Good news (with a question)

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TeddyG
Regular Member


Date Joined Apr 2009
Total Posts : 133
   Posted 4/23/2009 9:02 PM (GMT -6)   
Hello All,
During the first post surgery app't with surgeon I had the catheter removed (which was not as bad as I feared) and received news that the pathologist found no cancer in the prostate. My biopsies were 2/12 positive with 5-10%. I do not know how a pathologist disects the gland but suffice it to say that finding the occurence of bad cells in the biopsies was very fortunate. I did have the biopsies sent to Dr. Epstein at Johns-Hopkins for a second opinion when I was diagnosed, and he concurred (though he did down grade Gleason from 3+4 to 3+3) so I have no doubt that they were present. My surgeon says that this is only the 3rd time he has seen this occurrence in his career. Of course I am very pleased with results and i am assumming that we caught it very early. Has anybody had this experience?
 
Stats:
Dx Feb  3, 2009
PSA 2007: 1.5
PAS 2008: 2.8
PSA 2009: 5.3
Surgery: laproscopic nerve sparing April 9 (3 days in hospital)
Cath. removal: April 21
Path report: no cancer, clear margins

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/23/2009 10:19 PM (GMT -6)   
I am confused here, so you had a biopsy that showed that you had PC, and ended up with major surgery to remove your prostate and then find out there wasn't even any cancer in it? Am I missing something here?
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
 
 


Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 4/23/2009 10:34 PM (GMT -6)   
Wow, a rare thing indeed.
 
I've read abstracts on vanishing cancer. There are some found in Entrez PubMed. Epstein and Bostwick come to mind.
 
On rare occasion small volume cancers found on biopsy are gone when the final pathology is done. One theory is....What was there may have been so small the biopsy got it all. Good news is...There are no known recurrences are on record.
 
 

TeddyG
Regular Member


Date Joined Apr 2009
Total Posts : 133
   Posted 4/23/2009 10:41 PM (GMT -6)   
No, you aren't missing anything. It was in 2/12 biopsy samples (low volume, i.e. 5% in one and 7-10% in the second, Gleason 7, orig then down graded to 6) Samples reviewed at 2 major academic research/cancer centers. Then following surgery, of course I was worried about real pathology and the doc told me that the extent was "extremely low" and when pressed he said that pathology did not find any tumor and that the biopsy was fortunate to have found  it in early stage. Does this make sense? I am dealing with very, very respected docs with lots of experience.

TeddyG
Regular Member


Date Joined Apr 2009
Total Posts : 133
   Posted 4/23/2009 10:50 PM (GMT -6)   

Swimom,

Thankyou very much for the reply. The Doc did not use the term "vanishing cancer" but did note the I was "low volume" and more particularly said that a pathologist does not sample every cell looking for cancerous samples, but in whatever the protocol is, he/she did not find any.

After the experience I have been through, I am very pleased with the result, but such a possibility was no where in any of the research that I had done. Frankly, after reading many of the posts on this forum, I expected that they would find more than the biopsy indicated. Perhaps that is human nature.


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 4/23/2009 11:14 PM (GMT -6)   
Like Swimom, I have read of this before. It is thought that the cancer volume is so low that the needle biopsy takes it out and this is what the biopsy pathologist sees. When the surgical pathologist sets the prostate in paraffin and slices it for examination there is no visible cancer, hence the term "vanishing cancer". It would seem to be unusual in there originally being two cores positive, one would assume some distance apart, yet the biopsy needles excised all the tumour. This quote is from the American and Canadian Academy of Pathologists

"pT0: No Residual Carcinoma in the Radical Prostatectomy Specimen
Up to 3 to 4% of radical prostatecomy specimens will have minimal or no residual prostatic adenocarcinoma. This has been referred to as the vanishing cancer syndrome. This occurs in the absence of previous TUPR or pre-operative hormone therapy and it is likely a result of our increased ability to detect prostatic carcinoma at an increasingly early, low-volume stage. If no carcinoma is found, the case is classified as pT0. In one series of 3,038 consecutive radical prostatecomies, 4 cases (.13%) had no residual carcinoma identified. In another seires of 6,843 radical prostatectomies, 38 cases (.56%) had no residual carcinoma. Given that the specimen has been totally submitted for histological examination, that the pre-operative diagnosis is confirmed and there is no misidentity of specimens, it is reasonable to assume that the cancer is very small, without resorting to exhaustive sectioning of the wax block material.
www.uscap.org/newindex.htm?92nd/companion10h2.htm
Bill
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)
PSA February 09 <0.01

Post Edited (BillyMac) : 4/23/2009 10:44:28 PM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/24/2009 8:00 AM (GMT -6)   
Well, Teddy, I am most thankful there is no cancer, or no more cancer, you are in the most fortunate category, and I hope your recovery goes well. That would have to be a big sigh of relief
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
 
 


TeddyG
Regular Member


Date Joined Apr 2009
Total Posts : 133
   Posted 4/24/2009 1:43 PM (GMT -6)   
Thankyou all for the responses. Who would have known that there is such a possibility? I am still recovering from surgery and will try to go back to work next week. This book has many chapters and the next one is gaining continence...
 

soxfans4life
Regular Member


Date Joined Apr 2008
Total Posts : 63
   Posted 4/25/2009 7:05 PM (GMT -6)   
Teddy, Oh yes, we have heard of this! Rod had Davinci May 29 2008, with the same pathology results. It was his fourth biopsy over time, all negative,due to a slowly rising psa and a family history. Gleason 6 , one core of 12. 2 pathology readings revealed no evidence of cancer. We are still confused, somewhat frustrated, but of course, very thankful to be cancer free. Subsequent psa's have been 0.00, our M. D.has had little comment on these results. We have researched and read about vanishing cancer,but it always seems so unusual to have the only evidence removed by biopsy. Our advice is be thankful, go forward, and advise always  careful research before surgery, second opinons, and ongoing education in prostate health! Also, THANK YOU for posting: we have never heard from anyone with our story, it makes such a difference! Rod & Annie smurf

dx. 3-08  @ age 63. gleason 6 . 1 out of 12 cores positive. 4th biopsy in 8 years. previous 3 negative. followed closely due to family hx.grandfather, father and 2 uncles dx. with prostate cancer. dre negative, cat and bone scan negative. davinci scheduled for may 27, 2008. 2 daughters, retired hospital administration, air force family years ago. Davinci on May28,2008, both nerves spared. Catheter removed in 8 days, pathology report revealed precancerous lesions. Presurgical psa was 5.9, 1st  psa scheduled for August. 1st post surgery psa 0.00, august 6,2008. 2 following psa's 0.00.Yearly followup & psa sched for may 2009.


CPA
Veteran Member


Date Joined Feb 2008
Total Posts : 655
   Posted 4/26/2009 8:06 AM (GMT -6)   
Greetings, Teddy.  Congratulations, I think!  Glad the surgery went well.  Take it easy in your recovery - back to work next week is very soon.  I went back at 3 weeks, part time, but just sat in my office for a few hours catching up on 3 weeks worth of mail and email. Keep us posted.  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


TeddyG
Regular Member


Date Joined Apr 2009
Total Posts : 133
   Posted 4/26/2009 10:30 PM (GMT -6)   

Once again, Thank you for your responses. Regarding returning to work, if anything this journey has done to me is to hit the "reset" button on many life issues including work and family. I do want to get out of the house and feel the need to try to get a semblance of the new "normal" whatever it is. I will be taking it easy, so to speak because after facing the angst of the past 100 days, other stressors are going to look like a piece of cake. What a journey in the last 100 days...my biopsy was on inaugural day and I am quite sure that I will never forget Jan 20, 2009. (I actually joked that I felt like the entire inaugural parade marched in my back door!

Rod & Ann, No looking back and it is a relief beyond description.

Best wishes to you all and thanks for the encouragement.

 

TeddyG  


Background:
Age 55, two teens, very fit cyclist (avg 2000+ miles per year) and weight, diet, etc. consistent with good habits. Stressful job as attorney; very supporting wife who ishelping me through every stage of this war.
Stats:
2006 PSA - 1.5
2007 PSA - 2.3
2008 PSA - 5.3 (18 mos.)
2009 Jan. 20 - Biopsy 12 samples
        Feb 3 Dx 2/12 samples positive, low volume  (5% and 7-10%)
Gleason 3+4, later downgraded by second opinion at Johns-Hopkins to 3+3, but "it's still PCa" as my Doc said.
Laproscopic surgery April 9, 3 days in hospital, catheter removal April 21.
Pathology: clear margins, no cancer in prostate: told that this is very rare but review of literature says ~1.3 %; family says "miracle."
Now working w/ post-surgery issues....
 

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