Interpretation of Pathology Report

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RandyJoe
Regular Member


Date Joined Jan 2015
Total Posts : 262
   Posted 3/4/2015 3:14 PM (GMT -6)   
In preparation for an upcoming appointment with the folks at Emory next week, I am going over my husband's pathology report and I noticed something that I have not noticed before.

It reads like this:

"Tumor is present in the right and left lobes, anteriorly and posteriorly, and extends from the apex through the base (level VI)

The peripheral margin is positive in the right anterior lobe (level III) involved by Gleason grade 3 tumor as well as the right posterior lobe (level VI), involved by Gleason grade 4 tumor."


My questions is this: what does level VI and/or level III refer to? I have tried to google this, but have come up empty. Does anyone know, or do I just need to wait to ask the docs? Thanks in advance for your help.
Age: 55
PSA July 2014: 26
Bx Aug. 2014: 8 out of8 cores positive; Gleason 7; 89%, 71%, 94%, 94%, 92%, 63%, 30%, 8%
Bone Scan/CT Scan Neg.
10/22/2014: Robotic Prostatectomy-Nerves spared
Post-Surgical Pathology: Gleason 9; one positive lymph node; most margins positive; seminal vesicles positive, Left Bladder neck positive
Stage pT3bN1
Post-Op PSA @ 7 weeks = 10.0 @ 11 weeks 14.2

ASAdvocate
Veteran Member


Date Joined Feb 2015
Total Posts : 595
   Posted 3/4/2015 6:59 PM (GMT -6)   
Before you really get yourself into a spin with something that could be mis-interpreted, I will try to guess at what it references.

It sounds to me like they are using the roman numerals, in this case, to refer to prostate "zones", or even to needles that were used in those areas. I have never heard of VI as any type of staging or diagnostic criterion.

Maybe someone else has a definite answer.
DOB: May 1944
December 2010: PSA 3.4 biopsy negative, HGPIN
March 2012: PSA 4.4 biopsy abnormal cells, HGPIN
April 2012: Prostate MRI w/coil, suspicious/indeterminate
July 2012: Biopsy <5% 1 of 14 cores, 3+3; T1c
Enrolled in AS program at Johns Hopkins
September 2013 PSA 3.7 biopsy: < 5% 3 of 14 cores, 3+3
OncotypeDX: 86 percent chance of PCa remaining indolent
Sept 2014: Biopsy negative.

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 3339
   Posted 3/4/2015 7:27 PM (GMT -6)   
As I read the signature, this is a post-surgical pathology not a biopsy, so it doesn't have to do with needles or staging. There are anatomic pathology codes denoted by roman numerals and I think that is what this is what the reference may be. I don't know what the codes mean, but you can Google them and get some insight. Better yet, call the doctor for an explanation.

I assume you are in close touch with the doctors. What are your next actions? With the pathology report it shows more treatment is in order. Have you discussed hormone therapy and when it may start? Have you seen the radiation oncologist to determine whether radiation will be used? What were the results of any CT and Bone scans? Post surgical PSA at that level and rising is certainly a concern to be addressed.

Since you are using Emory, I assume you are in Atlanta. I, too, am in the Atlanta area. Please let me know if there is anything I can help with.

Jack
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard and Jalyn started on 10-7-2010. IMRT to prostate and lymph nodes started on 11-8-2010, HDR Brachytherapy December 6 and 13, 2010.
PSA < .1 and Testosterone less than 3 since February 2011

RandyJoe
Regular Member


Date Joined Jan 2015
Total Posts : 262
   Posted 3/4/2015 9:01 PM (GMT -6)   
JNF

We are actually in Columbus. My husband started Lupton injections (6 month) a couple of weeks ago. Radiation begins in about 2 weeks. Bone and CT Scans are clear. We are coming to Emory because of some very disappointing encounters with our local urologist. The local medical community doesn't think we need a doc who specializes in prostate cancer (or anything for that matter). We disagree. The last few visits have convinced me that we had better know what's going on. We are hoping to find some reliable answers at Emory.

Do you see someone e at Emory?

Donna (RandyJoe)

Post Edited (RandyJoe) : 3/4/2015 8:11:53 PM (GMT-7)


Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4027
   Posted 3/4/2015 9:09 PM (GMT -6)   
Randy Joe, best wishes, I don't have answers to your questions but I'm sure others will jump in and fill in some of the blanks. One thing I have learned is we must be our own advocate.

JNF is a great guy. Feel free to reach out to him.

Cajun Jeff
9/08 PSA 5.4 referred to Urologist
9/08 Biopsy: GS 3+4=7 1 positive core in 12 1% cancer core
10/08 Nerve-Sparing open radicalSurgery Path Report Downgrade 3+3=6 GS Stage pT2c margins clea
r3 month: PSA <0.1
19th month: PSA <0.1
2 year PSA <0.1
Only issue at this time is ED but getting better

Almost a 10
Veteran Member


Date Joined Mar 2014
Total Posts : 859
   Posted 3/5/2015 10:50 AM (GMT -6)   
RandyJoe,

Here's a good link to a youtube video showing how a prostate pathology is performed. Maybe it will shed some light for you.

/www.youtube.com/watch?v=dwQ_j3hvhAI
11/2013 psa 240
DX 10/2013 PSA 187.5
PSA HIST 07/2011, 3.31;3/2010,1.87,3/06,.87
Biopsy 10/28/2013; 4 cores positive gs 9 (4+5)
BN SCN 12/09/2013 2 hot spots in spine
ADT 12/17/2013 22mg lupr, 50 mg Cas
BN biopsy 01/09/2013 neg
RALP 2/19/2014 NN , LVI ,Path T3B NX, MX, prost size 4.2 X 4 X 3 cm, 31 gms.Post Op PSA 3/14 .6, 6/14<.1;9/8, .6;12/8, 1.2
12/14 CT SCAN; 1/15 BN SCN

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 3339
   Posted 3/5/2015 11:35 AM (GMT -6)   
RandyJoe/Donna,

Good to hear he is getting aggressive treatment. In my opinion he very clearly needs a dedicated expert that is well experienced in treating aggressive high risk PCa.

I do not use Emory. My urologist is with Georgia Urology and they have an excellent dedicated urologic oncologist. I also use a medical oncologist with Atlanta Cancer Care that is well experienced with advanced PCa. I would be happy to provide you their names. So far my uro has been the lead and I am pleased and doing well. I meet with the oncologist regularly so he is up to speed on my case should I need his help.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard and Jalyn started on 10-7-2010. IMRT to prostate and lymph nodes started on 11-8-2010, HDR Brachytherapy December 6 and 13, 2010.
PSA < .1 and Testosterone less than 3 since February 2011

RandyJoe
Regular Member


Date Joined Jan 2015
Total Posts : 262
   Posted 3/5/2015 12:25 PM (GMT -6)   
Thank you, JNF

If this doesn't go the way we hope it will, I will definitely contact you regarding you docs. This road is too long to travel without someone you trust leading the way.
Age: 55 PSA July 2014: 26
Bx Aug. 2014: 8 out of8 cores positive; GL 7; 89%, 71%, 94%, 94%, 92%, 63%, 30%, 8%
Bone Scan/CT Scan Neg.
10/22/2014: Robotic Prostatectomy-Nerves spared
Post-Surg. Path: Gleason 9; lymph node +; most margins positive; SV=, Left Bladder neck positive
Stage pT3bN1
Post-Op PSA @ 7 wks = 10.0 @ 11 wks 14.2;
1/27/15-Lupron (6 mo.); 1/23/15-Bone/CT scans neg.
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