Oncas Pathology Results

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Regular Member

Date Joined Jan 2009
Total Posts : 390
   Posted 4/2/2009 11:24 AM (GMT -6)   
Hi guys,
Got a copy of my post op pathology but I haven't had a chance to discuss it with the doctor yet. Appreciably worse than I thought from what I can interpret.
Tumor upgraded to Gleason 9 (5+4) occupying 80%
Apex is positive, superior margins positive, seminal vesicles positive
Apical,uretheral,posterior and bladder margins negative.
two of nine lymph nodes positive.
pT3b, pN1, pMx
We're pretty much shell shocked. The lymph node involvement really erodes your hope. Puts your fight into a different category. I assume chemo or clinical trials will be the most likely options.
Oncas (Jim)
Edited by TC-LasVegas
  Added Subject line.

Post Edited By Moderator (TC-LasVegas) : 4/4/2009 12:11:28 PM (GMT-6)

Elite Member

Date Joined Oct 2008
Total Posts : 25380
   Posted 4/2/2009 11:37 AM (GMT -6)   

Sorry to hear what appears to be a pretty grim report, but remember, there is always hope, even with bad numbers and pathology reports. Surprised you weren't shown it with you dr, that's how it was with me. Please keep us posted closely, and see what kind of options you really have at this point. Now you need the help of some of the advanced fellows, they will be around soon, I am sure. My best to you, brother.

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 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, 6 month on 5/9

Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 4/2/2009 11:37 AM (GMT -6)   
Hi Jim,
There is hope and don't feel there isn't. You still have plenty of options and can expect positive results with them. I am very sorry to welcome you the advanced PCa club, but it is what it is. I had the option of Taxotere and declined it hoping to get more out of ADT and radiation. You may wish to look into both. Some radiologists may back away, but there is benefit to WPRT using IMRT in stage IV cases. ADT however is a likely path right now. And there may be benefit to Chemo with an investigational drug.

If you look at the last line of my signature, you will see the best advice I can give you. I have been here over two years and have met many with similar or worse than you that are doing well at over well ten years. You will see some comparitive cases on www.YANANOW.net.

Stay with us, buddy. We will be here and I know you will get support.

Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 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  

New Member

Date Joined Jan 2009
Total Posts : 18
   Posted 4/2/2009 12:03 PM (GMT -6)   
So sorry to hear your path report was worse than you anticipated.  There is a 2005 Mayo Clinic Study about T3 cancers, lymph node involvement, and surgery I think you would find useful. I'm not sure how to put link here but if you email me (I believe email address is in my profile), I will send it on to you.

New Member

Date Joined Jan 2009
Total Posts : 18
   Posted 4/2/2009 12:16 PM (GMT -6)   
I'll try a second time here providing the link www.sciencedaily.com/releases/2005/04/050411112637.htm  
If it doesn't work, please email me and I believe I can send it as an attachment.  Certainly, I think the study results can provide some hope to you as many men with similar stats end up doing well.                                                                     

Veteran Member

Date Joined May 2008
Total Posts : 1010
   Posted 4/2/2009 1:24 PM (GMT -6)   

Hi Jim,

Sorry to see your report. However, my stats are very similar to yours. (see signature) I went to Mayo for a second opinion based on the article that Wife33 recommends. I met with a Dr Blute and his assistant. In spite of my lymph node involvement the recommendation was surgery since it was the local nodes. I was told that it would probably require follow up with radiation. And hormones at some time after the surgery and radiation. I did not elect to do the surgery but I did do the radiation.(IMRT) It was a combined protocol that radiated the suspect nodes and the prostate. And I am much like the fellow who jumped off of the skyscraper who would say at each floor "so far, so good". I am about seven months post radiation and in the middle of a two year hormone course. I feel as good as I felt before discovering I had the problem. My oncologist is optimistic about my prognosis and tells me not to obssess over the PSA. Good advice. Life, for now, continues in some manner of normalcy.

My reasons for not continuing with Mayo were primarily logistical and financial as I am over 2000 miles away and uninsured. Dr Blute was quite informative in regards to my case and treatment options. Be aware that Mayo has a bias towards doing the surgery based on thier past case experience. You may want to go there for a second opinion if things permit. They were very accomodating when I called to schedule one and had me in about two weeks later.

I guess my point is don't give up. There are options and there are experienced physicians and hospitals that will take on the tough cases. Jim, I sincerely wish you the best of luck and some solution to your problem.

Best regards,


Diagnosed 04/10/08 Age 58 at the time
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear and chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
Started Casodex on May 2 and stopped on June 1, 2008
Lupron injection on May 15 and every four months for next two years
Started IMRT/IGRT on July 10, 2008. 45 treatments scheduled
First 25 to be full pelvic for a total dose of 45 Gray to lymph nodes.
Last 20 to prostate only. Total dose to prostate 81 Gray.
Completed IMRT/IGRT 09/11/08.
PSA 02/08 21.5 at diagnosis
PSA 07/08 .82 after 8 wks of hormones
PSA 10/08 .642 one month after completion of IMRT, 6 months hormone
PSA 03/09 .38 six months post radiation and nine months into hormones 

Veteran Member

Date Joined Jul 2008
Total Posts : 966
   Posted 4/2/2009 1:38 PM (GMT -6)   
Ohio...you might want to remove your email address from the text and add it to your profile (not in your signature line) if you haven't already...prevents harvesting of email addresses....otherwise a mod can assist you
You are beating back cancer, so hold your head up with dignity
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
4 tumors in prostate - largest being 6 cm 
PSA 5 week Oct 2008 <.05
       3 month Jan 2009 .06

Regular Member

Date Joined Jan 2009
Total Posts : 189
   Posted 4/2/2009 2:03 PM (GMT -6)   
So sorry Jim- that is a tough report but you will handle it. Stay strong and I will be pulling for you.
63 years old-tumor discovered on digital exam- biopsy December 2008-
4 of 12 samples positive-all on right side
Gleason 3+3=6
Otherwise excellent health.
  "There may come a day when the courage of men will fail, but it will not be this day."

Doting Daughter
Veteran Member

Date Joined Aug 2007
Total Posts : 1064
   Posted 4/2/2009 3:35 PM (GMT -6)   
I know all too well the feeling of a devastating pathology report. My father also had a lymph node come back positive and we were absolutely devastated. The frustrating news is that most of what you will read on the internet is grim, however, pick up a copy of Dr. Snuffy Meyers book ASAP. In addition, try to keep in mind that the medical opinions are going to get even more frustrating at this point. Do your research, have faith in those close to you and believe that you will get through this. Make the best decision you can for yourself and don't look back. My father went through salvage radiation and is in his second year of HT. After his RP he didn't want to do any of it. He was devastated. IMRT was a breeze for him and he hates HT, but he manages. He looks incredible and is living again. I'm sorry you have to go into Round 2, but stay strong. You have friends here to support you and hope to hold on to. Keep us posted and let us know how we can help!
Father's Age 62 (now 63)
Original Gleason 3+4=7, Post-Op Gleason- 4+3=7,
DaVinci Surgery Aug 31, 2007
Focally Positive Right Margin, One positive node. T3a N1 M0.
Bone Scan/CT Negative (Sept. 10, 2007)
Oct. 17 PSA 0.07
Nov. 13 PSA 0.05
Casodex adm. Nov 07, Lupron beg. Dec 03, 2007 2 yrs
Radiation March 03-April 22, 2008- 8 weeks 5x a week
July 2, 08 PSA <.02
Oct. 10, 08 PSA <.02
Praying for a cured dad.

Co-Moderator Prostate Cancer Forum

Regular Member

Date Joined Dec 2008
Total Posts : 194
   Posted 4/2/2009 4:30 PM (GMT -6)   
Wow Jim, I read your pathology report and my heart sunk. And then I began to read the replies. And then I began to read the replies from guys with pathology reports very similar to yours. And I began to realize, as I know you have too, that there are a lot of very bright rays of sunshine on the horizon. Did you not come to the right place or what? Someone on this board who post pretty often has a tag line after their signature that has always inspired me. "As long as you continue to fight, you are winning." You are in our thoughts and prayers my friend, never give up!

Age at DX 57
5-18-07 PSA 7.7
5-06-08 PSA 4.6  8% free psa, but stable
10-23-08 PSA 5.65 4% free psa
11-04-08 biopsy
11-11-08 2 of 12 cores positive
Gleason 3+3  6  stage t1c / post-op 3+4  7  stage t2c
CT and Bone scan negative
Da Vinci RRP 01-09-09
Catheter removed 1-15-09
Pathology Report says it's gone!
First Post-op PSA 2-17-09   0.00

Veteran Member

Date Joined Feb 2008
Total Posts : 655
   Posted 4/2/2009 4:39 PM (GMT -6)   
Greetings, Jim.  We wish you had received a more positive path report and I know you do as well.  However, as you can see there are lots of guys here who have similar reports and are doing well.  No mountain too high, no river too wide - keep the faith and seek that next level of treatment.  It's a process that we all deal with - bottom line keep up the fight.  We'll be thinking of you and praying for you.  David

Age 55
Diagnosed Dec 2007 during annual routine physical
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 positive with 2 marginal
Gleason 3 + 3 = 6
RRP 4 Feb 08
Both nerves spared
Good pathology - no margins - all encapsulated - Gleason 4 + 3 = 7
Catheter out Feb 13 - wore pad for couple of days - pad free Feb 16
Great wife and family who take very good care of me

Regular Member

Date Joined Jan 2009
Total Posts : 390
   Posted 4/2/2009 5:41 PM (GMT -6)   

Once again I am deeply moved by the endless emotional and informational support offered in this forum. Quite honestly it has helped me put every obstacle in perspective. Truly I had some grim stats laid on me today but I am learning of others in the same arena fighting on and still alive many years later. I fully intend to join that crowd and I'll do whatever necessary to make it happen. Thanks so much to all in the fight.

Oncas (Jim)


John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4237
   Posted 4/2/2009 7:16 PM (GMT -6)   
Devestating news. Try to get the best Prostate Oncologist you can. Radiation and ADT3 are still good options that will give you many more good years.

64 years old.

I had an initial PSA test in 1999 of 4.4. PSA increased every 6 months reaching 40 in 5-08. PSA free ranged from 16% to 10%. Over this time period I had a total of 13 biopsies and an endorectal MRIS all negative and have seen doctors at Long Beach, UCLA, UCSF and UCI. DX has always been BPH and continue to get biopsies every year.

In 10-08 I had a 25 core biopsy that showed 2 cores positive, gleason 6 at less than 5%. Surgery was recommended and I was in the process of interviewing surgeons when my wife's oncologist recommended I get a 2nd opinion from a prostate oncologist.

I saw Dr Sholtz, in Marina Del Rey, and he said that the path reports indicated no tumor, but indolant cancer clusters that didn't need any treatment. He was concerned that my PSA history indicated that I had a large amount of PC somewhere that had yet to be uncovered and put me through several more tests.

A color doppler targeted biopsy in 11-08 found a large tumor in the transition zone, gleason 6 and 7. Because of my high PSA Dr. suspected lymph node involvement, 30% chance, and sent me to Holland for a Combidex MRI, even though bone and CT scans were clear.

Combidex MRI showed clear lymph nodes and a 2,5 cm tumor in the anterior. I was his 1st patient to come up clear on the Combidex which has a 96% accuracy,

I've been on a no meat and dairy diet since 12-08 and PSA reduce to 30 while I awaited the Combidex MRI.

The location of the tumor in the anterior apex next to the urethea makes a good surgical margin very unlikely. Currently on Casodex and Proscar for 8 weeks to shrink my 60 mm prostate. Treatment will be seeds followed by 5 weeks of IMRT while continuing on Casodex and Proscar. So far no side affects from the Casodex.


Veteran Member

Date Joined Apr 2008
Total Posts : 1382
   Posted 4/4/2009 7:20 AM (GMT -6)   
WOW Jim you and I have almost identical pathology reports and YES YES there is much hope. I was told when I woke up from surgery that I had three positive nodes and the surgery was aborted. I went through 42 IMRT's and just got my last lupron shot. I am 21 months post op and doing great. Will the cancer come back? I am sure it will, but guess what? I am going to kick it down again and again. With the power of prayer (for me) and the love of everyone around me as well as the folks here I can do it. I have had my bought of depression, haha it took me a long time for it finally happen. Now I am up for whatever is next.
Jim, please stay in touch with us. Email me sometime and we will discuss the emotional aspects of this further. Please know I care very much.

peace and love
My PSA at diagnosis was 16.3
age 46 (current)
My gleason score from prostate was 4+5=9 and from the lymph nodes was 4+4=8
I had 44 IMRT's
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11
PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .06
Testosterone keeps rising, the current number is 156, up from 57 in May
cancer in 4 of 6 cores

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