HealingWell
Search Close Search
☰

I just got surgical path

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 7/19/2024 11:46 AM (GMT -5)
Hello everyone, I am new to this forum. I have read a few posts and you all seem really informed and supportive. I presented with an elevated psa 3.0 for multiple years but my free psa was always around 20 percent. This past winter I had an elevation to 6.1 and asked for an MRI which was positive for 3 areas of suspicion. I underwent fusion ultrasound guided biopsy which indicated Gleason 6 in two of the lesions.
The surgeon said I could continue to monitor or have prostatectomy and it was up to me. I am a high strung person and every blood test freaked me out, so I elected to have surgery which was completed last week.
Today my pathology came in and the dominant nodule (3cm) right apex had a focus of Gleason 4 disease. It made up less than 5%. So now I am a Gleason 7 patient. The second nodule was Gleason 6. Lymph node dissection was not performed. Nodules confined to gland no extension. Seminal vesicles normal. Periprostatic fat neg.
My question is how many people get upgraded with surgery? I was told they will check psa in 4 weeks and I should not worry. (I am worried that is how I am). Does anyone here have any suggestions as to anything more I should do? Is there someone else I should see? Should I chill? Of course this is not what I thought would happen was hoping to remain a Gleason 6
Posted 7/19/2024 12:30 PM (GMT -5)
Welcome to the forum and hope you are recovering well. I did not use surgery, but PSA upgrades occur in nearly 35% of surgeries according to several different studies. The biopsy only samples 1% of the prostate, so a lot can be missed. And since the G4 was relatively small it is expected the MRI would miss it. While you are not a G6, you appear to be a very favorable G7.

All you do now is recover from the surgery. Do your kegels religiously and get blood flowing to your penis. I am sure your doc has put you on a fitness routine. Other surgery guys will chime in to provide better advice from their experience. A PSA test in four weeks seems premature as it takes longer than that to get any residual PSA out of your system. Expect it to be greatly reduced from pre-surgery level, but doubtful it will be undetectable, which is what you want after about 90 days.
Posted 7/19/2024 1:18 PM (GMT -5)
Welcome to the Forum and congrats on your treatment!

As JNF posted, about one-third of G6 men are upgraded after surgery. Upgrades are the main reason why a surgeon should always take at least a few lymph nodes during a RP for G6 men. Nevertheless, perhaps half of surgeons don't take any if there was a G6 biopsy, even though the lymph nodes closest to the prostate (and statistically the most likely to be positive if there is spread of the cancer to the nodes) are right there for the taking.

What was your final pathological staging? Was it pT2 or something else? Were there any other adverse findings mentioned in your report, such as positive surgical margins or lymphovascular invasion?

Assuming your first post-op PSA shows an "undetectable" PSA (meaning below 0.1), your primary cancer treatment can be considered concluded, and, like all men after treatment, you'll monitor your PSA going forward, at intervals probably starting at 3-months and then less frequently.

All the best,

Djin
Posted 7/19/2024 3:33 PM (GMT -5)
Yes I am pT2 no invasion. I guess I should try to calm down. Thank you both for your response.
Posted 7/19/2024 3:50 PM (GMT -5)
Vcasa, welcome to a great forum. As the others have said, just chill, the worst is over for now. As to pathology, if you want, you may want to get the pathology slides sent out for a second opinion on the Gleason score. I think John Hopkins will do this plus many other centers of excellence. This way, you are assured as to your Gleason for the future. Good luck.
Posted 7/19/2024 4:34 PM (GMT -5)
Vcasa, welcome to HW. Hopefully your catheter is out and you are on the path to healing post-surgery. And I was also upgraded after surgery from a 7 to an 8 Gleason. That is not unusual. I would suggest focusing as much on recovery as anything. I remember walking up and down our driveway using a cane for a couple of weeks. My surgery was in 2009 and I did not have a second opinion done on the gleason score, but it might be helpful.
Michael
Posted 7/19/2024 7:02 PM (GMT -5)
Welcome. My post surgery pathology went from G6 to G7 (3+4), and they found multiple lesions all over the gland, even though my biopsy only showed 3 positive cores out of 12.

The key thing is to recover from the surgery. If your catheter is out, that's good. Are you continent? It may take a few weeks for erections to happen. Has your Dr put you on viagra or cialis? If not, ask for it.

Walk, walk, and walk some more. Drink lots of fluids. Don't push too hard, you'll be surprised how much the surgery takes out of you.

Normally they do the first PSA at 4-6 weeks, to confirm the downward trend. Don't be surprised if the 4-6 week PSA is still slightly there. At 12 weeks, you should be non-detectable--make sure you ask for the ultrasensitive low range test, now and forever more.
Posted 7/19/2024 9:07 PM (GMT -5)
Hello Vcasa - there are plenty of us that got upgraded so you should be fine from a statistical standpoint.

I think the early PSA tests are a waste of time, the 3 month test is definitive and lets you know you made the first hurdle. We always wonder why the doctor says the surgery was successful so why do they want to check your PSA for years? However, I am not a doctor…

As everyone else indicated, 99% of your efforts and thoughts should be on full recovery from surgery and the remaining 1% can be whatever you want, maybe baseball?

Your pathology is good which is a great result and reason to be happy. Yes, you should chill.
Posted 7/22/2024 6:40 AM (GMT -5)
Many, if not most, Gleason 6 are updated in the pathological report. It simply means that treament was really necessary. But you still are in the most favorable section. Just relax.
Posted 7/22/2024 9:18 PM (GMT -5)
Jmadrid. Where in the world have you ever read “many if not most” G6 are upgraded. That is absolutely factually untrue. The upgrade rate for all grades is approximately 35%. Not “many” and not even close to “most”. Old age gives you a higher chance of being in the 35%. You are causing fear in newly diagnosed G6 people that is completely unfounded, especially the younger ones.

Try doing a little research before spouting off.

Vcasa…..you are considered to be “very low risk” Gleason 7. Look it up on the Internet and you’ll see some studies for low risk G7 people they do just as well as the G6 people. In fact if you were diagnosed years ago you probably would have been called a G6 post op. because you had such low volume Gleason 4. Which means you have about the same chance of biochemical failure as most if not all, to quote somebody else here’s, of the people with G6. I was diagnosed and treated 15 years ago and I’ve seen a hell of a lot of G7 people who had your postop pathology report never have a problem again. And you wouldn’t know since your new to this, but yes, you’re worried way too much at this point about it. You got very lucky. You can chill.

And four weeks postop for a PSA is way too early. The standard is 12 weeks for PSA to wash out of your bloodstream, but given the fact yours was so low it will probably almost be undetectable, but don’t get upset if it’s not it’s still too early at four weeks.

Post Edited (ChrisR) : 7/22/2024 6:30:39 PM (GMT-8)

Posted 7/23/2024 9:29 AM (GMT -5)
Here's a link to a table in a peer-reviewed journal. The results are from the UK and about five years old (which shouldn't matter much IMHO).

https://bmcurol.biomedcentral.com/articles/10.1186/s12894-019-0526-9/tables/2

about 52% of the pathologies were upgraded from Gleason 6 to a higher grade after surgery (most to Gleason 7, not surprisingly).

There have been other studies which may have arrived at somewhat different numbers.
Posted 7/23/2024 12:18 PM (GMT -5)
With PCA time is usually on our side as it's slow growing.
I waited well over a year and two biopsy,s before I had treatment.
Of course there are exceptions where treatment ought not be delayed but you seem good for now.
Best wishes

Glen
Posted 7/24/2024 4:05 AM (GMT -5)
vcasa, As I said earlier, I was G6 upgraded to G7 post surgery. I was undetectable at 12 weeks, and have remained so for 9 1/2 years. Be prepared for semi-annual PSA blood draws at least semi-annually for anywhere from 2-5 years, and annually after that. Forever.

Always make sure your blood draw paperwork calls out ultra-sensitive PSA, and pay attention to the result having a "<". Which simply means that your test level is lower than the test can accurately measure.
Posted 7/24/2024 6:41 AM (GMT -5)

Vcasa said...
Yes I am pT2 ... I guess I should try to calm down.

A recent study found that pathological staging (pT), not Gleason score, is the most important overall risk (OR) factor for early biochemical recurrence (BCR) after surgery

Source: Predictive Factors for Early Biochemical Recurrence Following Robot-assisted Radical Prostatectomy (2024)

____________________________
Table III. Factors predictive of biochemical recurrence.

Risk Factor / OR of BCR

Initial PSA ≥10 ng/ml / 1.9
Pathological Staging ≥pT3 / 6.31
Pathological Gleason Score ≥8 / 2.10
Extraprostatic extension (EPE) / 0.82
Positive Surgical Margin / 3.02
____________________________

For the patients in this study, having a high-risk Gleason score post-RP doubled their risk of encountering early BCR, whereas having a pathological staging of cancer above pT2 increased their risk more than 6 times. Note that a positive surgical margin also carried a greater risk than a Gleason score of 8 or higher.

This agrees with another study I saw a few years ago that concluded that pT staging is the single most important risk factor predicting BCR. Remember that no one dies from prostate-confined cancer. Of course having a pT2 staging following surgery doesn't guarantee that your cancer was truly prostate-confined, meaning no cancer escaped the prostate before surgery, no cancer was left behind after surgery, and that your path exam was 100% accurate.

Djin
Posted 7/24/2024 7:37 AM (GMT -5)

ChrisR said...
Jmadrid. Where in the world have you ever read “many if not most” G6 are upgraded. That is absolutely factually untrue. The upgrade rate for all grades is approximately 35%. Not “many” and not even close to “most”. Old age gives you a higher chance of being in the 35%. You are causing fear in newly diagnosed G6 people that is completely unfounded, especially the younger ones.

Try doing a little research before spouting off.

Lets keep the tone civil please.
We are talking semantics. I would not consider 35% to be "most" I would certainly consider it "many".

That aside, vscaa, welcome to there forum, you've gotten good advice here. The only thing I would add, is be very diligent about your PSA's.
I'm a surgery guy, and I am one of the 35%. I was upgraded from g6 to g7(3+4) at my surgery in January 2015. It's still considered low intermediate risk, and with a clean path report, you are very likely to be fine, even one and done. So try not to stress, even though it's normal, especially prior to getting PSA results.

As far as 4 week PSA tests, each doctor has their own protocol. I agree that 4 weeks is probably too soon, in that a positive result with detectable PSA is not cause for alarm. With that said, I was tested at 4 weeks and was undetectable.

Good luck. Go out and celebrate. Sounds like you've had successful surgery, and thats what you should assume, unless and until proven otherwise somewhere down the road.
✚ New Topic ✚ Reply