CancerCompass message board discussion started by DARDANELLE on 3/9/2008 http://www.cancercompass.com/message-board/message/all,21832,0.htm Tue, 07 Oct 2008 00:00:00 GMT Tue, 07 Oct 2008 00:00:00 GMT http://backend.userland.com/rss RSS.NET: http://www.rssdotnet.com/ I have surgery several months ago. Cancerous Prostate removed by the Devinci Robtic on November 27, 2007.  PSA test method using Beckman Acess II Immoassay system and Total PSA reagents:   I had a PSA reading of .84ng/mL 12/31/07.  Testosterone 128ng/dL( 1st post surgery test)I had a PSA reading of .46ng/mL 02/08/08. ( 2nd post surgery test)I have an appointment with my surgeon again on 03/31/08. I will have again, another PSA test at this time.What questions should I ask my doctor?I am 61 years young. My Gleason grade was 3+4 after the prostate was removed and biopsied.PATHOLOGY REPORTED BELOW:Prostate gland, radical prostatectomy: Prostate adenocrcinoma.7/> T2bNXM. (? Do Not know what this means?) The tumor focally involves both lobes of the prostate tissue. Foci of perineural involvement identified. No lymphatic space or vascular space involvement seen. The tumor involves the left apex margin. The non-neoplastic prostate tissue semonstrates foci of high-grade prostate intraepithelial neoplasia and glandular hyperplasia. The seminal vesicles are free of tumor. The bladder base margin is free of tumor. Anyone can offer any direction or information will be wonderful.SHOOT YOUR CONCERNS TO ME STRAIGHT, I AM IN NEED OF AS MUCH INFORMATION AS YOU CAN OFFER.WOULD YOU HAVE CONCERN IF THESE WERE YOUR PSA RESULTS? THANKS SO MUCH FOR THE WONDERFUL INFORMATION YOU PROVIDE ON THE MESSAGE BOARDS. -JIM FROM DARDANELLE, AR DARDANELLE Sun, 09 Mar 2008 00:00:00 GMT Jim:Thank you for a concise presentation of your case. Your pathology reports post-operative are critical. First, the stage description is p (pathological, or post op) T2b (Tumor involves half of one lobe, or more, of the gland) Nx (lymph nodes not assessed [likely not removed]) M(Metastases in distant locations not identified). Thus pT2bNxM(x?).Neoplastic tissue is another word for cancerous tissue. The part of your prostate that was not cancer demonstrated several areas of near cancerous  definition (intraepithelial neoplasia and hyperplasia). This is of less interest for the current discussion Your post surgical psa should be zero, or as close to zero as the assay allows. Yours is not, though it is declining. A critical issue is the margin identified at the Apex. This means that there was cancerous growth at the edge of the resected (cut) tissue. This may well be the source of your psa, though it is not certain that it means you still have cancer tissue. Where was this margin? Was it outside of the prostate itself? If so this means that the surgeon took tissue from just outside the prostate, as he should, but was not able to remove all cancer cells that had spread from this area of the gland. On the other hand, if the surgeon cut just inside the edge of the prostate, he may have left behind some original prostate cells which continue to produce psa, though perhaps not cancerous. This would be unclear without more information from the Pathology report. Best case, your remaining prostate cells produce small amounts of psa and you can monitor it for many years without further treatment. Or, if the remaining cells were cancerous, cut from their blood supply they wither and the psa continues down to zero, or nearly so. Next case, psa dribbles around at a low level for a while with no particular direction or a slow decline, and further treatment decisions are delayed until a clear trend is identified. Last case, there is a clear call from all evidence that surgical failure has occurred and treatment decisions are discussed. One very important factor you mention is Gleason score, or the rating of the aggressiveness of the cells. It would be an important piece of information in the Path report about the ratio of G3 to G4. Any G4 is a higher risk issue and must be considered in decisions. If you had 3+4 90%/10% (less troubling)  this is different than 55/45. If radiation is determined to be the next step, sooner rather than later is the usual practice. Your positive margin is certainly highly suspicious as the culprit for this continued psa.There are side effects to radiation, usually of the urinary and sexual kind. For a man your age, even if radiation does not cure, then if it delays progression this can be meaningful. SWOG 8794 clinical trial (Google it) may provide you with interesting reading.I am not a medical professional. My advice is worth what you pay for it. In addition to your surgeon, an oncologist and radiologist may well be consulted. The work of your surgeon is done. Further treatments, if any, will be outside his specialty.Let us know how it goes.  Thoosier Tue, 11 Mar 2008 00:00:00 GMT Thanks so much for the wonderful insite. The information was great and was a great help. Jim DARDANELLE Thu, 13 Mar 2008 00:00:00 GMT  On 3/11/2008 Thoosier wrote:Jim:Thank you for a concise presentation of your case. Your pathology reports post-operative are critical. First, the stage description is p (pathological, or post op) T2b (Tumor involves half of one lobe, or more, of the gland) Nx (lymph nodes not assessed [likely not removed]) M(Metastases in distant locations not identified). Thus pT2bNxM(x?).Neoplastic tissue is another word for cancerous tissue. The part of your prostate that was not cancer demonstrated several areas of near cancerous  definition (intraepithelial neoplasia and hyperplasia). This is of less interest for the current discussion Your post surgical psa should be zero, or as close to zero as the assay allows. Yours is not, though it is declining. A critical issue is the margin identified at the Apex. This means that there was cancerous growth at the edge of the resected (cut) tissue. This may well be the source of your psa, though it is not certain that it means you still have cancer tissue. Where was this margin? Was it outside of the prostate itself? If so this means that the surgeon took tissue from just outside the prostate, as he should, but was not able to remove all cancer cells that had spread from this area of the gland. On the other hand, if the surgeon cut just inside the edge of the prostate, he may have left behind some original prostate cells which continue to produce psa, though perhaps not cancerous. This would be unclear without more information from the Pathology report. Best case, your remaining prostate cells produce small amounts of psa and you can monitor it for many years without further treatment. Or, if the remaining cells were cancerous, cut from their blood supply they wither and the psa continues down to zero, or nearly so. Next case, psa dribbles around at a low level for a while with no particular direction or a slow decline, and further treatment decisions are delayed until a clear trend is identified. Last case, there is a clear call from all evidence that surgical failure has occurred and treatment decisions are discussed. One very important factor you mention is Gleason score, or the rating of the aggressiveness of the cells. It would be an important piece of information in the Path report about the ratio of G3 to G4. Any G4 is a higher risk issue and must be considered in decisions. If you had 3+4 90%/10% (less troubling)  this is different than 55/45. If radiation is determined to be the next step, sooner rather than later is the usual practice. Your positive margin is certainly highly suspicious as the culprit for this continued psa.There are side effects to radiation, usually of the urinary and sexual kind. For a man your age, even if radiation does not cure, then if it delays progression this can be meaningful. SWOG 8794 clinical trial (Google it) may provide you with interesting reading.I am not a medical professional. My advice is worth what you pay for it. In addition to your surgeon, an oncologist and radiologist may well be consulted. The work of your surgeon is done. Further treatments, if any, will be outside his specialty.Let us know how it goes. I return to the Doctor on 03/31/08 had blood drawn.I recieved a call from my doctors nurse with the 3rd post-radical prostectomy and it went up to 0.64ng from .46ngso post surgery 1st psa was .84, 2nd psa was .46 and now .64.nurse stated the doctor wants a biopsy of my bladdar neck.I am not so sure about this request of the biopsy?If taking the biopsy could (if I have cancer still in the area?) cancer be spread by them taking the biopsy?What about the new I am hearing on the New Blood Biomarker for determainiing prostate cancer in lymph nodes?Your help and personal advice is always so great. Thanks, Jim and Kim from Dardanelle, AR DARDANELLE Thu, 03 Apr 2008 00:00:00 GMT Excuse my typing!In the message above...... That was the 3rd PSA of course not the 3rd prostectomy!  DARDANELLE Thu, 03 Apr 2008 00:00:00 GMT