Pathology/Surgery Question

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Regular Member

Date Joined Aug 2008
Total Posts : 328
   Posted 10/10/2008 8:38 AM (GMT -6)   
Not sure if anyone could anser this but going to throw it out their since it has been on my mind and dont see doc for another two months... I noticed on my post op pathology report the doctor took a sample from the left apex of my prostate, and left base of my prostate during the operation with a frozen sample to be looked at during operation. Which he  said to me he was going to do samples during operation to ensure he got everything. They both were negatve. He is also took a sample of my right lynmph node and the took out my entire left lymph node. My biopsy beforehand showed all the cancer in my right prostate lobe. In postop pathology showed majority cancer in right and some in left. Why didnt he take a froxen biopsy of my right side apex and base, not my left and take my right entire lymph node since that was were the side of the cancer was?  Also do you know when during surgery can the doctor see the tumor inside your prostate? So fo me that he could see it was predominately on my right lobe?? My margins were clear which I thank God every day but I was just curious if he mistakenly thought everything was on the left during the surgery or did he see this and was ensuring the left was clear.... Thanks!
Age Dx 37, 7/2008
First PSA : 4.17 5/2008
Second PSA After 2 weeks of antibiotics : 3.9 6/2008
DRE: Negative 5/2008
Biopsy : 6 out 12 Postive all on right side, Gleason 7 (3+4).
Bone Scan/CAT Scan: Clear 7/2008
Cystoscope: Normal 7/2008
Prostate MRI: Normal 7/2008
Da Vinci Surgery 7/2008
PostOp: T2c (On Both sides), margins clear, seminal clear, nodes, clear. Gleason 6(3+3).
First PostOp PSA 9/2008: <0.01
2nd PSA 12/2008: Praying for <0.01

Veteran Member

Date Joined Jul 2008
Total Posts : 966
   Posted 10/10/2008 10:12 AM (GMT -6)   
SHU93....I maybe wrong, but it sounds like your surgeon was looking for spread of cancer, knowing that the right side from the biopsy would be checked during the final pathology. Much like a my surgeon that tested the lymph nodes on both sides at the beginning before moving forward with the removal of the gland. Just take it as he was looking around and becoming familar with your cancer before doing any cutting to make sure he could get clean margins. As far as being able to "see" the cancer...good question, but I think it can be felt easier than seen if it is large enough. With robotic that tactical feel isn't there. Most PCa is multiplicity which means more than one tumor is present in either lobe. PCa is not generally one mass but made up of several smaller ones. That is why the biopsy won't catch all of the cancer locations and is why the pathology is usually different than the biopsy when it comes to the amount of PCa and the grade and sometimes stage.

Great news on being zero and here's hoping for a lifetime.
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base)
Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1,2008
Gleason 7 (4+3) Staged pT2c NO MX
Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
14 tumors in prostate - largest being 6 cm 

Doting Daughter
Veteran Member

Date Joined Aug 2007
Total Posts : 1064
   Posted 10/10/2008 11:17 AM (GMT -6)   
In my opinion, the only negative with the Da Vinci is that the surgeon might not be able to get all the lymph nodes he/she would like. Therefore, in your particular case, he might have wanted to get more on the right side, but couldn't get the angle. The surgeons are not always able to see the cancer, that is why they send the slides to the pathologist. Like Les said, he was probably looking for spread, which is normal and it is fabulous news that your results were negative!! Have a great weekend!
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

Veteran Member

Date Joined Apr 2006
Total Posts : 1732
   Posted 10/10/2008 3:58 PM (GMT -6)   

There was no indication for the surgeon to remove nodes. He checked the close nodes and removed just one, leaving the rest (you have many) after finding a clean pathology. He did pretty much what all good surgeons will do...checked before doing more than he needed to. He's the kind of Doctor I can respect.
Lookin out for his patient :>)


Veteran Member

Date Joined Apr 2008
Total Posts : 1382
   Posted 10/10/2008 7:38 PM (GMT -6)   
That is standard procedure SHU, I had 13 lymph nodes removed during surgery, for me though the cancer had spread and the surgery was aborted. Be thankful the surgeon checked like he did. Sounds to me like all went well and you are on the road to recovery. How are you doing physically and emotionally?

peace and grace
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

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