Your cancer was already developing a couple years ago with your PSA higher than 4.0ng/ml. Unfortunately, very few men know to request their biopsy tissues be sent to a pathologist who has expertise in reading prostate cancer presence. And you escalating PSA since 2006 confirmed whoever was your physician was not providing sufficient concern. I would be apprehensive of a urologist who only recommended "open" surgery. Obviously that recommendation is because he is not trained in robot assisted laparoscopic radical prostatectomy - a much less invasive procedure with less blood loss and faster recovery. The 4+3/7 Gleason grades/score is of concern and prior to surgery it would be appropriate to have blood serum testing for PAP, CGA, CEA, and NSE to determine possibility of metastasis. Early development is unlikely to show up on MRI/CT scan. If these blood tests indicate possible metastases, neither surgery nor radiation will completely eradicate all cancer, although physicians might still recommend these options to "debulk" the majority of cancer. Your report is a bit confusing in identifying two tissue samples with one 3+4 and the other 4+3, but then commenting "All 7 cores tested positive with 60-80% cancer." You should identify what Gleason Score was assigned to each individual tissue sample, and what percentage of PC was present on each individual tissue sample. If the pathology report doesn't indicate these numbers, then the pathologist did not provide an appropriate report. And if that's the case, you should ask that your biopsy tissues be sent to a pathologist with PC expertise, namely Bostwick Laboratories/ Pathologist David Bostwick
Virginia - Corporate Headquarters 4355 Innslake Drive, Glen Allen, VA 23060
(and when samples are sent in, they should be accompanied by a request that ONLY Dr. Bostwick perform the review)
Jon Epstein (Hopkins) 410-955-5043 or 410-955-2162 (Dr. Epstein does not do ploidy analysis)
David Grignon, Centennial Professor of Pathology, Vice Chair for Clinical Programs, Indiana University School of Medicine, Clarion Pathology Laboratory, 350 West Eleventh St. Room 6014, Indianapolis, IN 46202 317-491-6685
Jon Oppenheimer, Owner and Chief Pathologist, Oppenheimer Urologic Reference Lab, Nashville, Tennessee, 888-868-7522 JPathologist@gmail.com
M. Scott Lucia, Director, Prostate Diagnostic Laboratory, Co-Director, Prostate Cancer Research Laboratories, University of Colorado, Denver – School of Medicine at Fitzsimons Dept. of Pathology, 303-724-3470 E-mail: Scott.Lucia@uchsc.edu
And, in the meantime, I'd check around to find out if there are urologists in the area who provide robotic assisted LRP. And if there is and you are comfortable, I would add that you direct the physician to include the removal of lymph nodes adjacent to the prostate gland as well as seminal vesicles, since if the cancer has migrated, those are the key pathways.
Like another suggested in replying to your report, purgatory isn't the most appropriate name to use in a setting of patients fighting cancer.