Path report - not what the doctor said

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Godfather
Regular Member


Date Joined Jan 2009
Total Posts : 64
   Posted 5/3/2009 12:13 PM (GMT -6)   
An interesting development. As some of you guys may recall, I had my surgery (robotic) on 4/23. As a matter of fact, my cath comes out tomorrow, 5/4.

A few days after the procedure, my doc called with the post-op pathology results. He told me that it was contained, margins negative, lymph nodes clean. His tone was upbeat and said that he couldn't be happier at the way this all turned out. Time to celebrate, right? Maybe not. Just got the written report which says "Extraprostatic Extension - Present" and the staging is now pT3. How is that contained? How can I have clean margins and with extraprostatic extension? Isn't that in itself an oxymoron?

The report focuses a lot on the fact that my tumor was real close (0.6 mm) from the inked margin but "no extension to an inked margin is identified histologically". Then there is the sentence "Rare extra-prostatic extension is identified".

Obviously, this will be question #1 tomorrow but as today is a Sunday, the only place I trust that's open is HW. So, my new friends, any ideas?

Tony
Age at diagnosis 61 5'10" 260 lbs. Resides in SW Florida
12/07 PSA 2.6 12/08 PSA 4.0 Biopsy 1/09 - 6 of 8 nodes positive
Left - 2 of 4 positive, 2% involved, 4+3=7 Gleason Right - 4 of 4 positive, 40% involved, 4+3=7 Gleason
Perineural invasion is present - MRI suspicious for extracapsular extension
Scheduled for open RRP @ MSK 3/10/09 - canceled due to cardiac clearance issues
Da Vinci RLP w/ Dr Carey @ Sarasota Memorial 4/23/09
Post op pathology - staging and Gleason unchanged at T2c, 4+3=7
All lymph nodes, seminal vesicles and margins negative


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 5/3/2009 6:02 PM (GMT -6)   
I could be interpreting this wrong, but can't you technically have an extra-prostatic extension, but the surgeon cut a wide enough margin that it is contained within his margin? In that case, the margins would still be clear? Hopefully, someone else will chime in. It sucks getting these types of reports over the weekend. If it is driving you crazy, I am sure they have an on call doctor that you could have paged. Otherwise, try to stay positive and to me, it sounds like he still got it all, but I am no expert.
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


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 5/3/2009 6:15 PM (GMT -6)   
http://www.yananow.net/Mentors/TomR.htm

Check out the above Yana Mentor's website. His situation sounds pretty similar to yours and I think you will be very pleased with his status two years out. If the link does not work, his name is Tom Randall.
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


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 5/3/2009 7:26 PM (GMT -6)   
The terms used are sometimes confusing to us lay folks. "Margin" is used when talking about the prostate but can be the margin of the prostate (the surrounding capsule containing all the gland) as well as the surgical margin. You can quite easily have an "extra-prostatic extension (EPE) but a negative surgical margin. All in all it sounds pretty good to me.
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


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2457
   Posted 5/3/2009 8:10 PM (GMT -6)   
Godfather,
My pathology report indicates extra prostatic extension yet I have clear margins. The way my doctor explained it is that he removed a wider margin beyond where the EPE was. As you can see my first PSA was zero and I hope to get many more. By the way my staging is also pT3a.
Age: 67
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
Dx 12/30/08
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09
Surgeon: Dr. Randy Fagin, Austin TX.
Pathology report:
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Bilateral 10-20% involved
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx
Negative margins
seminal vesicles clean
Lymph nodes: not dissected
1st PSA test 4/7/09 result <0.1


Octorobo
Regular Member


Date Joined May 2009
Total Posts : 397
   Posted 5/3/2009 8:32 PM (GMT -6)   
Don't be discouraged, I am T3a- clear margins- at 15 months past surgery constant PSA .004 ( four readings at three month interval) - 4.5 before surgery GS3+4=7- Robotic surgery in 2007- going in two weeks for 21 month check up- expecting .004 again. My doctor said it's like real estate, location, location, location- that pesky cancer was just too close to the edge - not what we wanted but so far so good. You have a great doctor with good results.

Kark60
Regular Member


Date Joined Jun 2008
Total Posts : 91
   Posted 5/3/2009 9:01 PM (GMT -6)   
I also had EPE (actually in two places), but clear "surgical margins" with T3a. The surgeon told me he took a wider margin during the surgery. I've had FIVE post surgery PSA tests all coming back at 0. I think your report actually is good and you should accept what your doc is saying. Be well...
Husband and father of two (current ages 5 and 7).
Age when diagnosed: 47 (currently 48)
Pre-surgery PSA: 13.7
Pre-surgery Gleason: 4+3=7
CT Scan, Bone Scan, PET Scan: Clear
Robotic Surgery on May 28, 2008, at Barnes Hospital in St. Louis.
Right nerve bundle spared; left bundle removed.
POST-SURGERY PATH REPORT:
Gleason: 4+3=7
Involved 10% of prostate; all quadrants involved
Extraprostatic extension at left base and apex
Extensive perineurual invasion present.
Bladder neck, lymphvasular space, seminal vesicles, 17 examined lymph nodes, and all surgical margins FREE of tumor.
T3a
Four-week post-surgical PSA = 0.1
Seven-week post-surgical PSA = .01
October 2008 PSA = 0.0
January 2009 PSA = 0.0
April 2009 PSA - 0.0
Next PSA scheduled for July 2009.


Godfather
Regular Member


Date Joined Jan 2009
Total Posts : 64
   Posted 5/4/2009 4:50 AM (GMT -6)   
Thanks all. I'm off to see the wizard...

Tony
Age at diagnosis 61 5'10" 260 lbs. Resides in SW Florida
12/07 PSA 2.6 12/08 PSA 4.0 Biopsy 1/09 - 6 of 8 nodes positive
Left - 2 of 4 positive, 2% involved, 4+3=7 Gleason Right - 4 of 4 positive, 40% involved, 4+3=7 Gleason
Perineural invasion is present - MRI suspicious for extracapsular extension
Scheduled for open RRP @ MSK 3/10/09 - canceled due to cardiac clearance issues
Da Vinci RLP w/ Dr Carey @ Sarasota Memorial 4/23/09
Post op pathology - staging and Gleason unchanged at T2c, 4+3=7
All lymph nodes, seminal vesicles and margins negative


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 5/4/2009 7:22 AM (GMT -6)   
Godfather, hope your doctor visit gives you some peace and assurance. Your post-op situation is very similar to my husband's and many have already chimed in. After the biopsy, the surgeon knew that one of the cores was close to the edge of the prostate gland. When he went in to remove the prostate, he cut a wider margin than he thought necessary to give a better chance of clean surgical margins - which were achieved. Post-op report indicated a microscopic EPE but no evidence of disease outside the capsule. I think this defines "confined".

My husband's clinical stage was T1c but his surgical stage is T3a. He is 13 months post-op and has had PSA readings of 0.0. His doctor wants to continue the PSA testing every 3 months for the next year to ensure that we stay on top of this.

Godfather, you will be fine...good luck with your visit today!
Husband diagnosed in February 2008 (age 57). Cancer discovered during routine annual physical. Clinical Stage T1c, Gleason 7 (3+4), with 2 out of 10 cores testing positive. Perineural invasion identified on biopsy. DRE was negative.

Robotic surgery in March 2008. Pathological stage upgraded to T3a, Gleason still 7 (3+4). Miniscule invasion into prostate capsule but no cancer found outside capsule (surgical margins and seminal vesicles were clean).

1st PSA 3 weeks post op: 0.1; 2nd PSA 7 weeks post op: 0.0. PSA remains at 0.0, and will continue to be checked every 3 months for the first 2 years due to capsular penetration.

Currently on Enablex to control frequency of urination (tried Vesicare but stopped due to heart palpitations) and on Viagara 2 - 3 times a week. Recuperation from surgery was uneventful.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 5/4/2009 7:30 AM (GMT -6)   
Sephie, glad to hear from you and that your husband is still doing well. :)

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
 
 


Godfather
Regular Member


Date Joined Jan 2009
Total Posts : 64
   Posted 5/4/2009 7:36 AM (GMT -6)   
Back. What was said here was confirmed by my doc. He said that the tumor was out of the capsule but he cut a wider margin to assure he got it all - thus the negative margins and EPE. As is typical, what I was worried about eventually took a back seat during the meeting. His focus was the focal Gleason pattern 5, even though my Gleason stayed at 4+3=7. He said that was very aggressive and that some recommend post-op radiation treatments with this just in case.

No decision but we're leaning towards waiting for the 90 day PSA to see what's going on. Again, thanks to all who take the time to write.

Tony
Age at diagnosis 61 5'10" 260 lbs. Resides in SW Florida
12/07 PSA 2.6 12/08 PSA 4.0 Biopsy 1/09 - 6 of 8 nodes positive
Left - 2 of 4 positive, 2% involved, 4+3=7 Gleason Right - 4 of 4 positive, 40% involved, 4+3=7 Gleason
Perineural invasion is present - MRI suspicious for extracapsular extension
Scheduled for open RRP @ MSK 3/10/09 - canceled due to cardiac clearance issues
Partial nerve sparing Da Vinci RLP w/ Dr Carey @ Sarasota Memorial 4/23/09
Post op pathology - Gleason unchanged at 4+3=7 Focal Gleason pattern 5
Staging pT3 pNO pMX
All lymph nodes, seminal vesicles and margins negative


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/4/2009 10:28 AM (GMT -6)   
While you are awaiting the PSA, Tony, you may wish to do the research now on adjuvant radiation. I waited 3 months before starting mine. Things were working (I did not have ED nor incontinence) but the hormonal therapy I started put my sex life on hold. But I did my homework and know that Surgery/HT/Radiation is a great combination for the T3 and beyond. I am sorry that you appear to have some more work to do, but having been down the next steps, I can say that I am doing well and feel ok. HT has been the worst treatment to deal with for me, but still tolerable.

Feel free to write to my Email. I will be glad to chat with you.

PS: I will be in Miami Friday through Sunday morning. How's the weather?

Tony
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  
 
STAY POSITIVE!


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 5/4/2009 12:43 PM (GMT -6)   
Godfather, glad you talked to your doctor. Sounds like he gave you some good advice and at least the start of the next phase of your treatment. The next PSA or two should tell a lot about what is going on or could be going on. I hope you do well.

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
 
 


Jake T
Regular Member


Date Joined Mar 2009
Total Posts : 44
   Posted 5/4/2009 3:06 PM (GMT -6)   
Hey Tony, sounds like you are getting some good advice from this site, so stay positive and i wish you well, Jake

Godfather
Regular Member


Date Joined Jan 2009
Total Posts : 64
   Posted 5/4/2009 3:45 PM (GMT -6)   
TC

90's and humid - bring your trunks.

Tony
Age at diagnosis 61 5'10" 260 lbs. Resides in SW Florida
12/07 PSA 2.6 12/08 PSA 4.0 Biopsy 1/09 - 6 of 8 nodes positive
Left - 2 of 4 positive, 2% involved, 4+3=7 Gleason Right - 4 of 4 positive, 40% involved, 4+3=7 Gleason
Perineural invasion is present - MRI suspicious for extracapsular extension
Scheduled for open RRP @ MSK 3/10/09 - canceled due to cardiac clearance issues
Partial nerve sparing Da Vinci RLP w/ Dr Carey @ Sarasota Memorial 4/23/09
Post op pathology - Gleason unchanged at 4+3=7 Focal Gleason pattern 5
Staging pT3 pNO pMX
All lymph nodes, seminal vesicles and margins negative


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 5/4/2009 3:53 PM (GMT -6)   
Purgatory, thanks for the good wishes. I hope that you too are doing well. Some good news on the ED front ... hubbie had his first usable erection recently (with help from the little blue pill). It was his first orgasm since the surgery. I was so happy for him because he said it restored some of the confidence he had lost right after surgery and brought him closer to "feeling normal."

Life goes on...thank God!
Husband diagnosed in February 2008 (age 57). Cancer discovered during routine annual physical. Clinical Stage T1c, Gleason 7 (3+4), with 2 out of 10 cores testing positive. Perineural invasion identified on biopsy. DRE was negative.

Robotic surgery in March 2008. Pathological stage upgraded to T3a, Gleason still 7 (3+4). Miniscule invasion into prostate capsule but no cancer found outside capsule (surgical margins and seminal vesicles were clean).

1st PSA 3 weeks post op: 0.1; 2nd PSA 7 weeks post op: 0.0. PSA remains at 0.0, and will continue to be checked every 3 months for the first 2 years due to capsular penetration.

Currently on Enablex to control frequency of urination (tried Vesicare but stopped due to heart palpitations) and on Viagara 2 - 3 times a week. Recuperation from surgery was uneventful.


mirv
Regular Member


Date Joined Nov 2008
Total Posts : 30
   Posted 5/5/2009 1:05 PM (GMT -6)   
Hey Tony,
Good news on the negative margins!  Did they give you a percentage on the focus point of Gleason 5?  I had a similar focus point and the doc hasn't mentioned radiation at all.  It seems that these focal point Gleason scores aren't mentioned too often, it may be a more recent thing to include them in pathology reports, or maybe they're just uncommon.  I go in for my first post op PSA in 9 days.
Take Care!!
Mark

Age 52
PSA 3.1 fPSA 26% Dx: 11-07-08
1 of 12 cores with 5% adenocarcinoma
11 of 12 cores clear Gleason grade 3+3=6
Robotic laproscopic surgery 2-4-09
Dr. Garret Matsunaga, Torrance Memorial Hosp.
Free hernia repair! 2 day stay.
Pathology: pT2c NXMX
upgraded to 3+4=7 and <2% tertiary 5
negative margins
negative extraprostatic extension
negative seminal vesicle invasion

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