here is my post patholgy report

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gregory m helman
New Member


Date Joined Oct 2009
Total Posts : 16
   Posted 11/9/2009 6:55 PM (GMT -6)   
 i have posted my post pathology report in my signature
i have my second opinon next week with oncologist.
it looks like radiation  for me, and psa right now 0.45
 
i don't think waiting is an option.
 so what do you think?.
  age 52
had rectal exam and found prostrate nodule detected.
psa was .097 before exam.
referred to urologist and also rectal exam , but couldn't feel anything.
we discussed about biopsy to be on safe side.
Final   Diagnosis of biopsy
specimen  is received in formalin in 8 parts labeled A-H.
 
 
 
A-G ------ no atypia or malignancy found.
H---- prostrate needle biopsy, left anterior horn:   Adenocarcarcinoma,
gleason score 3 + 4= 7,    4 mm in greatest linear dimension, involving approximately 20% of tissue from this site. less than 1ml cancer and less 1% of gland involved.
 
 
prostrate surgery done 7/29/2009 -- radical perineal surgery.
robotic was out of the question due to previous surgeries, hernia repair,gall bladder,had mesh put in.
 before surgery , psa was at 0.97.
09/2009 psa ---- 0.55
10/2009 ----- 0.39
11/2009 ------- 0.45
10 days with foley  cathereter
drain tube for 2  days
hospital stay--- 2 1/2 days
 had trouble with bowl movements constipated due to pain meds .
on stool softners
 after cath was out 2 pads a day
6 weeks later just 1 pad a day.
slight leakage , when lifting, sneeziing
 
post op pathology report
 
comment
Macroscopic
specimen type - radical perineal prostatectomy
specimen is intact
pre op psa level 0.97/ng/ml
other organs-seminal vesicle(s)
microscopic --tumor site-1 nodule
nodule#1- involves left lateral mid and left lateral
dimensions--0.6 x 0.2 x 0.6 cm
Histologic type------ Adenocarinoma
histologic grade---gleason
primary pattern is-grade 3 : single acini of variable size and seperation , cribriform and papillary patterns
Secondary pattern is: grade 4 : irregular masses of acini and fused epithelium , can show clear cells
gleason score (primary + secondary)  = 7 : Moderately poorly differentiated
 
Tumor Quantitation:
preportion of prostrate involved by tumor =<1 %
estimated tumor volume(% involved by tumor x prifixation vol) =< 1 ml
 
extraprostaic extention - absent
seminal vesicle invasion- absent
perineural invasion - absent
blood /lymphatic vessel invasion --absent
extent of invasion : pT2a: tumor involves < one half of one lobe
regional lyph nodes: NX; cannot be assessed
 
margins :
 
margins involved by tumor : anterior left lateral mid
margin involvement is extensive (> 1 HPF)
beingn prostatc acini are present at margins , not in area of tumor
 
 
 
 
 
 
 
 
 


Dave7
Regular Member


Date Joined Jul 2006
Total Posts : 202
   Posted 11/9/2009 7:48 PM (GMT -6)   
Hi Gregory,
 
Sorry to say, with the positive margins and your current PSA, I agree with your assessment that waiting for further treatment isn't an option.
 
I'm sure others more knowledgable than me will post their thoughts about what that treatment might be.
I'm amazed that you had PCa with such a low pre-surgery PSA score.  You were fortunate to have a nodule detected by whom I assume is your GP.  Particularly in light of the fact that your urologist couldn't feel it.
 
Best wishes with your future treatment.
 
Dave


Age:54
PSA 5/22/06: 5.6
DaVinci surgery: 9/14/06
Gleason: 3+3
Organ confined, clean margins.
Both nerve bundles spared.


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 11/9/2009 7:49 PM (GMT -6)   
The positive margin is actually a good news in this case. It explains elevated PSA post surgery and suggests a good likelihood of success with adjuvant radiation treatment.

It is surprising that such a small tumor would have extensive positive margins.
<SPAN style="FONT-FAMILY: 'Garamond', 'serif'; COLOR: black; FONT-SIZE: 10pt; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: 'Times New Roman'">Father died from poorly differentiated PCa @ 78 - normal PSA and DRE<SPAN style="FONT-FAMILY: 'Garamond', 'serif'; FONT-SIZE: 10pt; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: 'Times New Roman'"><?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p>

<SPAN style="FONT-FAMILY: 'Garamond', 'serif'; COLOR: black; FONT-SIZE: 10pt; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: 'Times New Roman'">5 biopsies over 4 years negative while PSA going from 3.8 to 28<SPAN style="FONT-FAMILY: 'Garamond', 'serif'; FONT-SIZE: 10pt; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: 'Times New Roman'"><o:p></o:p>

<SPAN style="FONT-FAMILY: 'Garamond', 'serif'; COLOR: black; FONT-SIZE: 10pt; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: 'Times New Roman'">Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8<o:p></o:p>

<SPAN style="FONT-FAMILY: 'Garamond', 'serif'; COLOR: black; FONT-SIZE: 10pt; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: 'Times New Roman'">Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere+Avastin)

<SPAN style="FONT-FAMILY: 'Garamond', 'serif'; COLOR: black; FONT-SIZE: 10pt; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: 'Times New Roman'"><SPAN style="FONT-FAMILY: 'Garamond', 'serif'; FONT-SIZE: 10pt; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: 'Times New Roman'">PSA prior to treatment<SPAN style="FONT-FAMILY: 'Garamond', 'serif'; COLOR: black; FONT-SIZE: 10pt; mso-bidi-font-family: Arial; mso-fareast-font-family: 'Times New Roman'"> on <SPAN style="FONT-FAMILY: 'Garamond', 'serif'; COLOR: black; FONT-SIZE: 10pt; mso-bidi-font-family: Arial; mso-fareast-font-family: 'Times New Roman'">1/8/2008 is <SPAN style="FONT-FAMILY: 'Garamond', 'serif'; COLOR: black; FONT-SIZE: 10pt; mso-bidi-font-family: Arial; mso-fareast-font-family: 'Times New Roman'">33.90, bounced on 1/31/2008 to <SPAN style="FONT-FAMILY: 'Garamond', 'serif'; COLOR: black; FONT-SIZE: 10pt; mso-bidi-font-family: Arial; mso-fareast-font-family: 'Times New Roman'">38.20, and down at the end of the treatment (4/24/2008) to <SPAN style="FONT-FAMILY: 'Garamond', 'serif'; COLOR: black; FONT-SIZE: 10pt; mso-bidi-font-family: Arial; mso-fareast-font-family: 'Times New Roman'">20.60

<SPAN style="FONT-FAMILY: 'Garamond', 'serif'; COLOR: black; FONT-SIZE: 10pt; mso-bidi-font-family: Arial; mso-fareast-font-family: 'Times New Roman'"><SPAN style="FONT-FAMILY: 'Garamond', 'serif'; COLOR: black; FONT-SIZE: 10pt; mso-bidi-font-family: Arial; mso-fareast-font-family: 'Times New Roman'"><SPAN style="FONT-FAMILY: 'Garamond', 'serif'; COLOR: black; FONT-SIZE: 10pt; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: 'Times New Roman'">RRP at Duke (Dr. Moul) on 6/16/2008, <SPAN style="FONT-FAMILY: 'Garamond', 'serif'; COLOR: black; FONT-SIZE: 10pt; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: 'Times New Roman'">Gleason downgraded 4+3=7, <SPAN style="FONT-FAMILY: 'Garamond', 'serif'; COLOR: black; FONT-SIZE: 10pt; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: 'Times New Roman'">T3a N0MX, focal extraprostatic extension, two small positive margins<o:p></o:p>

<SPAN style="FONT-FAMILY: 'Garamond', 'serif'; COLOR: black; FONT-SIZE: 10pt; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: 'Times New Roman'">PSA undetectable for 8 months, then <SPAN style="FONT-FAMILY: 'Garamond', 'serif'; COLOR: black; FONT-SIZE: 10pt; mso-bidi-font-family: Arial; mso-fareast-font-family: 'Times New Roman'">2/6/2009<SPAN style="FONT-FAMILY: 'Garamond', 'serif'; FONT-SIZE: 10pt; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: 'Times New Roman'">-<SPAN style="COLOR: black">0.10, 4<SPAN style="FONT-FAMILY: 'Garamond', 'serif'; COLOR: black; FONT-SIZE: 10pt; mso-bidi-font-family: Arial; mso-fareast-font-family: 'Times New Roman'">/26/2009<SPAN style="FONT-FAMILY: 'Garamond', 'serif'; FONT-SIZE: 10pt; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: 'Times New Roman'">-<SPAN style="FONT-FAMILY: 'Garamond', 'serif'; COLOR: black; FONT-SIZE: 10pt; mso-bidi-font-family: Arial; mso-fareast-font-family: 'Times New Roman'">0.17, 5/22/2009<SPAN style="FONT-FAMILY: 'Garamond', 'serif'; FONT-SIZE: 10pt; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: 'Times New Roman'">-<SPAN style="COLOR: black">0.20, <SPAN style="FONT-FAMILY: 'Garamond', 'serif'; COLOR: black; FONT-SIZE: 10pt; mso-bidi-font-family: Arial; mso-fareast-font-family: 'Times New Roman'">6/11/2009<SPAN style="FONT-FAMILY: 'Garamond', 'serif'; FONT-SIZE: 10pt; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: 'Times New Roman'">-<SPAN style="COLOR: black">0.27<o:p></o:p>

<SPAN style="FONT-FAMILY: 'Garamond', 'serif'; COLOR: black; FONT-SIZE: 10pt; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: 'Times New Roman'">Salvage IMRT + 6 Months ADT: Casodex started 6/12/2009<SPAN style="FONT-FAMILY: 'Garamond', 'serif'; FONT-SIZE: 10pt; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: 'Times New Roman'">, Lupron 6/22/2009, PSA 6/25/2009-0.1, T=516, 7/23/2009-<0.05, T<10, 10/21/2009-<0.05, T<10, salvage <SPAN style="FONT-FAMILY: 'Garamond', 'serif'; COLOR: black; FONT-SIZE: 10pt; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: 'Times New Roman'">IMRT to prostate bed and pelvis. 72gy over 40 treatments finished 10/21/2009.


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 11/9/2009 8:55 PM (GMT -6)   
It certainly is a somewhat unusual pathology. Although I know very little it would seem that the tumour had its origins very close to the edge of the prostate and spread outwards. But it is confusing in reporting that extraprostatic extension is not present but the margin is positive. The actual quantity of tumour is not that large at 1 ml (1 cc) and only 1% of the gland. It is odd that surgery had only a quite small effect on your PSA level. You may be correct about the adjuvent therapy and it will be very interesting to hear what your oncologist will say. I wish this bloody disease would follow a logical set of rules. May the next course of action get you the good result you deserve.
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
PSA August 09 (2 year mark), <0.01

My Journey: www.yananow.net/Mentors/BillM2.htm


Herophilus
Veteran Member


Date Joined Sep 2009
Total Posts : 663
   Posted 11/9/2009 11:03 PM (GMT -6)   

Gregory,

I too wish that you did not have to make the difficult decisions ahead. May you and your family find some peace soon.

Jack


Age:  51
Overall Health: Excellent
PSA 08-31-2009  6.8
DRE 09-10-2009  Normal
BXY 08:30 on 09/24/2009 OUCH!
Gleason: 3+3 = 6
Cores 10 of 12 positive
75% of 1 core, 25% of 2, cores... all others 5-20% 
Surg: da Vinci November 2 2009 Wash U- Barnes Hospital
11/06/2009, Doing Excellent

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