pathology report

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kreplerfp
Regular Member


Date Joined Oct 2008
Total Posts : 56
   Posted 10/14/2008 4:27 PM (GMT -6)   
 
I just received my pathology report from my surgery on Sept 18. A little bit of it I understand and some I don`t. I don`t understand how good or bad the report is. I would like to post the microscopic Examination and see if others could help interprid  the results. I do realise also that we are all not doctors, but any help would be appreciated
 
1. Sections show 3 lymph nodes with surronding fibroadipose tissue
2 evidence of sinus histiocytosis. negative for metastic adenocarinoma
3 there is partial fat infiltration in the parenchyma and changes of sinus histiocytosis
4 lymph nodes are negative for metastic adencarcinoma.
5. presence of prostatic adenocarcinoma in right and left lobes.it is multifocal
overal gleason score is 6  3+3
tumour cells show aggressive features of moderate to sever pleomorphism.
7 there is involvment of the margins identified at the right and left apex as well as the right anterior surface.
8. there is perineural invasion
No extraprostatic extention identified.
There is no seminal vesicle invasion.
 
I don`t see my doctor till Nov 12 for first PSA.

LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 10/14/2008 5:13 PM (GMT -6)   
Basically what I can tell, there is some sort of condition with the lymph nodes but it isn't PCa. Your doc can explain that better for you. You did have positive margins in the apex (bottom of the prostate) and one in the anterior (front side). That would be the only concern I can see from the report, but not to the extent of worry. Follow up closely with your PSA for any rise in the future. Positive margins could mean that some cells were left behind during the surgery. Most of the time (70-75%) they die off with no further treatment. Some doctors will recommend salvage treatment as a precautionary and others don't based on original PSA and gleason score from the path report. Overall, looks like a fairly good report..no lymph node or seminal vesicle involvement which means cancer was contained to the removed prostate.
Les
 
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 


Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2331
   Posted 10/14/2008 5:19 PM (GMT -6)   
The lymph nodes near the prostate and the seminal vesicles are negative for cancer.  A Gleason score of six is relatively low.
The cancer was at the prostate margins (surface) and in the nerves, but did not extend beyond the prostate. 
      It looks like the cancer was organ-confined, but because it was at
      the surface of the prostate, you should be monitored closely.
    
      You're a lucky guy you got it treated when you did since the       
     cancer was at the edges but hadn't spread anywhere yet! 

Gordy
Veteran Member


Date Joined Jun 2005
Total Posts : 528
   Posted 10/14/2008 6:00 PM (GMT -6)   
Doesn't anyone have an issue with a doctor giving the patient his path report (with all its "medical-ese") and making him wait for yet another month without any explanation?

-Les
1/2005 Dx PSA 26.5 Gleason 7 (4+3) @Age 61
1/2005 Start Casodex and Zoladex
PSA drops to <0.01
7/2005-8/2005 5 weeks of IMRT and then HDR brachy
1/2007 Rad Oncologist orders CT scan of pelvis
because of complaints of pain in both thighs
MRI confirms pain not caused by cancer BUT
1/2007 CT scan of pelvis picks up a nodule at bottom of left lung
5/2007 CT scan of lungs shows 1/2007 nodule has grown and
there are numerous nodules on both lungs.
6/2007 Thoracic surgeon removes wedge of left lung for biopsy
6/2007 Path report says 95% chance of metastatic PCa, but she's
never seen cells like this before.
8/2007 2nd opinion at M.D. Anderson in Houston.
They confirm: mutated PCa, very rare, but seen there 2 or
3 times. Recommendation: have CT scans every 6 weeks
and watch for change. At that point start chemo and will
survive for 22 - 24 months thereafter.
PSA still undetectable, but get Lupron shot to bring T down from 27
2/2008 Trip to Houston – PSA now 0.5 and nodules larger. Lupron shot.
6/2008 Trip to Houston - Finally got results from doc. A number of lung nodules have grown, but, more important to him, is the fact that the malignant lesion on my pelvis seems to have flared up and he wants me to start chemo. He said I could wait a few months, but I told him I want to start now. He to get me signed up for a clinical trial in nearby NY.
9/2008 Interim bone and CT scans show progress vs. scans done before beginning trial. I'm cautiously optimistic. Next scans 10/30/08.

Post Edited (Gordy) : 10/14/2008 5:42:05 PM (GMT-6)


Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2331
   Posted 10/14/2008 6:35 PM (GMT -6)   
Gordy said...
Doesn't anyone have an issue with a doctor giving the patient his path report (with all its "medical-ese) and making him wait for yet another month without any explanation?

-Les

Les--It does seem that the doc should have reviewed this personally rather than sending the detailed pathology report without explanation, if that's what happened.
 
My urologist called me when he got the pathology report a few days after I was released from the hospital cancer ward.  He assured me that everything was excellent and pronounced me free of cancer. He personally reviewed the detailed results with me about 2 weeks after the prostatectomy, when I was decatheterized.
 
 

mvesr
Veteran Member


Date Joined Apr 2007
Total Posts : 823
   Posted 10/14/2008 8:59 PM (GMT -6)   
Hi kreplerfp

Man you screen name mouthful. On the other hand I agree with Les. Yor Dr should give you the news as soon as he has the path report. I got a phone call and got the report in writing when I returned to get the cath out. And by the way Les, have you been driving the corvette?

Mika
age at dx 54 now 56
psa at dx 4.3
got the bad news 1/29/07
open surgery Duke Medical Center 5-29-07
never more than 2 pads
Tossed the pads this spring
ED still a problem
first year PSA less than zero
 


Gordy
Veteran Member


Date Joined Jun 2005
Total Posts : 528
   Posted 10/14/2008 10:08 PM (GMT -6)   
Hey Mika-

The clinical trial in which I'm enrolled is in a hospital 70 miles from where I live. It's almost all Interstates and they have me going up there at least once a week and sometimes twice (I'm out on disability). So, yes, I'm getting to drive the Corvette and still loving it. Thanks for asking.

I hope you're well.

-Les
1/2005 Dx PSA 26.5 Gleason 7 (4+3) @Age 61
1/2005 Start Casodex and Zoladex
PSA drops to <0.01
7/2005-8/2005 5 weeks of IMRT and then HDR brachy
1/2007 Rad Oncologist orders CT scan of pelvis
because of complaints of pain in both thighs
MRI confirms pain not caused by cancer BUT
1/2007 CT scan of pelvis picks up a nodule at bottom of left lung
5/2007 CT scan of lungs shows 1/2007 nodule has grown and
there are numerous nodules on both lungs.
6/2007 Thoracic surgeon removes wedge of left lung for biopsy
6/2007 Path report says 95% chance of metastatic PCa, but she's
never seen cells like this before.
8/2007 2nd opinion at M.D. Anderson in Houston.
They confirm: mutated PCa, very rare, but seen there 2 or
3 times. Recommendation: have CT scans every 6 weeks
and watch for change. At that point start chemo and will
survive for 22 - 24 months thereafter.
PSA still undetectable, but get Lupron shot to bring T down from 27
2/2008 Trip to Houston – PSA now 0.5 and nodules larger. Lupron shot.
6/2008 Trip to Houston - Finally got results from doc. A number of lung nodules have grown, but, more important to him, is the fact that the malignant lesion on my pelvis seems to have flared up and he wants me to start chemo. He said I could wait a few months, but I told him I want to start now. He to get me signed up for a clinical trial in nearby NY.
9/2008 Interim bone and CT scans show progress vs. scans done before beginning trial. I'm cautiously optimistic. Next scans 10/30/08.


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 10/14/2008 11:51 PM (GMT -6)   
Gordy,
I have to agree with you. It seems a little foolish to give a patient a pathology report and then not discuss exactly what all the terms mean for another month. It could well be the cause of a month long period of unnecessary concern and worry. Far better to get the report in his office with the doc taking the time to explain all the terms and implications.
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)


Lungman
Regular Member


Date Joined Jan 2008
Total Posts : 276
   Posted 10/15/2008 7:15 AM (GMT -6)   
I agree that giving a technical path report is confusing, but on the other hand, it gives you something to research and learn about. I would rather have that than "it all looks ok" which some guys get. I also had adipose tissue replacement in the lymph nodes, most likely to my being overweight for many years, it is simply a deposit of fat cells (adipose tissue) in the lymph nodes. The best case would have been the MD explaining the report to you in person, that is where I have a problem. Something like this should not be mailed unless you requested an advance copy prior to your follow-up visit. Good Luck, sounds like you are going to be fine.
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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