A few miscellaneous questions regarding treatments

Here are a few things I have been curious about but haven't been able to find the answers for.

1) My Gleason was 3+4 prior to surgery. The post op pathology report was 3+3. Of course I was happy about this, but my question is: Am I considered a 3+3 or a 3+4 now? It would be logical that I would be considered the worse of the two, even though the more thorough pathology report is the post op one which is the lower one.

2) I have a friend who got the seed implants and he said he had no side effects other than a little blood in the urine for 1/2 a day afterwards. Why is it a prostate biopsy will give most men bloody semen for a few weeks and the seed implants don't? It seems as though have those seeds inserted in the prostate would be as intrusive as a biopsy.

3) When gas is pumped into the abdomen during a robotic surgery (to improve the access to the prostate), what keeps the abdomen inflated since there are 5 unsealed holes through the skin?

4) Why do robotic surgery patients usually get the catheter out in a week and open surgery patients get it out in 10-14 days. In other words, why does it take a little longer for the urethra to heal for open patients--or is that not the case?

5) If someone is still working on incontinence, why are they more likely to leak late afternoon or evening, than morning or mid day.

I did find the answer to an earlier question I had--why is the operating room so cold? It is not for the patient's (direct) benefit. According to a couple of sources, it is so the operating room staff is more comfortable once the operating room lights start warming up things. I had heard theories that a cold operating room lessened the chance for infection or that it reduced blood flow at the patient's skin (reducing bleeding) but couldn't find anything to back this up.

Dan

1) Gleason scores occasionally get down-graded after surgery, a different lab, a different pathologist. In your case, a second, expert opinion might be worthwhile,, as this is important..

2) The biopsy procedure penetrates the urethra, perhaps multiple times, to get the samples the U-doc wants..With seed implants, they stay away from the urethra..

3) The gas (nitrogen) is kept at very low pressure, they seal the incisions up as best they can, there is some leakage but the slight pressure is maintained..

4) One of the advantages to robotic surgery is the ability of the surgeon-robot to join the urethra back to the bladder. The machine can do this with great precision...

5) After standing all day, pressure builds on the sphincter muscles which are tiring anyway..Those of us who indulge in a little afternoon libation compound the problem...JMHO..

i had more "severe" side effects from BT, like urinary frequency that had me getting up to pee 7-8 times a night.  i was also taking flomax at that time which made me very dizzy.

ed

 

Thanks for the answers!

Dan

Tim,

My understanding of the post op pathology is that, yes, it is more accurate than the pre-op biopsy because a lot more of the tissue is tested and viewed.

But even in the post-op path report, not 100% of the tissue is scrutinized under a microscope, so I am thinking it was possible that some of the gleason 4 that was found in the initial biopsy, was not viewed in the post-op path report, even though it was present in small qtys.

So, there are two scenarios for a lowered Gleason post op:

1) A similar tissue sample is interpreted differently by two different pathologists.

or

2) Even though statistically it is less likely, maybe the initial biopsy included Gleason 4 tissue that the post op path report didn't examine.

Tarhoosier mentioned that less than 1% of the prostate is sampled in the intial biopsy. Does anybody know what percent of the tissue is examined in the post op pathology report? Either by volume or number of slides prepared and examined?

Dan

Dan,

You're correct, that only representative sections of the prostate (not 100%) are viewed by the pathologist.  In addition to a gross anatomy and examination of lymph nodes, seminal vesicles, margins, etc., my pathologist examined 14 sections from different areas of the prostate. 

My initial biopsy slides were reviewed by Jon Epstein at Johns Hopkins, and the same local pathologist (with a consult) viewed both biopsy and organ-section slides. All examiners agreed on the Gleason score.  The only surprise, according to my urologist, was that the post-surgical examination found only one cancerous area.  He said that usually, because the biopsies are such a small sample, if cancer is found in one place, it will be in multiple locations. 

It's possible that there was still a miniscule amount of Gleason 4 tissue found on your pathological exam, but that the overwhelming majority was 3 +3.  You could call the pathology lab where you had your prostate examined and they may be able to provide you with additional review notes that indicate whether or not any G4 was present.

Tim

Tim, Tudpock,

My pre op and post op were prepared and read at different places---whoever the doctors chose to use. This could have accounted for the difference. I can't remember the lab's names but it wasn't one of the famous labs like Bostwick or famous university hospital.

I'm not really worried if I am a Gleason 6 or 7, just curious about it. If I was one or the other, it wouldn't change my post op treatment (which is just blood tests every three months). Way, way more important for my peace of mind was the the cancer was contained to the prostate and I had a low percentage of tumor volume.

Dan