Post op results

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Tobmeister
Regular Member


Date Joined Jan 2009
Total Posts : 41
   Posted 1/25/2009 3:30 PM (GMT -6)   
If anyone can explain the couple of "positive" results in post op pathology report and how they fit in with "specimen confined" description I would appreciate it. The doctor said it was a good "negative" report but I still don't completely understand.
Tom, age 51
Diagnosed 11/12/2008
PSA 2006 - 2.8, 2007 3.06, 2008 4.6 (remember the rate of increase is as important as the level), PSA free 8.7%
Gleason score 7 (4+3); 6 out of 19 cores sampled positive for cancer; perineural invasion present
Bone scan and CT scan both negative
Prostate mildly enlarged, DRE negative
DaVinci radical prostatectomy 12/30/2008 - Duke Medical Center - left side nerves spared
Catheter removed 1/15/09 - no pain!

Post operative results:
Pathologic stage - T3aN0Mx
Post surgery biopsy - Bladder neck margin negative, lymph nodes negative, specimen confined, extracapsular extension positive, perineural invasion positive, seminal vesicle invasion negative, all margins negative, Gleason 3 + 3 = 6.

1st post op PSA scheduled for 4/16/09

"Pick a good doctor and say your prayers"


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/25/2009 3:56 PM (GMT -6)   
Let me ask this simplistic question, I didn't do surgery and don't know all the parameters enough, why can't you get a written copy of this, just like we can for pathology report. Then you can have someone else review what it says and/or means. Myself I insist on verifying anything the docs tells us and it is with good reasons.
 


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 1/25/2009 4:05 PM (GMT -6)   
Hi Tobmeister,

It means that there were no positive surgical margins identifiable but that the cancer had begun to spread and was no longer confined totally within the prostate.

It is a good report, pathologists do not like to play with this, if there was a questionable surgical margin they would have said so.

Organ confined totally within the gland, speciman confined totally within the mass of excised tissue.

I am sure your Dr. will explain this to you completely on your followup to have the Foley removed.

Good report, continued well wishes for a speedy recovery. Scott
Diagnosed @ 48yo 04/07
focal, low volume tumor gleason 6
RRP 07/30/07
Persistance of PSA
IMRT 11/07-01/08
Emerg, cysto obstructed bladder 01/08
Persistance of PSA
08/08 learned Dr. left significant amount of prostate
12/08 saturation biopsy 36 cores 24 having normal prostate tissue
12/08 referred whole to med malprac attorney


DJBearGuy
Veteran Member


Date Joined Dec 2008
Total Posts : 797
   Posted 1/25/2009 4:41 PM (GMT -6)   
The description seems consistent with the staging, T3aN0Mx.

T3a the cancer is growing outside the prostate but has not spread to the seminal vesicles.

N0 means that the cancer has not spread to any lymph nodes.

Mx means that tests to detect distant cancer spread have not been done.

I copied the above from a brochure from the American Cancer Society, picked up at my hospital.

My layman's interpretation is that while the cancer has spread beyond the prostate boundary (capsule), it hasn't gone very far, and seems to be limited to the chunk of tissue that the surgeon has removed. Sounds pretty good.
Diagnosis at age 53. PSA 2007 about 2; PSA 2008 4.3
Biopsy September 2008: 6 of 12 cores positive; Gleason 4+3 = 7
CT and Bone scan negative
Da Vinci surgery at City of Hope December 8, 2008
Radical prostatectomy and lymph node dissection
Catheter out on 7th day, replaced on 8th day, out again 14th day following negative cystogram
Pathology: pT2c; lymph nodes negative; margins involved; 41 grams, 8% involved by tumor; same Gleason 4+3=7
PSA 1/22/08 non-detectable! 8-)


Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 1/25/2009 6:06 PM (GMT -6)   
Anything other than "confined" will be roudned up. PNI is the only exception I've seen to this rule.

Swim
 


Tobmeister
Regular Member


Date Joined Jan 2009
Total Posts : 41
   Posted 1/25/2009 6:21 PM (GMT -6)   
OK thanks, that helps. I guess the main thing I didn't understand is the difference between organ and specimen confined. But I do so that makes sense.

I do have the written report but just didn't totally understand what it was saying and you know you never have time to ask the questions you think of later.

By the way, once I had my catheter out 1-15 I was pretty much dry from day one. I wore a pad for precaution until yesterday and went the last two days without a pad and no significant leaks to report!

Thanks all for your responses.
Tom, age 51
Diagnosed 11/12/2008
PSA 2006 - 2.8, 2007 3.06, 2008 4.6 (remember the rate of increase is as important as the level), PSA free 8.7%
Gleason score 7 (4+3); 6 out of 19 cores sampled positive for cancer; perineural invasion present
Bone scan and CT scan both negative
Prostate mildly enlarged, DRE negative
DaVinci radical prostatectomy 12/30/2008 - Duke Medical Center - left side nerves spared
Catheter removed 1/15/09 - no pain!

Post operative results:
Pathologic stage - T3aN0Mx
Post surgery biopsy - Bladder neck margin negative, lymph nodes negative, specimen confined, extracapsular extension positive, perineural invasion positive, seminal vesicle invasion negative, all margins negative, Gleason 3 + 3 = 6.

1st post op PSA scheduled for 4/16/09

"Pick a good doctor and say your prayers"


divo
Veteran Member


Date Joined Jul 2008
Total Posts : 637
   Posted 1/25/2009 6:48 PM (GMT -6)   
Really happy that you are dry...The Tobemeister is Dry!! ....That is just great. Pete has not been dry for two years.....Count your blessings! D
Husband Pete
dx Jan 2001 gleason 4 + 3 PSA 16.5
Seed implant and conformal radiation and Lupron from Jan 2001 to Jan2002
2005 Dec PSA began to rise from .5 to 8 within 6 months
Salvage surgery at MSK 9/06 Dr. Eastham
Fistula operation 2/07 MSK Dr. Wong
Many cystoscopies and ER visits with strictures
Catheter for one year....Catheter taken out Sept 07..
Total Incontinence since then....
PSA .52 3/08
AUS Operation at MSK Sept 8 2008 Dr. Sandhu
Activated Oct 28th Dr. Sandhu..MSK
Some difficulty with AUS arising Nov 10 2008
Meeting with Dr. Sandhu to discuss AUS problems and new PSA test Dec 11, 2008
PSA .6 12/08
AUS improving..only 2 pads a day and one at night
Complete hip replacement surgery Dr. Waters Gainesville, FL 1/9/09
Forging ahead to health!


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25382
   Posted 1/25/2009 7:44 PM (GMT -6)   
Tobe, congrats on you going so dry sometimes, like everything else with PC, you never know what you are going to draw out of the hat. Good luck to you
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3, 9/8 14.9, 10/8 16.4
3rd Biopsy 9-2008 Positive 7 of 7 cores positive, 40 - 90%, G 4+3 & 3+4
Open RP surgery 11/14/8, Non-nerve sparing, 4 days hospital, staples out 11/24/8, Catheter out on 12/15/8. Stopped flowing, new catheter put in 12/16/08, Catheter out 12/29/08. Emergency room put in Catheter # day 45, 1/5/9 - Cath #3 out, dr. did cycloscope, saw potential blockage, put in Catheter #4, 1/13/9 - removed blockage, put in Cath #5, 1/19/9 -out
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grams, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery  Scheduled now for 2/9/9
 
 


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 1/25/2009 7:45 PM (GMT -6)   
Hey Tom,
 
Great that Foley is gone from your life and I hope forever.
 
And even better news that your continance issue is not an issue.  :-)
 
Scott


Diagnosed @ 48yo 04/07
focal, low volume tumor gleason 6
RRP 07/30/07
Persistance of PSA
IMRT 11/07-01/08
Emerg, cysto obstructed bladder 01/08
Persistance of PSA
08/08 learned Dr. left significant amount of prostate
12/08 saturation biopsy 36 cores 24 having normal prostate tissue
12/08 referred whole to med malprac attorney

Post Edited (gpg) : 1/25/2009 6:11:03 PM (GMT-7)


DJBearGuy
Veteran Member


Date Joined Dec 2008
Total Posts : 797
   Posted 1/25/2009 9:08 PM (GMT -6)   
Tom,

I just re-read your sig, and I see you're one of the fellows whose post surgery Gleason was actually lower! Seems like things are going well for you. Good luck on your April test; you'll likely do just fine.

DJ
Diagnosis at age 53. PSA 2007 about 2; PSA 2008 4.3
Biopsy September 2008: 6 of 12 cores positive; Gleason 4+3 = 7
CT and Bone scan negative
Da Vinci surgery at City of Hope December 8, 2008
Radical prostatectomy and lymph node dissection
Catheter out on 7th day, replaced on 8th day, out again 14th day following negative cystogram
Pathology: pT2c; lymph nodes negative; margins involved; 41 grams, 8% involved by tumor; same Gleason 4+3=7
PSA 1/22/08 non-detectable! 8-)


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 1/26/2009 8:28 AM (GMT -6)   
Tom, your path report is virtually identical to my husband's. I too had difficulty understanding the definition of local vs. regionally local disease. My husband's PCa had a "miniscule" (pathologist's word) extension into the prostate capsule which put him at stage T3a (clinical stage was T1c). All margins were clean as were the bladder and seminal vesicles. The urologist explained that once the cancer leaves the prostate proper and enters the capsule, it becomes regional rather than local regardless of how small or large the extension is. His path report clearly stated that the cancer was found in the capsule but not outside of it - which is what is most important. Perineural invasion is very common and means that cancer cells were found around the nerves (in my husband's case, this was noted on his original biopsy report so no surprise there). Husband's PSA pre-surgery was 6.3 with fPSA of 11. His DRE was negative and his prostate was ever so slightly enlarged but considered normal for a man his age (he was 58 at dx). Had robotic surgery in March 2008 and his PSA hit 0.0 seven weeks post op and has remained there.

The "normal" check-up is a PSA test every 3 months for the first year, then every 6 months for years 2 through 4, then annually starting in year 5. Urologist told me that he's thinking of keeping my husband on a 3 month schedule for the first 2 years just to be safe because the cancer had escaped the gland (the actual prostate) and moved into surrounding tissue (the capsule).

The bottom line is that 2 urologists we work with both felt that the path report was good and that my husband's chances at a "cure" are excellent. Of course, nothing is guaranteed but the odds are definitely in his - and your - favor.

I wish you a speedy recovery and nothing but zeros in your future!

kcragman
Regular Member


Date Joined May 2008
Total Posts : 240
   Posted 1/26/2009 1:19 PM (GMT -6)   
Tobmeister:

I was a pT3a and the way my doctor described it was - it had bulged out, but not necessarily broken out. Everything around the prostate was negative, and as far as I can tell - I'm good to go PCa wise. I hope you are the same. But you are kicking my butt in the incontinence department. Good for you.

Every day above ground is a great day!
kcragman
Age: 53; 52 at DX
March 2006: PSA 2.5
Dec 2007: PSA taken for insurance application. I did not see the results until late
              Jan '08 - after I was rejected. Their lab said PSA 4.5.
Feb 2008: PSA 3.7.
March 2008: Biopsy. Gleason 7 (4+3) 12 cores taken. 5 on the left side were
              cancerous and the 6th was suspect.  
May 5, 2008: Da Vinci robotic laparoscopy at GW Hospital, Washington DC.

Post op: Gleason 9 (4+5). 15% of prostate involved. Stage: pT3a. Negative margins. Lymph node and nerve samples taken, and appeared to be cancer free.

July 2008: PSA at 7 weeks was undetectable.
August 2008: PSA at 14 weeks (3 months) was undetectable.
Nov 2008: PSA at 6 months was undetectable.

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