biopsy results

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student25
New Member


Date Joined Aug 2009
Total Posts : 13
   Posted 9/9/2009 9:03 AM (GMT -6)   
well! here we are. A little over a month after dad's first diagnosis. Several little panic attacks on my part and a prostatectomy later (on his) we finally got some good news...

The doctor called me yesterday with the biopsy results. He summarized them and then said they were 'better than he expected'. He was in fact a bit surprised. I gathered a long time ago this doctor is the aggressive/alarmist/worst case scenario type, which is exactly what me and my dad respond to. We have a 'hope for the best, plan for the worst' kind of mentality. We never wanted anything sugar coated, just the bittersweet reality, which this particular doctor is always inclined to give. Which is why I found reassuring the results came back 'better than he expected'. In fact, yesterday I was elated. Today, after actually reading the pathology report myself, I've come down a bit from the high. Let's get on with it..

pre-op PSA 5.26
pre-op Gleason 3+4 = 7
6 of 12 scores positive, mostly right side, 40-90%

Bone scan, CT scan negative.
open radical prostatectomy on september 2nd. No post surgical pain or nausea. 4 days on dad's already walking around, taking showers by himself, and generally being a pest he he.

Pathology Report:
Lymph nodes clear
prostate gland 34.6 grams
Gleason the same at 3+4 = 7
Tumor confined to prostatic capsule (this is the part that surprised the doctor)
Negative margins
'several areas' of perineural invasion noted.
'small focal area' of vascular invasion noted.
right seminal vesicle positive for neoplasia.
urethral margin/apex free of neoplasia.

pathologic staging T3b, N0, MX-stage III


Doctor suggested aggressive radiation therapy.


Ok ok, so clearly I plan to research the hell out of every single sentence in that pathology report, but what do you guys think so far? Based on your signatures, his stats seem fairly average among men who went down to undetectable PSAs after radiation. Do I have a reason to be optimistic? And just like the good Dr. Lykins, don't sugarcoat it anything turn

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/9/2009 9:29 AM (GMT -6)   
Your father and I have a lot in common. My suggestion is to talk to a big name oncologist if possible. Your dad can do well but he should keep the best care available. Radiation is a good step at this point, but should he add hormonal therapy? should he look into a clinical trial? These questions may be important.

So far, he does have a serious case, but he still has many options on what to do next. My Email address is open in my profile. I would be glad to work with him or you in lending my experience with a very similar pathology result...I am on year three...

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!


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 9/9/2009 9:45 AM (GMT -6)   
I have a question to all of you guys. T3b means seminal vescicals invasion, but pathology says neoplasia. That's benign, right? How do you square this?

Father died from poorly differentiated PCa @ 78 - normal PSA and DRE

5 biopsies over 4 years negative while PSA going from 3.8 to 28

Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8

Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere+Avastin)

PSA prior to treatment on 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60

RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins

PSA undetectable for 8 months, then 2/6/2009-0.10, 4/26/2009-0.17, 5/22/2009-0.20, 6/11/2009-0.27

Salvage IMRT + 6 Months ADT: Casodex started 6/12/2009, Lupron 6/22/2009, PSA 6/25/2009-0.1, T=516, 7/23/2009-<0.05, T<10, IMRT to start mid-Aug


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4223
   Posted 9/9/2009 10:42 AM (GMT -6)   
Student,
You now have partial information.
In determining a treatment you have to answer 3 questions:
Is the PC indolant or agressive? Indications are that your Dad's is moderately agressive.
Is the PC contained in the Gland, localized to the bed or matastized? You don't have enough information to make ths decision. Your doctor seems to think it was not contained if he is recommending radiation.
Is the PC acting normal or is it a devient? Only a Prostate Oncologist can determine this.
Tony's recommendation to seek an opinion from a top name oncologist should be your next step.
JohnT

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


student25
New Member


Date Joined Aug 2009
Total Posts : 13
   Posted 9/9/2009 3:42 PM (GMT -6)   
well i think the reason why the doctor suggested radiation is because they noted on the pathology report a small focal area of vascular invasion, and radiation seems the next logical step.

@ John T-
The path. report says negative margins, and tumor confined to prostatic capsule. Doesn't this mean it's either localized to the bed or contained in the prostate? What am i missing?

geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 9/9/2009 4:02 PM (GMT -6)   
It seems to me that your dad's case is right on the edge. Do you pull the trigger now and start radiation or do you wait for a post surgical psa?
Given that the path suggests some escape beyond the prostate it is easy to see why your doc is for radiation now. You might plug your dad's figures into the nomograms and see the percentages. With my extra prostatic extension my chances of being progression free are still over 60% and, based on this, my doc recommended watching the PSA rather than do what was more likely to be unneeded treatment. This agreed with my reading that delaying radiation in marginal cases did not increase risk -- but you should do your own research

This PCa is a tough call every step of the way. A further consult with an oncologist sounds like a good course.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads


student25
New Member


Date Joined Aug 2009
Total Posts : 13
   Posted 9/9/2009 4:45 PM (GMT -6)   
I looked at different nomograms and the results give 80-89% 10 yr. chance of no recurrence. I personally favor radiation soon. I don't like to take chances, specially with this.

I also followed your advice and got the phone number for the Emory Winship Cancer Center, will set up an appointment tomorrow for a second opinion with a prostate oncologist.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4223
   Posted 9/9/2009 5:15 PM (GMT -6)   
Student,
It's a very good queston and don't have the knowledge or skill to answer it. There must be a reason your doc recommended radiaton.

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 9/9/2009 5:28 PM (GMT -6)   
Sounds like you have received some very good advice.  I'd see the prostate oncologist and go from there.  Thanks for being such a good daughter! I'm sure your Dad appreciates it.  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


Radical
Veteran Member


Date Joined Mar 2009
Total Posts : 739
   Posted 9/9/2009 11:49 PM (GMT -6)   
Every time you read a post here at HW, you learn more and more, well I certainly do.
Q. Stage T3 my understanding tumor has left the capsule ! So why then does this path report state - tumor confined to prostatic capsule eyes . This is confusing to me, help please Tony or someone.............cheers Kev
 
 
Age 51yrs
DX 11/11/08
6 out of 8 cores positive 3 X 60% / 3 X 10%
PSA 4
Gleason Score 3+4=7
Stage T1c
Robotic Surgery 24/12/08
Upgrade Gleanson Score 4+3=7 Gleason Differential 60%/40%
Stage T2c
Three small foci total volume <10%
Neg Margins and Nodes
Nil - Extraprostatic Extentions
Dry less than 1 week.
ED- taking Meds- Its been 9 mnths now getting some action ! yah
PSA 1/09  .03
PSA 2/09  .03
PSA 5/09  .03
PSA 9/09  .03
"Everyday in Everyway I get better"


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/10/2009 1:05 AM (GMT -6)   
Student25,
I made a mistake looking at your fathers stats on the final pathology. I believe that this report is questionable. The first order of business is to have a second opinion on the pathology. I it were me I would have this prostate be sent to Johns Hopkins University attention Jon Epstein. Before any further action. The guys here raised some great points and I looked only at the 3B stage and the neoplasia (which btw should not be present in the seminals).

This pathology is not properly described in the report.

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!


Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4106
   Posted 9/10/2009 4:43 AM (GMT -6)   
I must say you guys know some stuff!!!!!! I am blown away you your knowledge.

Jeff T
Jeff T Age 57
9/08 PSA 5.4, referred to Urologist
9/08 Biopsy: GS 3/4=7
10/08 Nerve sparing open RRP- Path Report: GS 3+3=7 Stg. pT2c, margins clear
3 mts: PSA .05 undetectable
 10th month  PSA <0.01
ED- 5 mg Cialis daily, pump daily, going to try MUSE next


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 9/10/2009 10:05 AM (GMT -6)   
Tony....correct me please if I am wrong here.

But neoplasia is abnormal growth of cells...which may or may not be cancerous. The pathologist may not have been able to distingish the type of cells accurately due to the sample size or sample condition after surgery. And because of them being located within the seminal vesicles, it would lead to staging of a T3 as the seminal vesicles are not clean and free of any abnormal cell growth. I would think that the staging and followup radiation recommendation would be correct in this instance. And I also agree regardless of the questionable seminal vesicle...a second reading by another pathologist is in order.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month Apr 2009 .06
                   9 month Jul  2009 .08

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