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Thread: Four years post RP

  1. #1
    Senior User
    Join Date
    Apr 2015
    Posts
    160

    Four years post RP

    It was four years ago today that I left my cancerous prostate at the Cleveland Clinic. Good riddance! As of my last PSA, I'm still in the Zero club and hope to stay that way for a long time. Aside from some annoying incontinence (apparently too light to consider surgical intervention), the whole thing is just a distant memory. I don't post much here, but do check in from time to time. Best of luck to all who are going through the process and I hope all experiences are as good as mine was.
    First PSA in 2005 at age 55 was 2.5. Slight rise each year until 9/2014 = 5.8. After 14 days of Cipro PSA=6.3 in Oct 2014. Dec 2014 PSA=8.2. June 2015 = 6.9
    Met with urologist Jan 2015, biopsy done 2/2/15, 6 cores left side, 6 cores right side, 3 cores transition zone. Gleason 6 (3+3) in both sides, transition zone negative. Bone scan and CT scans negative.
    Second opinion of biopsy by Cleveland Clinic: Left side, Gleason 3+3, one of three cores submitted, 25%, 3.0 mm. Right side, Gleason 3+3, two of three cores submitted, 100%, 50%, 5.0 mm,. Perineural invasion identified. Transition zone, benign prostatic tissue.
    DaVinci RALP on 9/9/2015 at the Cleveland Clinic. Final pathology: Gleason upgraded to 7 (3+4), 13 lymph nodes, seminal vesicles, and surrounding fatty tissue all negative. Positive surgical margin at urethral resection.
    Final staging pT3a

  2. #2
    Congrats, oshguy!! Keep up the good work! Just curious -- did you have extraprostatic extension noted in your path report? The path staging for positive surgical margins alone (SM+, EPE-, LNI-, SVI-) is usually pT2.

    Thanks,

    Djin
    Last edited by DjinTonic; 09-09-2019 at 03:10 PM.
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg., then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional
    SM EPE BNI LVI SVI LNI(16): negative, PNI+, nerves spared
    pT2c pN0 pMX acinar adenocarcinoma G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    11-10-17 Decipher 0.37 Low Risk: 5-yr met risk 2.4%, 10-yr PCa-specific mortality 3.3%
    Dry; ED OK with sildenafil
    9-16-17 (5 wk) PSA <0.1
    LabCorp uPSA, Roche ECLIA:
    11-28-17 (3 m ) 0.010
    02-26-18 (6 m ) 0.009
    05-30-18 (9 m ) 0.007
    08-27-18 (1 yr.) 0.018 (?)
    09-26-18 (13 m) 0.013 (30-day check)
    11-26-18 (15 m) 0.012
    02-25-19 (18 m) 0.015
    05-22-19 (21 m) 0.015
    08-28-19 (2 yr. ) 0.016
    Avg. = 0.013

  3. #3
    Welcome back oshguy! Congrats on passing the 4 Year Milestone! Glad all is well and RP is now fading in the rear view mirror.

    Keep in touch.

    MF
    PSA: Oct '09 = 1.91, Oct '11 = 2.79, Dec '11 = 2.98 (PSA, Free = 0.39ng/ml, % PSA Free = 13%)
    Referred to URO MD
    Jan '12: DRE = Positive: "Left induration"
    Jan '12: Biopsy = 6 of 12 Cores were Positive: 1 = G7 (3+4) and 5 = Gleason 6
    Referred to URO Surgeon
    March '12: Robotic RP: Left: PM + EPE. MD waited in surgery for preliminary Path Report then excised substantial left adjacent tissue(s) down to negative margins and placed 2 Ti clips for SR guidance, if needed in future.
    Pathology: Gleason (3+4) pT3a pNO pMX pRO c tertiary pattern 5 / Prostate Size = 32 grams / Tumor = Bilateral: 20% / PNI: present
    3 month Post Op standard PSA = <0.1 ng/ml
    1st uPSA at 7 months Post Op = 0.018 ng/ml
    uPSA remains "stable" at 91 Months Post Op: Mean = 0.022 (22x uPSAs: Range 0.017 - 0.032) LabCorp: Ultrasensitive PSA: Roche ECLIA
    Continence = Very Good (≥ 99%)
    ED = present

  4. #4
    Experienced User
    Join Date
    Apr 2019
    Posts
    78
    Quote Originally Posted by DjinTonic View Post
    Congrats, oshguy!! Keep up the good work! Just curious -- did you have extraprostatic extension noted in your path report? The path staging for positive surgical margins alone (SM+, EPE-, LNI-, SVI-) is usually pT2.

    Thanks,

    Djin
    The positive bladder neck margin alone will earn the upgrade.

    Glad to hear of your 4 years in the zero club oshguy!
    Wife Posting, Husband D.O.B. 1975
    2/2018 - routine physical PSA 15
    3/2018 - PSA 13
    4/2018 - PSA down to 11.6, free PSA, 18%
    6/2018 - PSA 10, free PSA 20%
    7/2018 - mp- MRI done, prostate volume =22cc, "inflammation consistent with prostititis"
    11/2018 - PSA 14, free PSA 11%,
    3/2019 - PSA 12, free PSA 17%, 2nd opinion on MRI = PI RADs 3 lesion
    4/2019 - Cognitive Fusion Biopsy
    5/12 cores positive
    4 Gleason 3+3
    1 Gleason 3+4 5% (Where PIRADs 3 lesion IDd)
    Decipher Biopsy score: .07 very low risk

    Bone scan negative
    MRI 6/19 said PIRADS 4 lesion, no definite EPE

    RRP 7/19 Final Path: pT3a
    G6 - 75-90%
    G7 (3+4) - 11-25%
    24mm tumor, 30% of prostate
    EPE+, BNI+, SM + (at bladder neck), LVI-, SVI -, PNI-, Nodes -
    Decipher Post RP score: .78, high risk
    6 week PSA = .015 (ultra-sensitive Labcorp)

  5. #5
    Quote Originally Posted by oshguy View Post
    It was four years ago today that I left my cancerous prostate at the Cleveland Clinic. Good riddance! As of my last PSA, I'm still in the Zero club and hope to stay that way for a long time. Aside from some annoying incontinence (apparently too light to consider surgical intervention), the whole thing is just a distant memory. I don't post much here, but do check in from time to time. Best of luck to all who are going through the process and I hope all experiences are as good as mine was.
    Congrats on being 4 yrs out.. I wish you a Lifetime of undetectable PSA
    DOB 5/76
    Age 42
    PSA 2017 n/a, 1/2018 2.66 1/2019 3.39 Reset 2/019 3.04
    MRI 3/2019 3 Lesions 2 Pirads 3 and 1 Pirad 4
    Biopsy 4/11/2019
    PCA positive- all grade group 1 and Gleason score 6(3+3)
    RMB: involving 10% of 1 core
    RMM: involving10% of the tissue (fragmented specimen).
    RMA: High-grade prostatic intraepithelial neoplasia.
    RLB: involving 25% of 1 core.
    RLM: involving 70% of the tissue
    RLA: involving 50% of 1 core.
    LMB: involving 80% of 1 core.
    Lesion #2, in 3 of 3 cores, involving 80%
    of total tissue
    RALP 6/5/19 USMD Arlington Dr Robert Parham
    Cath 6 days, bladder spasms, cath back in for 5 days
    Grade group 1, Gleason 6(3+3)
    SV, bladder neck invasion, adipose tissue, ECE, Margins, 0 of 8 lym- all negative, prostate confined~ PT2N0
    10% of prostate involved by tumor

    Quest Diagnostics: uPSA
    9/7/19 (3m) <0.02

  6. #6
    Experienced User
    Join Date
    May 2019
    Posts
    73
    Quote Originally Posted by AceVA View Post
    The positive bladder neck margin alone will earn the upgrade.
    Hi Ace, that caught my eye too. I suppose the positive margin could have been at the apex - which is common as there isn't much fat in that area to allow for a wide cut. Also, I think most surgeons use cauterization at the apex to better kill any residual cancer in that region. Certainly, positive margin at the base of the prostate can be more problematic as the bladder neck is right there.

    IG
    DOB: 10/1962

    6-01-15 PSA 2.5
    Having urination flow issue in first half of 2018. Flomax 6/1-6/21 - no help.
    6/25/18 PSA 14.25; Cipro 14 days
    8/1/18 PSA 17.44; rec. Urologist appt
    8/15/19 First Uro appt. + for bacteria. Cipro 4 weeks
    10/2/19 PSA 22.4; Still + for bacteria. Antibiotics 4wks
    12/28/19 PSA 27.5
    1/15/20 Biopsy results 6/12 cores positive - all left side; GS 4+3
    1/18/19 Bone scan and CT scan both negative
    2/15/19 Di Vinci RP
    2/18/19 Path report pT3a, GS 4+3 (60%+35%) 5% GS5, SM +, EPE +; LVI -, SVI -, LNI(9) - ; Tumor size: 3.5cmx3.5cmx1.5cm; single foci left side; right side nerves spared; SM+ at apex limited <1mm; benign prostatic cells at spared right nerve bundle. Prostate size 45gm.
    Cath out at 7 days: 100% continent with some ED; ok with 10mg Cialis.
    Decipher 0.73

    3/26/19 (6 weeks) 0.033
    5/10/19 (3 months) 0.010
    8/02/19 (6 months) 0.019
    8/30/19 (7 months-recheck) 0.024
    9/26/19 Started RT

  7. #7
    Senior User
    Join Date
    Apr 2015
    Posts
    160
    You guys are correct, the pT3a was due to microscopic extraprostatic bladder neck extension. My surgeon was confident that the cauterization would have killed any cancer cells remaining. Also, the pathologist made a note on the path report emphasizing that the extension was solely microscopic, hence the 3a designation.
    First PSA in 2005 at age 55 was 2.5. Slight rise each year until 9/2014 = 5.8. After 14 days of Cipro PSA=6.3 in Oct 2014. Dec 2014 PSA=8.2. June 2015 = 6.9
    Met with urologist Jan 2015, biopsy done 2/2/15, 6 cores left side, 6 cores right side, 3 cores transition zone. Gleason 6 (3+3) in both sides, transition zone negative. Bone scan and CT scans negative.
    Second opinion of biopsy by Cleveland Clinic: Left side, Gleason 3+3, one of three cores submitted, 25%, 3.0 mm. Right side, Gleason 3+3, two of three cores submitted, 100%, 50%, 5.0 mm,. Perineural invasion identified. Transition zone, benign prostatic tissue.
    DaVinci RALP on 9/9/2015 at the Cleveland Clinic. Final pathology: Gleason upgraded to 7 (3+4), 13 lymph nodes, seminal vesicles, and surrounding fatty tissue all negative. Positive surgical margin at urethral resection.
    Final staging pT3a

  8. #8
    Quote Originally Posted by IndyGuy View Post
    Hi Ace, that caught my eye too. I suppose the positive margin could have been at the apex - which is common as there isn't much fat in that area to allow for a wide cut. Also, I think most surgeons use cauterization at the apex to better kill any residual cancer in that region. Certainly, positive margin at the base of the prostate can be more problematic as the bladder neck is right there.

    IG
    BNI+ was changed from pT4 to pT3a in the penultimate (7th) edition of the TNM staging guide and recognized as a form of EPE (extraprostatic extension). It is distinct from a positive surgical margin at the prostate base (which, if no major adverse feature is present, would still be pT2).

    Djin
    Last edited by DjinTonic; 09-09-2019 at 09:13 PM.

  9. #9
    Senior User
    Join Date
    Feb 2017
    Posts
    174
    Congratulations, and many more undetectable PSA years to come.
    2010-PSA 3.59; 2011-PSA 3.58; 2012-PSA 5.28, 4.26; 2013-PSA 5.98, 7.37; 2014-PSA 5.90, 4.70; 2015-PSA 5.18, 7.35
    RALP 16 March 17, Wesley Long, Greensboro, NC
    Pathology: pT3a, pN1 Gleason 4+5=9 adenocarcinoma with + surgical margin at bladder neck; 3 of 16 lymph nodes positive; neg seminal vesicles, vasa deferens
    Referral to Dr. Ken Pienta, Clinical Dir Research, Brady Center, Johns Hopkins
    Enrolled in Clinical Trial IRB002120414 “Phase II Study of definitive therapy for oligometastatic prostate cancer post surgery"
    Completed: Docetaxel 12 Jun 17, 3 Jul 17, 24 Jul 17, 14 Aug 17, 15 Sep 17
    Lupron every 90 days for two years. Completed March 2019
    Bone/Body Scans - 15 Sep 17 - neg; 15 Mar 18 - neg; 14 Sep 18 - neg; 17 Mar 19 - neg
    EBRT: 69 Gy total (46 to fossa, 23 boost to suspect areas) 1st treatment 28 Sep 17, last 22 Nov 17
    PSA: 25 May 17=0.2; 5 Sep 17=0.1; 18 Dec 17=0.1; 6 Mar 18=0.1; 29 May 18=0.1; 5 Sep 18=0.1; 17 Dec 18=0.1; 12 Mar 19=0.1; 15 Jul=0.1

 

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