Prostate Cancer - Looking for people who have had the Da Vinci Surgery with Dr. Vipul Patel

Hope your recovery from surgery goes well. Keep us posted. Most of the time, they don't even start talking about follow up therapies until you're at least 3 months post surgery, to allow the tissues to heal before attacking them again.

Please do let us know what your final pathology report said. If you came out still at G7 with no SVI or Lymph node involvement, doing ART and/or ADT seems like overkill.

DVQ - I would like to think that it is strange to have an increase in Gleason score but the biopsy samples are small reflecting a small percentage of prostate vs. the entire gland to analyze post-op. It happened to me and many others here so not that strange to have an increase from intermediate to high risk scores.

There are two reasons to wait: your body needs to heal from surgery and you need to see the 3 month PSA results for a starting point. I might suggest having your pathology slides sent to Dr Epstein at Johns Hopkins for a second opinion while you are waiting for the PSA like I did. It will help knowing you have confirmed pathology classification data.

The problem areas in your report are “non organ contained... infiltration of seminal vesicles”, “regional lymph node metastasis” and “G9 Gleason”. The combination of these negative factors will most likely require the full treatment scenario that your doctor recommended. I would not be surprised if they want to do a PET scan of some sort if you have a significant PSA at 3 mos to see what else they can find prior to treatment.

I am sorry to be the first responder here but your post-op report is the not the best news to get and you should expect aggressive treatment recommendations from everyone you see. You may wish to visit other cancer centers with your results and see what the collective treatment wisdom is for your situation. The good news is that there are ways to address the situation that should control the situation of which hormone therapy is part of and probably cannot be avoided at this point.

Others will follow me with their thoughts and recommendation so please be patient as you try to understand your version of PCa.

I agree with others the doctors are given you the best advise. I just would wait before radiation, incontinence and other SE effects could more easily come back if you are not fully healed before radiation starts.

Really no reason to have Epstein do a second look as the surgical pathologist had the entire prostate to sample. It is easy to do, just have your doctor arrange for them to be sent. Second opinions on the biopsy slides are encouraged unless Epstein or Bostwick reads them first. Unless you or your surgeon suspects the pathologist that did the surgical pathology is not capable, then you go with that report.

Mumbo and JNF said it well. With your upgrade--which does happen about 1/3 of the time (I had upgrade from G6 to G7, and from 1 quadrant to all 4 quadrants), --you are most likely going to need additional treatment. At the G9, the added radiation and the ADT are almost certainly in your future.

That being said, waiting for the 3 month PSA is important--that will give everyone an idea of what's happening. It's entirely possible that you'll have a very low or even non-detectable PSA at that point. That will great if it happens....but it also might not. It's also a good idea to wait for as much healing as possible before the next steps.

There are some great docs in Europe...and the cool thing is that all the international experts know each other, and talk to each other. I would say that your center in Italy sounds good--and if they are planning your treatment, it sounds as if you are in good hands.

JNF said...
about a third of the time the Gleason score is upgraded surgical pathology. Not what you want, but not uncommon.

Your report confirms that the PCa is not organ confined and will require additional treatment. Your docs will want to move quickly to start ADT and then radiation, including the pelvic lymph nodes. As Mumbo mentioned there may be additional scans to determine whether there are detectable Mets elsewhere.

Gleason 9 is very high risk and can be very aggressive. You must treat it aggressively.

the upgrade is not uncommon but 3+4 to 4+5 is a real kick in the nuts. one reason I never tell anyone to "take your time" and also why you have to consider that actual pathology could be worse than what biopsy shows.

I'd be pushing for ADT ASAP to push SRT out to heal a bit. good luck to you.

I just had ART with the Varian Trilogy machine and it worked well. Link below may be of interest to you:

https://www.varian.com/de/news/treatments-commence-italy-using-truebeam-radiotherapy-system-varian-medical-systems

F8 et.al - It seems to me that it would be beneficial for DVQ to have a post-op PSA test (3 month or 12 week minimum) before starting ADT as a point of reference. It may also shape the treatment plan somewhat if it is really high or really low. In my simple mind, a post-op PSA of 3.0 vs <0.10 would determine if additional scans might be helpful. Once the ADT starts, the PSA should quickly drop and no longer be that helpful. Maybe I am wrong, speed is important but you want to make sure you are heading in the right direction also.

It’s the LN involvement that has me thinking there’s only upside to starting ADT right away.

I agree that the 3 month PSA and further imaging are necessary before starting RT so that the RO’s team can map out the optimal area for treatment and the dosimetry.

Agree with SP, g9, out of capsule? Start ADT. Maybe do a six week PSA as Mumbo suggested so that if it’s high enough to warrant a scan it might yield more information. But I wouldn’t wait t00 long before fighting back