pathology report

 

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.

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Les

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

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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)

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

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age at dx 54 now 56

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

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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.

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.

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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)

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.

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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