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  • Post-surgery expectations

    June 2nd is my robotic prostate removal with some lymph node removal. What are the realistic expectations? Any for sure do this or don't do that advise? Mobility, and such. I work from home which is a blessing. I understand the cath for a week or so, No heavy lifting. I think I have pretty good pain tolerance, but who knows with this. When did you return to driving? Exercise? Anxious of course about pathology, even though CT and Bone scan were negative, but having Perineural invasion and some cribriform pattern present, looks like there is some risk of involvement with lymph, SV, and Extracapsular Extension.
    2/17/22 PSA of 19.2 in blood lab from general physical. Referred to Urologist.
    3/10/22 Urology 1st visit. DRE (unremarkable) New PSA lab 18.8
    4//14/22 12 core biopsy.
    Left base - Gleason 4+3, Gleason pattern 4/60%.. carcinoma 2 of 2 cores 5-10% of tissue..
    Left mid Gleason 4+3 , Gleason pattern 4/90%..Cribiform 4 present, carcinoma 2 of 2 cores, 10% of tissue
    Left Apex Gleason 4+4, Gleason pattern 4/100%, Cribriform 4 present, carcinoma present in 2 of 2 cores, 5-10% of tissue. Perineural Invasion
    4/22/22 Bone scan (negative for MET) CT with contrast (also negative)
    5/12/22 EKG (ECG) UA and blood labs prior to Da Vinci LRP.
    5/30/22 Buy diapers. LOL
    6/2/22 scheduled procedure
    Let the journey begin

  • #2
    Based on your signature data, rounded numbers, your post surgery pathology report has a 90% chance of the PCa being outside the gland and about 40% chance of seminal vertical or lymph node invasion. Be prepared for pathology report.

    Until the cath is removed, you should be able to do some office type work, just be prepared for fatigue. You might want a couple of chucks pads for your bed due to leaks while sleeping.
    YOB 1957

    DX 12/18, GS 8, 4+4 6/12 cores, LL Apex 100%, LM Apex 60%, LL Mid 50%, LMM 40%, LL Base 5%, LM <5%, Right side negative.

    3/6/19. Post surgery Pathology Report - Grade Group 4 Intraductal Carcinoma
    T3aNO, <1 mm non focal EPE, GS8, 21 mm uni-focal tumor involved 10% of prostate.
    7 Nodes, SV, SM, PNI, and BNI were negative.
    LVI and Cribriform pattern present.
    Decipher .86 High Risk.

    Post Surgery PSA
    3/25/19 .03. (25 days)
    4/25/19 <.03. (2 months)
    5/25/19 <.02 (3 months)
    9/10/2019. <.02 (7 months)
    11/27/2019. <.02. T < 3 (9 months)
    5/19/2020. <.02 (15 months)
    11/2/2020. <.02 (21 months)
    5/11/2021. <.02 T <3 (27 months)
    8/25/2021. <.02 T <3 (30 months)
    12/6/2021. <.02 T <3 (33 months)
    6/14/2022. <.02 T <3 (39 months) T=37

    3 Part Modality Treatment Completed

    2/25/19 Robotic Laparoendoscopic Single Site Surgery outpatient Cleveland Clinic, Dr. Kaouk, surgery #41 in US.
    ART - 7/25/-9/25 2019 (78 Gy, yes, I glow in the dark).
    ADT - 5/19- 5/21 Eligard and Casodex.



    3 Part Modality Treatment Completed

    2/25/19 Robotic Laparoendoscopic Single Site Surgery outpatient Cleveland Clinic, Dr. Kaouk, surgery #41 in US.
    ART - 7/25/-9/25 2019 (78 Gy, yes, I glow in the dark).
    ADT - 5/19- 5/21 Eligard and Casodex.

    Comment


    • #3
      I moved my "office" from its' upstairs location to the downstairs dining room before surgery.

      I was back upstairs the day the catheter came out.

      I didn't use anything for pain after the surgery. (But I have a higher tolerance than most)

      Make sure you have a comfortable **roling** chair. You don't want to be lifting a heavy chair at the dining table.

      You will not like low couches, and etc. You'll learn how to get off of them by rolling to the side....
      Age Dx'd 57
      PCa History: Father, Grandfathers
      Oct16 Bx: Gleason 4+3 Grade Group 3 w/PNI
      LB: 4+3 (60% pattern 4),
      RA: 3+3, RLM: 3+3, RLA: 3+3

      Jan 2017 RALP - Dr. Grant Taylor - Pathology = pT3a; Gleason 4+3; Weight: 42g

      Jun 2019 AMS800 installed, Jul 2019 activated - Dr. David Rapp
      PSA_TESTS
      Apr16-5.10
      Jul16-4.70
      Aug16-5.13

      ---Surgery---
      Mar17<0.01
      Jul17<0.01
      Oct17<0.01
      Jan18<0.01
      May18<0.01
      Nov18<0.01
      Jan19<0.01
      Jun19<0.02
      Nov20<0.10
      May21<0.10
      Apr22<0.10

      Comment


      • #4
        Thanks for the feedback.
        2/17/22 PSA of 19.2 in blood lab from general physical. Referred to Urologist.
        3/10/22 Urology 1st visit. DRE (unremarkable) New PSA lab 18.8
        4//14/22 12 core biopsy.
        Left base - Gleason 4+3, Gleason pattern 4/60%.. carcinoma 2 of 2 cores 5-10% of tissue..
        Left mid Gleason 4+3 , Gleason pattern 4/90%..Cribiform 4 present, carcinoma 2 of 2 cores, 10% of tissue
        Left Apex Gleason 4+4, Gleason pattern 4/100%, Cribriform 4 present, carcinoma present in 2 of 2 cores, 5-10% of tissue. Perineural Invasion
        4/22/22 Bone scan (negative for MET) CT with contrast (also negative)
        5/12/22 EKG (ECG) UA and blood labs prior to Da Vinci LRP.
        5/30/22 Buy diapers. LOL
        6/2/22 scheduled procedure
        Let the journey begin

        Comment


        • #5
          Keep the cath clean. Be careful not catch it on anything, especially around the shower.
          YOB 1963, PSA:

          10/16 4.1
          01/17 6.4
          10/17 6.4
          02/18 6.3
          07/18 8.7 "Don't worry about it"
          04/19 9.8 Biopsy results:

          RB 3+4 1 core 3.5mm 23%
          RBL 3+3 3 cores 20.5mm 45% PNI

          Surgery 05/19, Pathology:

          pT3 pNO
          EPE focal one location
          PNI+
          SVI-
          LVI-
          margins clear

          Comment


          • #6
            When you surgeon checks on you pre-op, ask and make sure--given your G8 biopsy-- that he/she plans on taking out a good number of lymph nodes along with the prostate and seminal vesicles. Sampling a good number of negative nodes gives you a bit more confidence of being node-negative with regard to those remaining regional nodes. Also, if any positive nodes are found in the post-op path exam, it isn't at all impossible that the removed nodes were the only positive nodes you had.

            Best of luck to you on your surgery and subsequent path report.
            Last edited by DjinTonic; 06-02-2022, 08:46 AM.
            69 yr at diagnosis, BPH x 20 yr, 9 (!) negative biopsies, PCA3-
            7-05-13 TURP for BPH (90→30 g) path negative for PCa, then 6-mo. checks
            6-06-17 Nodule on right + PSA rise on finasteride: 3.6→4.3
            6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
            Nodule was negative for PCa
            Bone scan, CTs, X-rays: neg.
            8-7-17 Open RP, negative frozen sections, Duke Regional Hosp.
            SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
            pT2c pN0 pMX, G9 (4+5) acinar adenocarcinoma
            5% of prostate (4.5 x 5 x 4 cm, 64 g) involved
            Dry; ED OK with sildenafil
            11-10-17 Decipher score: 0.37, Low Risk:
            5-yr met risk: 2.4%, 10-yr PCa-specific mortality: 3.3%
            9-16-17 (5 wk) PSA <0.1
            LabCorp uPSA:
            11-28-17 (3 m ) 0.010
            02-26-18 (6 m ) 0.009
            05-30-18 (9 m ) 0.007 (nadir)
            08-27-18 (1 yr.) 0.018 (huh?)
            09-26-18 (13 m) 0.013 (retest)
            11-26-18 (15 m) 0.012
            02-25-19 (18 m) 0.015
            05-22-19 (21 m) 0.015
            08-28-19 (2 yr. ) 0.016
            12-18-19 (28 m) 0.015
            06-30-20 (34 m) <0.014
            12-30-20 (40 m) 0.037 (?)
            03-31-21 (43 m) 0.020
            07-13-21(46 m) 0.018
            01-25-22(52 m) 0.023

            Comment


            • Rob Lee
              Rob Lee commented
              Editing a comment
              Excellent point!

          • #7
            Read the stickies... Good info there...
            BD: 1959 PSA 4.9 11/2012 (no symptoms)
            Biopsy 12/2012 Negative
            PSA 5.9 05/2013 (still no symptoms)
            Biopsy 6/2013 3+4 (thank goodness for PSA tests)
            1 core positive (upper left), 1 suspicious (lower left) out of 12
            DRE: bump right side T1c; PCA-III = 20 (normala)

            Da Vinci 7/18/2013:
            Total prostatectomy with seminal vesicles (S13-6085, 1-29, 7/18/13, 29 H&E and 1 paraffin block)
            Invasive carcinoma involves left lobe of prostate only, extends from left apex to posterior mid region of left lobe Gleason 7/10 (4+3); G4 tumor comprises 75% of invasive carcinoma present
            Estimated total volume of carcinoma in entire prostate gland: 10%
            TNM: T2b NX MX (Stage IIA)

            PSA History:
            8/13 11/13 2/14 8/14 2/15 8/15 3/16, 8/16, 3/17,9/17,4/18, 9/18 PSA "undetectable" (PSA <.1)

            March '19 = 0.1
            April '19 = 0.10 <-- switched to uPSA tests
            June '19 = 0.10
            Sept '19 = 0.10
            Dec '19 = 0.09
            Jan '20 = 0.13
            May '20 = 0.2 <- standard test by mistake
            Jun '20 = 0.11 <- back to uPSA test
            Aug '20 = 0.16
            Jan '21 = 0.23
            Feb '21 =0.20
            Mar '21 - started ADT/HT, radiation scheduled
            Jun '21 Eight Weeks Radiation @MSKCC
            Jul '21 <.05 (T-Level 0)
            Feb '22 <.05 (T-Level back to normal)

            Comment

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