got final pathology report today. good news, bad news, and questions

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Regular Member

Date Joined Sep 2009
Total Posts : 187
   Posted 11/23/2009 5:38 PM (GMT -6)   
today, went back to cleveland clinic. get rid of catheter and drain. yeeha!

also got his pathology report. bad news first: gleason score is 3+4=7 (original was 3+3=6). stage is pT2c NX MX (original was pT1c) not happy with those bad news shakehead

good news: the tumor is confined to the prostate, surgical margins and seminal vesicles are negative for tumor, bladder neck shave is negative

1, apical involovement: positive (what is that means?)
2, High-grade PIN: positive (what is that means?)

thanks everyone. I am in the stage that trying to understand the every word of this report.


Regular Member

Date Joined Sep 2009
Total Posts : 187
   Posted 11/23/2009 6:01 PM (GMT -6)   
let me type out what's on teh final diagnosis page:

Prostate, radical prostatectomy-adenocarcinoma of the prostate, leason score is 3+4=7 (see comment)
the tumor is confined to the prostate
surgical margins and seminal vesicles are negative for tumor


Gleason score: primary 3. secondary 4, total 7
% of 4 and/or 5: 1-10%
% of 3: 91-100%

androgen deprivation effect: negative
apical involovement: positive
apical margin involovement: negative

extraprostatic extension (EPE): negative

Margin: negative

bladder neck: negative

areas of involvement: right posterior lateral peripheral zone 6-15 mm; left posterior peripheral zone 9-15 mm; right transition zone 12mm principal area of involvement: right posterior lateral peripheral zone 6-15,,

focality: multifocal

volume: medium
greatest dimension of larger tumor nodule: 12mm
ejaculatory duct apparatus: negative
seminal vesicles involvement: negative
peri-SV involvement: negative
vas deferens: negative
peri-vas involvement: negative
High-grade PIN: positive
neuroendocrine differentitaion: negative
symph nodes: n/a
lymphovascular invasion: nagative
other diagnoses: benign prostatic hypertorphic

pathologic stage: T2c NX MX

Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 11/23/2009 6:33 PM (GMT -6)   
Evening Jennifer,

You got a lot of news all at one time.

Glad his cath and his drain are history, thats a good start.

Please remember, that when you get a PC dx from a biopsy, at best, it is an estimate based on a small sampling of tissue. It is not uncommon to have the Gleason and/or staging upgraded after surgery. Why? Because they now have the whole gland to look at, as well as the other bits and pieces they took out of your husband.

There is a lot of good news in that pathology report. Yes, its a shame that it is now a Gleason 7 (3+4). But its not a Gleason 7(4+3), which I go with the school that says your husbands version is the lesser of evils. Also, look how small a percentage of Type 4 Cancer cells made up that Gleason 7, under 10%, that is good news.

High Grade PIN, are cells that are prone to turn cancerous, doesnt mean they will, but lots of time they will. The fact that they found that as well tells me that it was high time to get the cancerous prostate out of him, and good riddence.

Others will weigh in on some of the other highpoints of this pathology report, but all in all, I think its pretty decent.

I hope he continues to recover well, and that you start getting some peace of mind.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sess/72 gys cath #8 33 days, 11/2- SP Cath #9 in place

Veteran Member

Date Joined Sep 2009
Total Posts : 3172
   Posted 11/23/2009 6:36 PM (GMT -6)   

 “Apical” refers to the prostate’s apex.  The apex of the prostate (the tip end of the somewhat triangular-shaped gland organ, farthest from the bladder) is the most common site in which positive surgical margins are found after robot-assisted laparoscopic prostatectomy.

It is important to report involvement of the gland apex by PC because apical involvement is associated with a relatively high likelihood of positive surgical margins and postoperative incontinence.

From the report, it sounds like the apex was involved, but negative apical margin involvement.


This is a common, and very good report.  A very small amount of “4” resulted in the upgrade to 3+4, which just meant that the biopsy samples didn’t find the small amount of “4” cells.

Congratulations on a good report!

Regular Member

Date Joined Sep 2009
Total Posts : 187
   Posted 11/23/2009 6:57 PM (GMT -6)   
thanks David and Casey59,

I am so glad that things over now, at least, for now. the report is not bad, that gives us some peace. just wish we can get in ZERO club in 4 weeks.

Richard is very tired too. now without tubes he can recover better. He is very happy to be catheter and drain free.

from watch my husband's surgery, I totally understand everyone here who had surgery or surgeries, must experienced a lots of physical and mental challenge. it is not easy at all. So I solute to you that you all had great job done and deserve lots of credit.

leaking, on our way back, we stopped couple place, total about 4 hours, Richard had some leak on depend pants. Doctor let him do kegel every 12 minutes. so now he having a timer attach on his shirt, beeping every 12 minutes

Veteran Member

Date Joined May 2009
Total Posts : 2692
   Posted 11/23/2009 7:04 PM (GMT -6)   

Congratulations to you and Richard. I think it is a great report.

I agree with the other guys. I think the negative margins are a sign of the excellence of the surgeon. Although the cancer had worked its way to the surface of the tip of prostate, he was able to cut around it, and get all of the cancer.

Did you kiss him ?

Now it's just some hard work, getting the sphincter trained, and starting on the ED. You've got to keep Richard's spirits up during this time. Some guys experience depression during the recovery phase.

Best of luck and keep chatting with us. !
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injections

Veteran Member

Date Joined Jun 2008
Total Posts : 1804
   Posted 11/23/2009 7:31 PM (GMT -6)   
Congratulations Jennifer ... sounds like an excellent pathology report. Richard's cancer is a stage II which means that it has not invaded any other tissues - that's great news! Clean margins, seminal vesicles, no extraprostectic extension - these are all what we like to hear! The stage t1c is only used on a biopsy sample, as far as I know. All that means is that the PCa was found due to an elevated PSA. This is called the clinical stage. As Purgatory pointed out, the surgical specimen allows them to go over every inch of what was removed, resulting in a much more accurate staging of the disease.

Richard's incontinence will improve ... I know it's easy to say don't worry, but don't.

So happy for both of you ... it's been quite a journey, hasn't it?

With best wishes for a future filled with zeros,

Sephie & John
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (single small EPE in posterior left). Perineural tumor infiltration present. Apex margin, bladder neck and SV negative. Final Gleason 3+4 SA. PSA: 0.0 til July 2009. August 2009 PSA was 0.1, in September it was 0.3 Met with radiation oncologist, CT scan and bone scan clean. Third PSA on October 16 - PSA BACK TO UNDETECTABLE! Next PSA scheduled for early December. No radiation treatment at this time!

Regular Member

Date Joined Oct 2009
Total Posts : 171
   Posted 11/23/2009 8:06 PM (GMT -6)   
Jennifer,That is a great post surgical path report. If you go to the following web site, and you know your husbands pre-surgical PSA, and with the information you have, you can get a prediction of the likelyhood of recurrance. I think you will feel very optimistic with the results, which are going to be excellent.

Best of luck,


Regular Member

Date Joined Sep 2009
Total Posts : 187
   Posted 11/23/2009 8:41 PM (GMT -6)   
goodlife, I didn't kiss doctor because i was in the waiting room with my daughter. I left 4:30am this morning to get 7:40 apointment there so couldn't send daughter to daycare. also, Dr. kauk's assitance was seeing Richard today, today is Kaouk's surgery day. I didn't have chance to ask my question.

according to Dr, he saved both side of nurves. and I would like to try those nurves sometime later


Sephie, i guess next would be leaking problem, fun fun fun. I know it will get better day by day. We are joking that out daughter just graduated from diaper then daddy start it again.

Steve, thanks for your link. what you said were excaclly what doctor told us.

glad everything is over, for now.

good night everyone!


Regular Member

Date Joined Apr 2009
Total Posts : 133
   Posted 11/23/2009 8:41 PM (GMT -6)   
No use in duplicating responses about report: it is good. What is next is the recovery chapter. Now without being tethered to a bag, it is a wonderful feeling but once again, the next mental (and physical) challenge: continence , pads, kegels. It may come easy or may take a while. Remind him to be patient with himself and by the way, pads are easier mentally than Depends. After continence, then ED but don't push too hard. One chapter, one day at a time.
best wishes,
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 is helping me through every stage of this war.
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,  University of KY Medical Center, Lexington, 3 days in hospital, catheter removal April 21.
Pathology: clear margins, no cancer in prostate: told that this is very rare and Doc has only seen it in 3 out of over 1400 cases; I rearched the concept of "vanishing cancer" and found a tumor classification of tP0 and asked Doc if it applied to me. He said that it was unlikely because if a pathologist had done a much more detailed analysis of the tissue, he would likely find more foci somewhere, and biopsy found "needle in the haystack as opposed to the tip of the iceberg"; Nevertheless, it is a blessing;
Regardless of the science, my family says "miracle."
Now working w/ post-surgery issues....

Veteran Member

Date Joined Jun 2008
Total Posts : 1804
   Posted 11/24/2009 8:29 AM (GMT -6)   
Jennifer, I laughed at your comment about your baby "graduating" from diapers and daddy moving into them!

The incontinence will get better, I promise. It may not be what it was pre-surgery but it will be better than it is now.

Glad to hear those nerve bundles were spared - looks like you have your work cut out for you helping them to heal ( hee-hee).

So very happy that everything has worked out well for you and your family. This is one traumatic experience to go through but with the help of friends, we get through it.

Bet you and Richard will give plenty of thanks this Turkey Day! Enjoy the holiday.

Sephie & John
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (single small EPE in posterior left). Perineural tumor infiltration present. Apex margin, bladder neck and SV negative. Final Gleason 3+4 SA. PSA: 0.0 til July 2009. August 2009 PSA was 0.1, in September it was 0.3 Met with radiation oncologist, CT scan and bone scan clean. Third PSA on October 16 - PSA BACK TO UNDETECTABLE! Next PSA scheduled for early December. No radiation treatment at this time!

Veteran Member

Date Joined Jan 2007
Total Posts : 762
   Posted 11/24/2009 6:44 PM (GMT -6)   
Its a lot to go through but all seems really good for you and your hubby with that report. Enjoy your thanksgiving season and keep your spirits up. My husband was a 3 + 4 as well, and he has made a remarkable recovery over time. This is a great place to post any questions as they come up in his recovery as you know. Good luck & cheers, Lana (& CJ)
Creed_three - Husband 51 yrs (49 years at diagnosis)
PSA (2002) 2.1.  PSA (2006) 3.5.  1 x 5% core of 12 positive at biopsy. Open Radical Prostatectomy with nerve sparing April 2007. Gleeson 3 + 4 = 7.   Undetectable <.1 PSA since, specifically, June 2007-0.01, Oct 2007-0.02, April 2008-0.02: Oct 2008-0.03, Nov, 2008-0.02, April 2009-0.03. 

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