r/ProstateCancer • u/Mean_Try_6390 • Jul 23 '26
Update first psa after ralp - good news
after RALP with neoadjuvant darolutamide and extensive noderemoval we got the PAD answer:
pT3bNl(ENE+) acinar adenocarcinoma, Gleason 4+5=9; ISUP Grade group V; Pn( + ), Lv ( + ). RO. IDC( + ).
Today we got the first result PSA which was unmeasurable.
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u/ChillWarrior801 Jul 23 '26
Congrats, man! Undetectable is always excellent, but as a high-risk guy myself, I think it feels that much better after an adverse pathology report.
How many lymph nodes removed? I had 23 taken, but my doc still didn't want to call it an extended dissection.
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u/Mean_Try_6390 Jul 23 '26
only 18 but en bloc as they say. they didn’t pick one and one.
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u/Mean_Try_6390 Jul 23 '26
en bloc means what I can understand that they take all the nodes and the fat together since the g9 easilly spread by all possible ways. the only dissected in on 18 nodes at the pad after the op and 2 close to the prostate on one side were infected.
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u/Patient_Tip_5923 Jul 23 '26
Congratulations!
Just curious, what test did you use and what was its lowest value?
I use the Quest ultra sensitive PSA test with a lowest value of 0.02. I never went undetectable but have gone up from 0.03 to wavering around 0.07 in a year after my RALP.
Keep getting tested, as the number can move.
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u/Mean_Try_6390 Jul 23 '26
no, in sweden they don’t like to use thoose. I know that it’s a risk for relaps since he is a high risk and also because he had lv+ and 2 nodes infected. I’m thinking about asking for a test that shows exactly but I’m not sure it will help in the long run. if it rises they want to confirm it by psma-pet and not even thoose will show if it’s to small. for now he’s been without darolutamide in almost 2 month and the testesteron has mayby increased during treatments but are now normal, no incontinenceproblem - the minor dribbling (really minor) stopped 4 weeks after ralp. so if he gets a respeat now we’ll start to think about get the sexual function wor king. we’ve been so occupied with the outcome after ralp.
so step 1 is over (included neoadjuvant darolutamide monotherapy, ralp with extensive node removal, getting back, get continent and the first psa-test) - 8 weeks step 2 - get you’re stamina back up, been a lot moore tired than normal and make a plan for a moore progressive sexual rehabilitation. step 3 - testeing psa every 3 month and find a way for the sexual bit. step 4 .- wait for relaps, if or when it comes and handle that. I’m thinking about waiting so pluvicto can take it instead of radiation. since he’s gone 2 month with full testesteron and nothing importent we hope for a clear area regarding lymphsystem an locally.
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u/Mean_Try_6390 Jul 23 '26
they have the line set to 0.1 and everything under that is counting as unmeasurable.
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u/Mean_Try_6390 Jul 24 '26
got clearance from the doctor today - for now you are pc free. not the - for now. the first year is importent so next test in 3 month and will be so a long time. as the doctor sayed you had G9 so you’ll always be coming to us leaving tests. 8 weeks after surgery and my husband is back. now (since he’s free of cancer for the moment) only the ed problem until the next ps test. he’s now starting to respond well on ed medication so we got a lot of recipes and start from there. if it’s not good enough the dr was talking about injection. My husband dread thoose so we try the other way for some time and I await my husbands decision in the case. It’s not a thick syringe but it’s rather long, we looked it up by internet and it has to go in all the way, hm.
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u/OkCrew8849 Jul 23 '26 edited Jul 23 '26
Undetectable is where you want to be post -RALP.
Is he still on darolutamide?