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Regular Member

Date Joined Dec 2008
Total Posts : 28
   Posted 2/17/2009 9:24 PM (GMT -6)   
Got cath out and pathology report today. Their report was no lymph node nor seminal vesicle involvement, but as i looked at below report it seemed to say differently as far as lymph node involvement. Also dont understand the perineural involvement. They said return in 4 weeks for PSA and we will know if we are to do radiation. From what the docs said that best case scenario would have been no perineural involvement but because there is there is always possiblity of lymph nodes further up that may have cancer....anyway, maybe you guys could explain some of the below report to us. thanks
Age 56
DOB 9/02/52
DX Prostate Cancer 12/2/08
Double Bypass Heart Surgery 8/08
Gleeson Score 3+4=7
9 out of 12 cores were postive
PSA was 7.71 rose to 12.2 week of surgery
DaVinci surgery 2/06/09
Cath out 2/17/09
Path staging PT2c Bilateral disease, stage 11
PERINEURAL INVASION, present and extensive
vENOUS (large vessel) absent
LYMPHATIC (SMALL VESSEL) invasion SUSPICIOUS FOR LYMPHOVASCULAR INCASION (C5, C10, C20) (16) no evidence of malignancy
ADDITIONAL PATHOLOGIC FINDS High grade prostatic intraepithelial neoplasia, which is extensive

Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 2/17/2009 9:35 PM (GMT -6)   
Did you get a final Gleason?

Your doctor is wise to see you again in 4 weeks. Stay positive. This is not a worse case scenario at all. But you may indeed have more work to do if the PSA does not drop out. I may be in the SD area in that time, so let's stay in touch. Maybe we don't have to be in Baja to meet...

Peace and Love to you both!

Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 15, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (January 13, 2009): <0.1
My Journal is at Tony's Blog  

Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 2/17/2009 9:37 PM (GMT -6)   
Your next psa will be most important, and as Tony said above, what was the final Gleason score on your post surgery pathology report? It would help to know that. I hope you continue to heal well, and real glad you are among us for support and help.

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Right nerves saved, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05

Veteran Member

Date Joined Feb 2008
Total Posts : 1858
   Posted 2/18/2009 12:59 AM (GMT -6)   
There are lymphatic vessels within the gland that funnel lymph fluid to the nodes. It is sort of not surprising that when a patient has a tumour within the gland then it may show up in minute lymph vessels.........same with the small blood vessels and capillaries within the gland.

Concerning perineural invasion this is from Dr. Catalona's site

There are small nerve fibers that pass through the inside of the prostate gland. These nerves secrete a growth factor that attracts prostate cancer cells. Accordingly, in the great majority of prostate cancers, the cancer cells are seen to be lined up surrounding nerve fibers. This is called "perineural invasion." Perineural invasion is so common as to almost be a diagnostic feature of prostate cancer. Its clinical significance is that when it is found in a needle biopsy specimen, there is a greater chance that the tumor will be found to have spread outside the prostate gland. If the tumor has spread outside the prostate, there is a higher chance for tumor recurrence. However, if the tumor has not spread outside the prostate gland, there is little or no prognostic significance to perineural invasion.

You have no evidence of extracapsular extension. no seminal vesicle involvement and no sign of spread, so it's a pretty good outcome. All you can do now is recover and heal and wait on the PSAs (and don't I know how nerve-wracking that is)
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)

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4268
   Posted 2/18/2009 12:39 PM (GMT -6)   
My Onco says that perineural invasion is no big deal. Just means that the cancer is next to a nerve. I would be more concerned about lymph node invasion. There are two tracks that PC can take in the lymph system and only one of those tracks is sampled in surgery. There is a 40% chance that if the primary track is clear PC will appear in the 2nd track, especially if there was seminal vessel invasion. The only way to know now is your PSA reading after surgery.

I had a psa of 4.4 in 1999 and steadily increasing psa every 3-6 months before reaching 40 in 5-08.Free psa ranged from 16 to 10%

I had biopsies every year, 13 total in all. I saw 5 different doctors, all urologists or urological oncologists at Long Beach, UCLA, UCSF and UCI and had an MRIS at UCSF in 2007. All tests were negative and I was told that because of all the biopsies I most likely didn't have PC, but to keep getting biopsies every year.

in Oct 08 my 13th biopsy of 25 cores indicated 2 positive cores, gleason 3+3 less that 5% in 2 cores. Doc recommended surgery.

2nd opinion from a prostate oncologist, referred by my wife's oncologists said cancer found wis indolant and statistacally insignificant, but PSA histor was a major concern and ordered a few more tests.

Color Doppler ultrasound with targeted biopsy found a transition zone tumor 18mmX16mm, gleason 3+4 and 4+3. CT and bone scans clear, but Doc thinks that there may be lymph node involvement (30% chance) because of my high PSA, and referred me for a Combidex MRI in Holland, currently scheduled for Feb 14.

Changed diet and takiing supplements while I wait. The location of the tumor plus the high psa make surgery an unlikely option. I'm still evaluatiing all treatment options and will make a decision once I get the results of the Combidex scan.


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