Got post op pathology

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BillSD
Regular Member


Date Joined Sep 2008
Total Posts : 143
   Posted 10/8/2008 3:30 PM (GMT -6)   
To all my dear friends at HW,
 
I just returned from seeing my urologist/surgeon and received the pathology on my RRP (September 15).
 
Here goes:
 
Staging: pT2c pN0 MX
Gleason: 3+4=7 (biopsy indicated 3+3=6)
No discrete tumor mass
Bilateral involvement
No capsular penetration (carcinoma extends into but not through capsule bilaterally)
Perinueral tumor invasion: present
Perinuera margin: Free of carcinoma
Bladder neck: Free of carcinoma
Distal (urethral) Margin: Carcinoma present
Seminal Vesical: None present
Lymph Nodes: 18 nodes free of metastatic carcinoma
 
I am pleased with the results. Staging went down from Stage 3 to Stage 2, but Gleason went up from 6 to 7.
 
Only area of concern seems to be Distal Margin. My surgeon says he thinks he got it all. Pathologist is not so sure.
 
I will see my oncologist Monday to get his take on the path report.
 
Plan now is to see what PSA shows. May follow up with radiation, if indicated.
 
Cath came out September 30 (15 days)
 
I returned to work (restricted schedule) on Monday (three weeks to the day after surgery).
 
I feel great, and am 90% continent. Little dribbles when I take "Little Elvis" out, and sometimes he is not done when I am. turn But I am learning to manage the new plumbing.
 
Some white blood cells in urine, so I am on a week of CIPRO. Not uncommon with cath post op.
 
Thank you all for your wonderful support. I welcome your take on the path report...any concerns I may be overlooking.
 
Bless you, all.
 
Bill in San Diego
 
 
---
Age 59 at diagnosis (PSA 4.4)
May 15, 2008 – Biopsy, Gleason 3+3=6 (Most cores positive 40% or more)
Ambiguous core sample for seminal vesicles
Bone scan and pelvic/abdomen CT show no visible metastasis
Began weight loss program (lost 26 pounds between diagnosis and surgery)
June 15, 2008 – Began two months hormone therapy (Casodex 50 mg)
July 1, 2008 – Lupron shot (3 month dose)
July 11, 2008 – EKG
July 16, 2008 – Echo-cardiogram for surgery, OK
Aug 25, 2008 – Donated first unit of my own plasma for surgery
Sept 3, 2008 – Stress test and donated second unit of plasma
Sept 5, 2008 – Pre-op visits with Urologist and GP, chest X-ray, EKG
Sept 15, 2008 – open Radical Prostatectomy (non-laproscopic, non-robotic)
VIEW IMAGE
 
 

Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 10/8/2008 4:45 PM (GMT -6)   
Hooray Bill! The path report looks good!! Hopefully, the surgeon got everything and that margin won't give you any trouble! Great news about everything else! Cheers to a lifetime of undetectable PSA's!
Father's Age 62 (now 63)
Original Gleason 3+4=7, Post-Op Gleason- 4+3=7,
DaVinci Surgery Aug 31, 2007
Focally Positive Right Margin, One positive node. T3a N1 M0.
Bone Scan/CT Negative (Sept. 10, 2007)
Oct. 17 PSA 0.07
Nov. 13 PSA 0.05
Casodex adm. Nov 07, Lupron beg. Dec 03, 2007 2 yrs
Radiation March 03-April 22, 2008- 8 weeks 5x a week
July 2, 08 PSA <.02
Praying for a cured dad.

Co-Moderator Prostate Cancer Forum


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 10/8/2008 7:43 PM (GMT -6)   
Now that's a pretty good looking pathology. I'll be pulling for you when PSA time rolls around.
Bill yeah
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 (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)


Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2299
   Posted 10/8/2008 9:05 PM (GMT -6)   
Sounds like a good report to me, Bill, especially the downgrade.  Looks like they got it all.  Now you just have to focus on your recovery--physical and mental.  Take care and let us know how you're doing...Tim
 
P.S.  It's funny to read all the penile nicknames that people use. Hadn't heard  'Little Elvis' before!

RBinCountry
Regular Member


Date Joined Apr 2008
Total Posts : 270
   Posted 10/9/2008 7:30 AM (GMT -6)   

I would encourage you.  It looks like a promising pathology.  Isn't it great to have the surgery behind you, and also no more biopsy's.  I too had a Lupron shot, and it took a while for that to wear itself off.  Because of my biopsy the doc cut a little wider and my pathology is similar to yours.  The things associated with incontenence will continue to gradually improve and become less intrusive.

We will continue to follow your progress.  Blessings.

RB

Age 61
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA <.04


BillSD
Regular Member


Date Joined Sep 2008
Total Posts : 143
   Posted 10/13/2008 3:23 PM (GMT -6)   

UPDATE: I visited my oncologist this morning and we mutually agreed that I will begin adjuvant radiation in a couple weeks. While we THINK we got all the cancer in surgery, there is enough margin for concern that we should (as Tony says) "fire all torpedos". Why do just 90% of the job? This is all-out war. It is the right thing to do.

Thanks,

Bill in San Diego


PCADVOCATE&MENTOR
New Member


Date Joined Jul 2008
Total Posts : 8
   Posted 10/13/2008 7:24 PM (GMT -6)   
Hello, BillSD
 
Noticed your latest update regarding planned IMRT.  With extension to margins and having had the presence of PIN, IMRT is a reasonable safety measure to hit the prostatic periphery.  Did your physician also discuss continuing the Lupron through the radiation series?  Personally, with any ADT I support triple hormonal/androgen blockade as an all out attack and because antiandrogens and 5AR inhibitors play an important role in ADT.  I notice how often the word "capsule" is mentioned when, in fact, the prostate gland is just that, a mass of glandular tissue, though it does have visible "margins."  It is not an encapsulated organ that looks anything like the drawings indicating a gland within an acorn-like structure/capsule.  Good signs were clean lymph nodes and seminal vesicles.  PSA values won't mean much while on Lupron and during radiation.  More likely six months out from the completion of radiation and ceasing of Lupron will give a more accurate result, and at that time I would ask for an ultrasensitive/3rd generation PSA reading that can be performed by LabCorps or Quest Labs and should come back <0.01ng/ml since there is no longer a gland present.  Since radiation can play tricks with PSAs for quite some time, it may take more than six months to drop to its lowest nadir.  I'm glad to note that you intend to be ever vigilant, since our insidious men's disease requires continued monitoring so that in the event of recurrence, we nip that return in the bud before it becomes cumbersome to control. 
Chuck

BillSD
Regular Member


Date Joined Sep 2008
Total Posts : 143
   Posted 10/13/2008 7:51 PM (GMT -6)   

Thanks Chuck,

Your post is mosty helpful. No, the doctor did not indicate I will continue with Lupron, but after your commenst, I will ask why not!

Much appreciated,

Bill


BillSD
Regular Member


Date Joined Sep 2008
Total Posts : 143
   Posted 10/14/2008 9:40 PM (GMT -6)   
UPDATE: Just got a call from my Oncologist. He did blood work yesterday, but I was not expecting my first Post Op PSA results. To my surprise, he did the PSA test, and the results (drum roll) 0.1.

BillSD
Age 59 at diagnosis (Now 60)
PSA 4.4
05/15/2008 – Biopsy
Gleason 3+3=6
Most cores positive 40% or more
Ambiguous core sample for seminal vesicles
Bone scan and pelvic/abdomen CT show no visible metastasis
06/15/2008 – Began two months Casodex 50 mg
07/01/2008 – Trelstar shot (3 month dose)
09/15/2008 – Retropubic Radical Prostatectomy
Pathology: Staging: pT2c pN0 MX
Gleason: 3+4=7
No discrete tumor mass
Bilateral involvement
No capsular penetration (carcinoma extends into but not through capsule bilaterally)
Perinueral tumor invasion: present
Perinuera margin: Free of carcinoma
Bladder neck: Free of carcinoma
Distal (urethral) Margin: Carcinoma present
Seminal Vesical: None present
Lymph Nodes: 18 nodes free of metastatic carcinoma
10/13/2008 - PSA 0.1
 


M. Kat
Veteran Member


Date Joined Jul 2006
Total Posts : 715
   Posted 10/15/2008 5:48 AM (GMT -6)   
Bill - it sounds like you and your doctor are on top of this. congrats on the PSA test result! may you have a lifetime of zeroes!!
Husband Jeff 56 years old diagnosed July 27, 2006
PSA 6.5, 2 positive areas in biopsy, Gleason 3+3=6
Radical Retropubic Prostatectomy August 30, 2006
pathology report - all clear - cancer gone
1st post-surgery PSA test <0.1, 2nd post-surgery PSA test <0.1, 3rd PSA <0.1
no more pads Oct 12, 2006
first "real" erection with use of pump 12/16/06
3/07 - occasional dribbles and erections with Cialis and pump
8/07 - 1 yr PSA <0.1
9/1/07 - achieved erection with Viagra - no pump!
3/08 - 18 mo PSA <0.1
switched to Levitra - works much better than Viagra & Cialis - fewer side affects
summer of 2008 - have had a few erections with no drugs! yeah!!
8/08 - 2 yr PSA <0.1


Lungman
Regular Member


Date Joined Jan 2008
Total Posts : 276
   Posted 10/15/2008 6:04 AM (GMT -6)   
Good Post-op path Bill, now just get on with enjoying life, you deserve it.

Randy
46 you when diagnosed, now 47
Pre-Op PSA 9.9
1 of 12 cores positive, Gleason 3+3
DaVinci on 9/5/2007
Post-Op Gleason 3+6, Negative Nodes and Margins
Less than 1% of prostate involved with CA
3 Month PSA 0.01, 6 Month PSA 0.01, 9 Month PSA 0.01
One Year PSA 0.01
Incontinence resolved 9/15/2007, one day after cath removal
ED showing significant improvement.
Cialis 5 mg every night.
Success with BiMix

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