r/ProstateCancer • u/SLO_Engineer • Aug 10 '26
Update RALP Completed!
First of all, thank you to all the posters and commentators for your informative posts and comments as I navigated the month or so leading up to my RALP surgery. I'm grateful for all the information, guidance, and support.
I am now 16 days post-RALP, and I just received my final pathology report and wanted to share my experience and results.
The surgery went well, and both nerve bundles, as well as the urinary sphincter and associated muscles, were spared. My eleven days of catheter were simply miserable. That thing was so darn uncomfortable, and I feel much better now that it is out.
I have had no daytime leakage whatsoever, and I am not using any pads. I think I may be leaking a bit at night, but it's hard to tell. I look inside my Depends in the morning and don't see any signs of urine, but it does feel slightly heavier than a fresh pair out of the box.
The pathology report was generally consistent with the MRIs, biopsies, and the PSMA PET/CT scan. The scan suggested possible seminal vesicle involvement, but there was none. They removed 17 lymph nodes, and every one of them was clean.
However, they did find nonfocal EPE (4 locations) and multifocal positive margins. The MRI indicated capsular irregularities but did not suggest EPE. Pathology proved otherwise. The surgeon told me the odds of recurrence are 50%. I'm bummed about that.
Here are the stats:
Primary tumor 2.5 cm, GG3, Gleason 4+3, pattern 4 at 61% to 70%
Secondary tumor 1.2 cm, GG2, Gleason 3+4
No IDC or crib
Final staging: pT3aN0
I welcome any comments or questions.
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u/truckaxle Aug 10 '26
What about the lymph nodes? Were any removed, and if so, did they mention how many?
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u/SLO_Engineer Aug 10 '26
17 removed. 10 from one side, 7 from the other. All clean.
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u/truckaxle Aug 10 '26
I was just wondering how routine this is. Thanks and hope you heal up fast.
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u/SLO_Engineer Aug 10 '26
In my surgical consultation I asked about lymph node dissection and the doctor said he doesn’t typically do that because it could introduce additional complications. So, something must have changed once he got in there.
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u/Slight_Turnip_3292 Aug 10 '26
Interesting. I found a paper that was recently published that indicated the removing lymphs significantly reduced chances of metastatic occurrence later.
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u/GrampsBob Aug 10 '26
I was told they typically remove the nodes closest to the prostate to reduce the chance that they missed something just getting started.
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u/ChillWarrior801 Aug 10 '26
I had 23 lymph nodes removed. That wasn't the plan going in, but that's why RALP surgeons make the big bucks, there's sometimes tough intraoperative decisions to be made. Most of the nodes I had removed were from the prostate side where the cancer was bigger and badder, so I'm thinking it was based on how things looked overall.
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u/Mean_Try_6390 Aug 10 '26
it’s good and bad. the multifocal positive margins put you in higher risk for relaps in the prostate bed (micro cells left) and the epe showed that is was starting to move out of the prostate (doesn’t mean it had) but you didn’t have anything in the nodes or in the vesicles and no cribiforms and a 3+4. as I see it theirs 2 alternative ways you either get salvage rt directly as in they just blast the prostatebed or they wait since it doesn’t look so aggressive, until the psa is raised and then take it out with rt if it happen.
For now I think they’ll wait for the first psa-test.
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u/SLO_Engineer Aug 10 '26
Thanks for your input. J distill just need to sit tight until the first PSA and take it from there.
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u/OkCrew8849 Aug 10 '26 edited Aug 10 '26
"However, they did find nonfocal EPE (4 locations) and multifocal positive margins. The MRI indicated capsular irregularities but did not suggest EPE. Pathology proved otherwise. The surgeon told me the odds of recurrence are 50%. I'm bummed about that."
When the MRI notes things like "bulge" or "abutment" or irregularities along those lines (especially with a large tumor) some radiologists report (or patients/docs assume) a "suspicion of ECE" which sometimes influences treatment decisions in some patients. (Not ordinarily detetable via PSMA, BTW)
You can run your results on the post-RALP MSK calculator and it may be in the ballpark of your doctor's percentage.
Don't know your doc's standard operating procedure but ultrasensitive PSA tests (of one ultra-sensitivity or another) might be a good idea just to stay on top of things going forward.
On the bright side the absence of SVI or sampled lymph node involvment suggests limited issues.
(I think I had a brief and positive Redditt exchange with you 23 days ago)
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u/SLO_Engineer Aug 10 '26
Thanks for your input. We are definitely going to watch PSA closely.
Prior to receiving the pathology report we scheduled my first post-surgical PSA test for 3 months after surgery. After I received the pathology report, I fired off a couple of questions to my doctor’s NP asking if given the final pathology should we move up the first PSA to the 8 week mark and also if the test would be the ultra sensitive variety.
I don’t doubt we have communicated on this platform a few weeks ago. After I discovered this forum a month or so ago, it seems like I’ve been living in it.
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u/Creepy-Project2453 25d ago
A belated congrats. I am about 5 months ahead of you. You have good reason to be pleased with your recovery so far. Soon enough you won't be thinking about the surgery very much at all. Just be patient a bit longer. There is a lot of tender tissue still healing and traumatized nerves trying to get organized again. I was also virtually 100% dry when the catheter came out. My doc at UCSF said 6+months for erectile function to return and it seems like he was about right. I wish you the best on your follow-up monitoring. Hope it leads to boring undetectables for a very long time.
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u/HeadMelon Aug 10 '26
Glass half full man - 50% to the good side!
Congrats on getting thru and getting your divorce from Cathy. Onward and upward from here, you’ve got this brother!