DH’s primary tumor was destroyed with chemo followed up by EBRT. The result was an area of soft tissue that had eventually been determined to have cancer cells. The cancer cells were not like the original tumor in that there was no vascular invasion. In fact the ultrasound couldn’t really pick up a tumor. The MRI could detect that the “mass” extended to the prostate, but MRIs can’t determine if cells are cancerous. The MRI was not certain if the mass invaded the prostate, but the ultrasound stated that the prostate was not involved. The MRI considered it t3c and MRF+. Several biopsies were taken in which cancer was found in a FNA, which led to the decision to move forward with the APR.
His liver was also visually examined prior to the APR. No metastases we’re observed.
The pathology reported no positive lymph nodes, but a positive margin. It is my understanding that the positive margin was CRM, and that the other (non radial) margins were clear since the APR removed pretty much everything.
His surgery went all the way to the seminal vesicles. Colorectal surgeon operated to the MRF, and the urologist took over and examined the prostate, and concluded a biopsy was not necessary based on a visual examination. He removed tissue up to the seminal vesicles, and enough that it is actually considered more likely to cause nerve damage. In fact they were worried he’d need a catheter for an extended period. Luckily that was not the case.
So, although the cancer cells were found in the margin, they feel that any cancerous cells that would remain are in a very narrow amount of fat tissue which is outside the prostate. Additionally the urologist felt that the high amount of heat used (I guess the robotic surgery additionally cauterizes the wound) would likely kill cells in the immediate area.
My understanding is that the entire area that was previously radiated was removed.
The urologist explained that if radiation is determined to be administered, that it would not be EBRT, but something milder that would be applied along that plane. I didn’t get the name for the type of radiation he was referring to. But everything still needs to be reviewed by the team, and we probably won’t get a recommendation until close to the end of June.
The surgeon seemed to feel like the outcome of the surgery was great, so much that she believes no adjuvant therapy may even be the best approach, but we still need to hear from his oncologist. Her optimism makes me hopeful. It’s a multidisciplinary team of board certified surgeons along with his oncologist, and they will debate…
DH and I are partial to chemo since it worked so well initially. But of course we can only ask for that and see what happens. Also, I feel that in his case, the chance of systematic recurrence is greater than that of local recurrence, even with the positive margin. But a lot of weight is given to all negative lymph nodes.
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