Yes this was lower rectal and DH is recovering from an APR surgery, robotic. The surgeon removed the primary tumor that had been treated with radiation almost 2 years ago. It didn’t show on CT scans, and was flat, so didn’t show on physical exams. His CEA has been normal. So it’s been under the radar.
A biopsy proved cancer was present, and an MRI showed possible prostate invasion. The ultrasound ruled out prostate invasion.
He was given 3 options:chemo, a TME (sphincter preserving), or an APR. APR was recommended since a TME would end up with a poor quality of life.
The APR would possibly include a prostatectomy, and so a urologist was on standby. 4 hour surgery removed the rectum and tissue up to, not including, the prostate. The surgeon said she felt confident she removed all the cancer.
The pathology report showed that all the lymph nodes were indeed clear of cancer, but the cancer cells appeared very close to the margin, enough so we have to assume there may be some cancer cells left behind.
The surgeon felt optimistic with his prognosis, despite the strong possibility that there might still be a (small) amount of cancer cells.
She feels that radiation might be in order, but we have yet to hear from the oncologist who may recommend chemo. She feels there is a chance any remaining cancer cells might die off, and that there is little to no chance of it spreading.
I have contacted a reputable cancer center for a consultation with them, and they have already downloaded all his medical records. I expect to hear back from their oncologist early next week.
It seems as though the lymph nodes being removed will drastically minimize, if not prevent, the risk of spreading.
It’s possible there’s nothing to worry about, but there’s a good chance that there is.
It would take a long time for the cancer to form a tumor that could invade the prostate, whereby he would likely need to move forward with the prostate surgery that was just averted.
So it’s good that he still has his prostate, but the trade-off is that there’s a new type of watch and wait where it might need to be removed at a later date.
Personally, I feel like since he did so well on chemo the first time around, that he should try that, and then radiation if that doesn’t do the trick. Ultimately, he could do the prostate surgery, but it might quite likely never come to that in this lifetime.
He’s almost 65 years old, so we’re thinking if it takes 20 years to be problematic then screw it/ we can just go on with life. But we just don’t know.
2019 4A t3 n2 m1a
8/23 C-scopy, 5+cm mass. CEA:4.1
9/16 MSS. MRI: 2 lvr mets: 2.7 & 7mm
9/30 Start FOLFOX 1-6
10/4 Lg lvr met ~3.7cm, pri tmr stable.
CEA: 10/13,12.5;10/27-12/8 btw 4.7 & 3.1
11/5 both lvr mets ~ 2/3 smaller.
12/17 PET: sm lvr met gone, remaining tmrs @10% of orig sz & actvty
MWA 2/5, Lap resection 2/11
CEA: 3/1-5/31 btw 2.1&2.9
3/2 start FOLFOX 7-12
4/2022 EUS-FNA,MRI: recur.;
5/2022:CT scan no mets