Post surgery biopsy results

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New Member

Date Joined Apr 2008
Total Posts : 12
   Posted 8/8/2008 6:19 PM (GMT -6)   
Hi all - received biopsy results earlier in the week and they are not exactly what we had hoped for...original biopsy showed minimal involvement gleason 3+3 - results after surgery showed tumor took up 40% of prostate, upgraded gleason to 3+4=7 with small focus of gleason 5 and very small possible margin on right side although he did say that it was fully contained to prostate - a little confusing I think.   Doctor says that we should wait for 6 week and most likely 3 month PSA before we decide if husband should have radiation.  Has anyone had any experience similar to this where the doctors have decided to start radiation prior to PSA - or do they always wait until after.  The surgeon seems to think that even if the PSA's are at zero he might be better off doing the radiation just for insurance purposes...we are definatley a little confused and just looking for a little advise  - Thanks!!
husband diagnosed May 2008
PSA 4.4
age 47
biopsy showed less than 2% involvement
gleason 6  3+3
Davinci Surgery 7/21/2008 Dr. Shalhav University of Chicago
home 7/22/2008 -
Biopsy results - 40% involvement, gleason 3+4 = 7 with small focus of gleason 5,  small margin on right side
incontinence - minimal, ED - 95% with viagra

Veteran Member

Date Joined Apr 2008
Total Posts : 1382
   Posted 8/9/2008 8:30 PM (GMT -6)   
Based on what you have written I find it odd that radiation would be included. your diagnosis seems a bit vague. Even though you have already had surgery, it might still be worthwhile to get a second opinion. That is what I did, I had my surgery, but as I got into the treatment phase I opted to have a second opinion. Please keep me posted as to how things go. We are close to the same age, so I will follow this.

peace and love
My PSA at diagnosis was 16.3
age 46 (current)
My gleason score from prostate was 4+5=9 and from the lymph nodes was 4+4=8
I had 44 IMRT's
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11
PSA July 24th, 2008 is 0.04
cancer in 4 of 6 cores

New Member

Date Joined Apr 2008
Total Posts : 12
   Posted 8/10/2008 9:19 PM (GMT -6)   
Dale - from what we understand, the reason for possible radiation is that Paul has 3 high risk factors: The large volume of tumor, the small amount of gleason 5 cells and the possible margin. The surgeon said that it was something that we might want to consider even if the PSA's come back at zero - with his young age Im not so sure that I am against it - any thoughts?.....

husband diagnosed May 2008
PSA 4.4
age 47
biopsy showed less than 2% involvement
gleason 6  3+3
Davinci Surgery 7/21/2008 Dr. Shalhav University of Chicago
home 7/22/2008 -
Biopsy results - 40% involvement, gleason 3+4 = 7 with small focus of gleason 5,  small margin on right side
incontinence - minimal, ED - 95% with viagra

Veteran Member

Date Joined Feb 2008
Total Posts : 1858
   Posted 8/10/2008 9:39 PM (GMT -6)   
Hello Murphy,
I would think that your doctor is looking at the possibility of the tumour having escaped the prostate at the area of "possible margin" and is entertaining a pre-emptive strike by radiating that area if the 3 month PSA is not what he would like to see. You are right though, the "possible margin" and "fully contained" surgical results are confusing. At least the doctor is looking at all possibilities. Keep us posted on how you go.
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07----4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable
PSA August 08 <.001 undetectable

Every time I see an adult on a bicycle I no longer despair for the human race.

Regular Member

Date Joined Jan 2007
Total Posts : 165
   Posted 8/11/2008 12:43 AM (GMT -6)   
Hey Murphy
As you can see by my signature line, I had similar results in my post surgical pathology report and pre-surgery diagnosis.  It was a real jaw dropper for me when my surgeon gave me the news.  I had been "happy as a clam" thinking that once my prostrate was gone, I would be cured and nothing to worry about.  The only blessing I could think about for awhile, was that at least I knew the extent of my cancer, and by having the surgery, I had second options.  Try to relax, recover from your surgery, add some prayer, and do what you're doing now - getting more information.
At the three month mark, when my PSA was good, my surgeon and oncologist both discussed the prospect of adjuvant radiation therapy.  They discussed recent studies that showed that for cases like mine, this therapy in the first year decreases the incidents of biochemical reoccurance.  When my 6 month PSA went up to .08, I made up my mind, and opted for hormones and radiation.  I have a bit less than a year left on my hormones, and had no problems with the radiation.  My PSA's have been great, and I'm hoping that once I'm off the hormones, that will continue.
In all, my pathology report was a real bummer, but take heart in that you do have secondary options.  I personally don't feel you need to jump into a decision today, but look at your first PSA's and talk to your doctors.
Good luck
Age 57 at diagnosis (2006),  PSA 4.7 (up from 3.2 one year previous)
Biopsy November 8, 2006 1 of 10 cores positive 5% LEFT Side Gleason 3+3
Robotic surgery January 19, 2007
Post Surgery Pathology Stage T3a, Gleason 3+4, positive margins and capsular penetration RIGHT Side
Post Surgery PSA:  March 5, 2007:  0.01    5 month PSA  0.08
Adjuvant therapy began June 26, 2007 with Zoladex injection
Radiation began August 23, 2007, ended October 8
First post radiation PSA, December 18, 2007:  0;  March 2008 - still 0;  July 2008 - 0

Regular Member

Date Joined Jan 2007
Total Posts : 376
   Posted 8/11/2008 8:16 AM (GMT -6)   

You have results as explained to me after surgery that seem close to what I was told also. I had a couple of agressive 5 cells, was up-graded from gleaseon 3+3=6 to 4+3 =7 and 20% of the prostate was cancerous and stated mine was also contained but there was an area hard to say on the margin but odds were they had gotten it in the process anyway. My PSA dropped to <.1 at my 3 and 6 month follow-ups and then at about the 10 month check up found that my PSA had risen to .2. Long story short after about 15 months post surgery and my PSA at .422 again we did salvage radiation and finished in June. I just had my follow up appointment and PSA test which looked real good and has dropped back down to .09 or < .1 again. Your call on what you might what to do and when and they may have it all taken care of now also. In my case we waited to see what the PSA tests showed before starting and waited until it returned which they hoped it would not but was not the case.

Good luck
Current age 50, Age at Dx-48 PSA 6.22 on 9-26-06
Biopsy 11-01-06, 2 of 13 cores 10% cancer, 2 other cores abnormal Up-dated 20% prostate cancerous
Gleason score 3+3=6 After Surgery Pathology report 4+3=7 a couple agressive Grade 5 cells found
Da Vinci surgery 01-09-07 UW Madison
Pathology Report- cancer 100 % capsual contained 1-18-07
1st & 2nd Post PSA Blood Test .1 and less - Undetectable
3nd Post PSA Blood Test 01-17-07 .3
March 27th PSA .422 Begin Salvage Radiation April, 14 2008
Radiation Complete June 4, 2008 36 treatments
August 5, 2008 PSA .09 or < .1 again
Incontenence-Pad free since end of May 07 4 1/2 months post surgery 
ED back to 95% prior to surgery - no medication required.

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