Venous &Lymphatic Invasion

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Old Sailor
Regular Member


Date Joined Aug 2009
Total Posts : 208
   Posted 9/2/2009 10:56 AM (GMT -6)   
My path report states that venous (large vessel) invasion and lymphatic (small vessel) invasion are  "indeterminate" and "there are areas suspicious for lymphovascular invasion but no definitive invasion is seen" Everything else on path report good (margins, lymph nodes, seminal vesicles, no extraprostatic extension)
 
Question is what does "suspicious" and "indeterminate" mean when refering to the post surgery path report.  Should the path report be sent for another opinion?
 
The Old Sailor

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/2/2009 11:16 AM (GMT -6)   
I would have Jon Epstein review the specimen. He is at Johns Hopkins.

Indeterminate means not found (Nx on the TNM tumor grading scale) "Suspicious" is ambiguous. Probably felt hard or irregular. A second opinion is always a good idea...

Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Gleason 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 (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4237
   Posted 9/2/2009 5:44 PM (GMT -6)   
There is always the Combidex MRI which can detect Lymphnode invasion, but you have to travel to Holland to get it.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


CPA
Veteran Member


Date Joined Feb 2008
Total Posts : 655
   Posted 9/2/2009 5:47 PM (GMT -6)   
Greetings, Old Sailor. A second set of eyes never hurts anything.  I believe my first step would be to get someone else to take a look at the pathology.  David

Diagnosed Dec 2007 during annual routine physical at age 55
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 pos; 2 marginal
Gleason 3+3; upgraded to 4+3 post surgery
RRP 4 Feb 08; both nerves spared
Good pathology - no margins - all encapsulated
Catheter out Feb 13 - pad free Feb 16
PSA every 90 days - ZERO's everytime!
Great wife and family who take very good care of me

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