My prostate surgeon tells me post operative tissue analysis found a small amount of cancer on the outer “skin” of the removed prostate tissue, which means notionally it extended into adjacent un-removed tissue.
The lab found 75% of the right side surface of the removed prostate was covered by cancer tumors. When the criteria for scoring the cancer by aggressiveness and extent were applied, the resulting Gleason score for my cancer was 9. This was a big (nearly29%) increase over the Gleason score of 7 assigned at the biopsy just 9 weeks earlier. The biopsy analysis was based on ten tissue samples, and only one of the ten was cancerous; a malignant sample of 1 in 10 would indicate a very small amount of tumor growth at the time of the biopsy.
To put the changes in perspective, look at the diagnosis-scoring timeline:
· My internist identified a “wrong” response to the DRE on August 8; recommended a urologist double check; Prostate Specific Antigen (PSA) blood test returned a “normal” value of 2.1 (NOTE: I have heart disease and have been on an aspirin regime for 37 months...reports are aspirin reduces PSA scores)
· Urologist exam on August 18; independently drew me the same picture of the prostate and the affected area as my internist; both indicated the affected area confined to the upper right quadrant of the gland; scheduled biopsy
· August 28, biopsy; ultrashound measures showed prostate normal in size; lab results indicated one of the 10 samples cancerous, supporting an initial diagnosis that only a small area of the prostate was involved; Gleason scores of 4/3 for a total of 7 (upper end of the ‘moderate’ range) assigned to the tumefacient tissue; combination of normal prostate size, small area and moderate score indicated early detection of active cancer
· During September several meetings with urologists to discuss treatment options and approaches; finally decide on DaVinci robot surgical removal
· October 15 meeting with physical therapist related to regaining post-operative bladder control
· Surgery performed November 7; first available date for DaVinci system given I had to go off heart and blood medicine for at least 10 days prior to surgery
· Elapsed time from initial diagnosis to removal was just about 90 days; removed prostate measured to be "enlarged" on the right side; revised Gleason score based on post-op tissue review of 5/4 for total of 9 (near the maximum score of 10); 75% of surface covered by tumors.
The conservative interpretation of the cancer growth in relation to the timeline is that it—the cancer—was pretty aggressive. My Dad died within six months of his initial diagnosis of cancer (not prostate, though). His cancer was also very aggressive.
Sugeon's approach is very conservative—like most docs, he is primarily interested the efficacy of the outcome, meaning, no post-surgical cancer re-occurrence from that source. He tells me that after the removal of the tissue, he cauterized the adjoining area heavily. This has the effect of taking out additional tissue beyond that removed and sent to the lab; he believes he probably got the remaining tumor material with the cauterization, but says there is a continuing chance in the 60-65% range I'll need additional radiation therapy. We will take a new PSA exam around 12/7.
Here is my question: Assuming a PSA test above .2 (surgeon indicates the value for assuming continuing cancer) I'll need radiation treatment. Can proton therapy be used effectively in this post-operation environment?
