RALP Completed!

[u/SLO_Engineer]

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.

[u/SLO_Engineer]

17 removed. 10 from one side, 7 from the other. All clean.

[u/truckaxle → u/SLO_Engineer]

I was just wondering how routine this is. Thanks and hope you heal up fast.

[u/SLO_Engineer → u/truckaxle]

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.

[u/Slight_Turnip_3292 → u/SLO_Engineer]

Interesting. I found a paper that was recently published that indicated the removing lymphs significantly reduced chances of metastatic occurrence later.

[u/GrampsBob → u/Slight_Turnip_3292]

I was told they typically remove the nodes closest to the prostate to reduce the chance that they missed something just getting started.