My Dad's Journey

Hi Everyone,

This post is about my father. He is 60 Years old.

Date: April 2019
Blood work:
Total PSA: 11,88 ng/mL
Free PSA: 1,73ng/mL
Free/Total PSA Ratio: 15%

MRI findings:
Prostate Gland size: 47x28x40 mm, Prostate Weight: 20 grams, Prostate Capsule is intact.
Showed a dia. 12 mm sized PI-RADS 4 in the bottom-right
Showed a dia. 17 mm sized PI-RADS 4 in the mid-left

Biopsy MR-TRUS: 14 samples
Pathology Report Findings:
Gleason Score: 4+5=9 out of 10 (where Pattern 5 is consisting 10% of the samples and Pattern 4 is 80%)
Periprostatic fat tissue invasion: Not present
Seminal Vesicle invasion: Not present
Lympo-vascular invasion: Not present
Perineural invasion: Not present

Date: May 2019
PSMA Ga-68 PET/BT Scan:
PET Scan has seen a 1 mm lymph node on the backbone but It doesn't seem to be related with the cancer according to the doc, he says only a small possibility. So the report is considered "no metastasis with some suspicion" at the moment.

In the end, our doctor thinks that It is best to remove the prostate ASAP along with "the lymph area with 1 mm lymph node" to confirm with the pathology report that there is no metastasis outside the prostate.

Date: June 2019
Robotic Radical Prostatectomy: RP was performed with 12 lymph node dissection

Pathology Report Findings:  
Gleason Score 9 (4+5), Grade 5/5, Pattern 4 Ratio : 95%,
Tumor Type: Prostatic Adenocarcinoma, Tumor Volume: 4,5 cm3, Tumor Ratio: 14%
Positive Surgical Margin : Not Present
Cancer Spread Outside of Prostate : Not present
Bladder Neck Invasion : Not present
Vascular Invasion : Not Present
Seminal vesicle involvement : Not present
Lymphovascular Invasion : Not present
Perineural Invasion : Present
Lymph Nodes Metastasis : None out of the 12
Grading: pT2, N0

PSMA Ga-68 PET/BT Scan: The scan only caught a 1 mm size lymph node (as hot spot) near prostate area without any metastasis.

Date: May 2020

Considering my dad had by-pass heart surgery with a very strong family history of coronary heart disease; they decided to start radiotherapy without hormone treatment due to potential coronary side effects.

Date: June 2020

Salvage Radiotherapy: 36 sessions completed via IMRT. Total 66 gray : 45 gray to the pelvic lymph nodes + prostate-bed and later an additional 21 gray to the tumour area.

Date: September 2020

First PSA reading after radiotherapy PSA: 0,034 ng/mL

  • Hi What

    I wonder why the doc is suggesting that surgery is the only/main option, is he a surgeon by any chance?

    I would have thought that some kind of radiotherapy would have been a good alternative option in your dad's case.

    Regards

    Steve

  • Hi Steve,

    Sorry, forgot to mention the name. Okan here.

    Yes, his doc is a surgeon.

    I am no expert, but he has explained us his logic as follows: MRI concludes "the prostate is intact" and the pathology report confirms that there is no invasion in the surrounding area. If PET also confirms that there is no metastasis anywhere else in the body, he will remove the prostate because the cancer is very aggressive being Gleason 9. So the tumor has to come out along with the prostate ASAP to avoid any metastasis, the doc says.

    The doc said that If my dad's Gleason score had been lower (less aggresive) along with the same findings, he would've chosen a different approach (dunno If that would have been the radiotherapy).

    I am open to any counter arguments or experience to bring up to the doc.

    Regards,

    Okan

    Best Wishes,

    whatllhappen

  • Hi Okan

    A  difficult one, see what others say.

    The tumours are quite large as you indicated mm size.

    I would say try and find out if they are near the capsule edge or possibly about to break out of the capsule.

    If near the edge I would have thought RT would be better.

    This could be one case where it is worth getting a second opinion.

    Regards

    Steve

  • My wife had a PET Scan back in 2015.  She was quite ill after it for a few weeks.  Was sick that first evening as well and then a gippy tummy for a few weeks.  They checked the mixture given to her pre-scan and said it had not been contaminated - apparently this can happen but is rare and at the hospital she went to they asked her to call if she had any problems.  She did but all their checks showed that there was nothing wrong with their procedures etc so it must have been something with her - maybe even a slight allergy to something in the mix.  Presume there is a carrier used in the mix and quite often people can be allergic to that - the only one I have heard of for sure is an allergy to egg albumen which is used in contrast dye for MRI scans I don't remember her being asked if she was allergic to anything before the PET Scan but if your Father has to have another PET Scan it would certainly be worth asking about what is contained in any of the mixtures, injections or infusions which might be given.

    Hope everything goes well for your Dad.

  • Date: May 2019

    Gallium-68 PET/BT Scan: UPDATE

    * Prostate gland, mid-left posterior : malign character focal dense PSMA uptake.
    * Left external iliac : malign suspected, light PSMA uptake 1 mm lymph node.
    * Retroperitoneal area and bilateral iliac: have a few lymph nodes where the largest is dia. 1 cm with no significant PSMA uptake
    * Liver segment level-4B : focal mid-level PSMA uptake which is even constant on late images, with no significant pathology in BT scan. MRI correlation is suggested.

    Can anyone comment on the PET results?

    Best Wishes,

    whatllhappen

  • This is in technical jargon format which probably most of us would struggle with.

    I did have a look online to try and work out what the report says but. I don't want to say too much which could be incorrect.

    What does the consultant say that the report says in non  gobbaldy gook format?

  • Hi Okan,

    Like others we are not experts so you must follow the advice given by your medical team.

    Looking at your numbers, your Gleason is 9 (4+5) - same as me - and your PSA was at 12 - mine at 38.  Normally, but not always, the lower the PSA number, the less chance the cancer has spread somewhere else.  Reading your report it would appear the cancer is completely contained within the capsule.  This is probably why the surgeon is recommending the operation to remove it completely.  It becomes much harder if it has spread to the seminal vesicles for example - like me.  I was never offered the op, so I had radiotherapy and hormone treatment and so far I am doing well 3.5 years on with stable low PSA.

    Many men want the cancer 'cut out' so they can be cured.  Its worth asking the surgeon how much nerve sparing he expects from the scans.  If he says he can probably save one side for example then erectile dysfunction (ED) may well be avoided.  If he says there is little or no chance of any nerve sparing, then you have some serious decision making to do.  If you are not bothered about ED then it is not a problem for you.  

    I would be asking him/her if it has spread, if so how far: if it has not spread the chances of nerve sparing: would cyber knife (targeted radiotherapy) be available and suitable (less damage to other tissue as it is highly accurate): would radiotherapy and hormone treatment (probably for 2 years) be a good option?

    The survival statistics are fairly evenly matched between the op and radiotherapy so it is all worth thinking about.

    Regards

  • Thank you for your comment.

    One of my colleague's father is a professor in urology and he was a renown specialist in where I live before he was retired. He is now completely retired but I have the chance to consult him about my father's progress. He also believes that It is best to perform the surgery in my father's state to avoid a metastasis.

    This is what the PET Scan says in daily terms (as far as I can understand) :

    Gallium-68 PET/BT Scan:

    PET Scan images revealed a 1 mm lymph node on the backbone area but It doesn't seem to be related anything with the cancer according to the doc, he says only a small possibility.

    They have also seen a suspicious area inside the liver and the doc thinks that It is very unlikely for it to spread to the liver without showing up anywhere else.

    So the report is considered "no metastasis with some suspicion" by the doc at the moment.

    In the end, our doc thinks that It is best to remove the prostate ASAP along with "the lymph area with 1 mm lymph node" to confirm with the pathology afterwards that there is no metastasis outside the prostate.

    Best Wishes,

    whatllhappen

  • Reading your latest piece I suppose it makes sense to go with the surgery.

    You will also have the Radiotherapy to fall back on if necessary wheras it's very difficult to do the other way round. Ie Radiotherapy followed by surgery.

    Steve

  • Yep, listen to the experts.  But at least you can ask some questions about nerve sparing and pretend you know more than you do!!!

    All the best