continue the trifecta! And my subsequent, RO and MO agreed. The only real question for them, was whether I should have had surgery to begin with, but the damn MRI seemed to show that the PC was contained.

    As others have said, with much improved RT techniques and equipment, side effects are usually minimal. And my RO swears that my physical activity helped even more with the side effects (SE's). The exercise seems to help with the ADT SE's, too, as an aside!

    Best of luck and keep searching and studying and conferring!
    69 yr. old DOB 4/7/48 just W of St. Louis
    7/08-PSA 3.2 DRE norm
    7/11/17-PSA 51.2, 0 sympt
    7/24-DRE hard left, 31g
    8/11-Biopsy No PNI
    4 GS 7's, 5 GS 8's, 1 PIN, 1 Suspicious, 1 Benigh
    8/29-NUC/CT Scans (-)
    9/11-Prolaris T2b, 3.8/7, 10yr Mort Risk: 23.5%, Metast Risk: 29.6%.
    9/11-Consult w/URO Recom BT/RT/RALP
    10/12-Consult w/RALP SURG
    10/23-MRI 3T (-)
    11/15-RALP
    11/16-FINAL PATH,T3b, GS 9,70G, Pc 40%
    *Pelvic lymph Nodes 3/7 (+)
    *Margins + tumor involve (apex, prostatic urethra, & bladder neck)
    *SV's&PNi (+)
    *Periprostatic tissue (-)
    7/21-Lupron (6mo/45mg)/(Casodex 50mg)
    1/2/18-Axumin Scan (-)
    1/9-RO T level 20, Mtg RT plan
    1/31-Gold Markers
    2/6-Simulation
    2/20-4/16 IMRT/IGRT (25Tx 45Gy, 12Tx 66Gy)
    3/12 Bone Density - Normal
    5/22 PSA <0.10, T level 24
    5/30 Met w/MO - Lupron (6mo/45mg) stop Casodex
    11/14 Labs
    11/21/18 Meet w/MO - Lupron Injection

  2. #22
    Quote Originally Posted by john4803 View Post
    ... my RALP surgeon, even at GS8, said to plan on ADT and RT... the damn MRI seemed to show that the PC was contained.
    John (and Cajun) my MRI also showed my PCa was contained, and I had no idea what was to come. First post-op meeting with the Uro to have the cath removed he told me I would need salvage radiation in about six months. It wasn't until my first meeting with the RO that he said he wanted to put me on HT. Also he explained that I had 3 foci of EPE near the SV's and bladder neck.

    While I'm glad that so far it looks like everything is working out for the three of us, I'm wondering how the docs could have missed this. Someone on "that other message board" posted about SVI in a link named "I'm new here" (not my thread) but posted a link to a 2010 Japanese paper about predicting SVI from an MRI.

    The link can be found here: Nomogram to predict seminal vesicle invasion using the status of cancer at the base of the prostate on systematic biopsy ... I looked up my pre-op PSA and Gleason into the graph "M OHORI ET AL" in figure 1 and found that I had about a 60% likelihood of SVI.
    Late 2012: PSA 4, age 62 all DRE's 'normal'
    Early 2014: PSA 9.5, TRUS biopsy negative
    2015: PSA's 12, 20, Mar'16: PSA 25, changed Uro
    Jun'16: MRI fusion biopsy, tumor right base, 6/16 cores: 2-100%+2-40% G8(4+4)
    Aug'16: DaVinci RP, -SM, 11 LN-, 53g, 25% involved, PNI, 6mm EPE, BL SVI, pT3B
    Jan'17: started 18 months Lupron ADT, uPSA's ~.03
    May'17: AMS800 implanted, revised 6/17
    Aug'17: 39 tx (70 Gy) RapidArc IGIMRT
    Apr'18: Dx Radiation Colitis
    Aug'18: Dx Mesenteric mass presumed carcinoid
    Jan-Apr-July 2018: PSA's = 0.0, T=9 (still on Lupron)
    "Everyone you meet is fighting a battle you cannot see"
    Mrs: Dec 2016
    Dx stage 4 NHL/DLBCL, Primary Bone Lymphoma
    spinal RT boost+6X R-CHOP21+IT MTX via LP. Now in remission
    Read our story at CancerCoupleBlog.com

 

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