I know I'm very fortunate - 2 years post-op

Just over 2 years post - op and 1.5 years post ART, this quarter's uPSA still <0.014. I didn't get a good blood draw this time (very much bruised!) but will take these results every time.

Excellent!

Djin

Fortunate indeed. Here’s to many more years of undetectable

Congrats! I had my surgery at Morristown, too. Then SRT. So far so good with me as well.

Hi GG. I have a question about your post-op path report. You signature says:

"Post Op Surgical Path 3+3, tertiary 4, 10% grade 4"

Many urologic pathologists would interpret 10% pattern 4 as G7(3+4) rather than a G6 (3+3) with tertiary pattern 4. A 2019 survey of 95 specialized pathologists found:

"In a tumor with pattern 3 and less than 5% pattern 4, of the 95 respondents, 35 (37%) assigned 3 + 3 = 6 with TP4, while 56 (59%) assigned 3 + 4 = 7."

If over half the pathologists bump the 4 up to the secondary pattern even when it is <5%, I'm thinking very few would keep it as a tertiary pattern when it is as high as 10% (especially since your path findings include ECE+ and SVI+).

Perhaps you could have a look at your path report. Does it actually say "10% grade 4" ? -- because I'm thinking the 10% may refer to the percentage of your prostate involved by your cancer rather than the prevalence of Gleason pattern 4. If that is the case, then your tertiary pattern 4 would likely be <5% rather than 10%.

The percentage involved by PCa is usually specified in the path report, whereas the percentage of a tertiary pattern often is not.

Thanks!

Curious Djin

Hi Dijin - sorry for the delay

Path report has the following
Histologic Grade
Primary Gleason Pattern: Pattern 3
Secondary Gleason Pattern: Pattern 3
Tertiary Gleason Pattern: Pattern 4 (10%)
Total Gleason Score: 6 and focal 7
Grade Group 1
Grade Group 2 (10%)
Tumor Quantitation
Proportion (percent) of prostate involved by tumor: 45%
Extraprostatic Extension: present, left posterior
Bladder Neck Invasion: not present
Seminal Vesicle Invasion: present, tumor involving left seminal vesicle
Margins – all were listed as negative
They did do an Intraoperative Consultation, frozen section, etc.
Hope this information is helpful

Thanks, GG. That is fascinating. Of course with 45% involvement, 10% pattern 4 is still a fairly large amount. I know G6 sometimes grows out of the prostate (EPE and bladder-neck invasion), but in your case I think your EPE was from your focal G7, and your SVI almost definitely was.

Djin

Regarding the PSA test schedule:

Just before Covid, when I hit the 2-year mark, my uro said that, given my results, he was comfortable going from 3- to 6-month testing, but I could do 3, 4, or 6 --- whatever I was comfortable with (he mentioned that insurance shouldn't be a problem with continued 3-month testing, given my status). I said let's do 4 months, and go to every 3 in a year if all is still good. I did one more test at 2 yr, 4 months, but the next was at 6 months because of Covid. Since that result was good, I'm fine with continuing at 6.

A uro will set a surgery patient's test schedule according to all the factors we know: pre- and post-op PSA, post-op initial readings, path report findings and extent of the cancer. Of course this should be a joint devision, but immediately after RP a patient usually would defer to the doc's opinion.

Djin

GG1273 said...
Just over 2 years post - op and 1.5 years post ART, this quarter's uPSA still <0.014. I didn't get a good blood draw this time (very much bruised!) but will take these results every time.

Way to go, Bro!