Results of Pathology are back, please give me your advice.

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Regular Member

Date Joined Dec 2009
Total Posts : 316
   Posted 12/30/2009 10:33 PM (GMT -6)   
Okay my dads pathology results came back:
PT3b, with perineural invasion. Focal invasion on right seminal vesicle. Upgraded to Gleason 9. 60% of prostate involved, negative margins. I am going crazy right now. Can he still be cured? I put his stats into the prostate recurrence and it gave a meager 15% chance. Has anyone had similar stats and remained BCRF?
Additionally, I want him to get adjuvant radiation. I think it can only help with a gleason 9. If any of you have more experience in this field can you tlel me what you think? Thank you so much

Veteran Member

Date Joined May 2009
Total Posts : 2692
   Posted 12/30/2009 10:51 PM (GMT -6)   

This is not the time for despair. The perineural invasion is fairly common, and by itself probably doesn't raise too many flags. The seminal vesical is a little more of a red flag. The good news is negative margins. Gleason 9 by itself is not a guarantee that he will have a reoccurence.

I think seeing a radiation oncologist is a great plan.

I wonder if you read the nomogram correctly. 15 % sounds way to low. I would guess he would be in the 60 to 70 % range.

Without a signature telling us his PSA, all the postop pathology, etc., it is hard for us to check his numbers.

You must stay positive. We have seen much worse on this forum.

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 Apr 2008
Total Posts : 847
   Posted 12/31/2009 3:40 AM (GMT -6)   
I agree that 15% is way too low -- I suggest double-check the calculations. The negative margins are really good news, so you have a lot to be optimistic about.
Age 63 at diagnosis, now 64.
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores.
Non-nerve sparing RRP on 7 March 2008.
Two nights in hospital; catheter out after 7 days.
Continent; no pads needed from the get-go.
Pathology showed organ confined and negative margins. Gleason downgraded to 4+4=8.
6-week : <0.05
7-month: <0.05
13-month: 0.07 (start of a trend?)
19-month: 0.09 (maybe)
After a learning curve, Bimix injections (0.2ml) worked well. From 14 months, occasional nocturnal erections. Have "graduated" to just the pump.

English Alf
Veteran Member

Date Joined Oct 2009
Total Posts : 2218
   Posted 12/31/2009 4:40 AM (GMT -6)   

Yes definitely check the numbers. A signature with some extra details about your dad (age PSA etc) would I am sure help others here to give you more assistance)

And when I fed my numbers into a couple of different nomograms or computer models I got different results back.

Also some of the percentages they quoted back at me related to many years in the future, and all that basically means is that the longer you live the more likely you are to have a recurrence. But if you haven't had a recurrence at 5, 10 or 15 years then you remain on the starting line you don't suddenly leap to the finish simply due to the passage of time.

The negative margins is good news.

Happy New Year to you and your dad


Veteran Member

Date Joined Feb 2008
Total Posts : 1858
   Posted 12/31/2009 5:53 AM (GMT -6)   
Like all the others have said you have good news with the negative margins. Perineural invasion is very common. These are more commonly the nerves within the prostate and in my own case their involvement was "extensive". These along with the prostate are now gone. They can be a pathway for the tumour to escape the gland into surrounding tissue but given negative surgical margins this dows not appear to have happened in your father's case. As the seminal vesicles are also directly attached to the prostate this is another means for the tumour to escape the prostate. These have also been removed.
The Gleason 9 is a bit of bad news but even that does not mean it has escaped. It would be wise to have a consultation with a good oncologist...........they may want to go directly to adjuvent therapy or may even decide to wait on that first PSA and then decide. Either way he has first to recover completely from the operation. It is tough but try to relax and learn all you can about the next step. There are quite a few stories of Gleason 9 fellas to be found here:
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
PSA December 09 <0.01

My Journey:

Post Edited (BillyMac) : 12/31/2009 4:16:33 AM (GMT-7)

Veteran Member

Date Joined Jun 2008
Total Posts : 1804
   Posted 12/31/2009 8:23 AM (GMT -6)   
Luv, first order of business is to not go crazy (been there, done that). First, as others have already said, the perineural invasion noted likely will have no impact on your dad's prognosis. My husband had PI noted on both the biopsy and surgical report, and our urologist said it's rare that he doesn't see this on a specimen.

The focally positive invasion of a seminal vesicle indicates the cancer had spread out of the prostate but, the good news is that the invasion is focal (single) rather than multi-focal and he has clean surgical margins.

I agree that speaking with both a medical and radiation oncologist makes sense. Your dad should be having his first PSA test soon and that should help give a clear view of what's going on. I'm not so sure that I would make any decisions until you know more but the doctors should be able to guide you better than I.
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. PSA: 0.0 til July 2009. August 2009- 0.1, September 0.3, October back to 0.0, December 0.0. Thank you God!

Regular Member

Date Joined Dec 2009
Total Posts : 316
   Posted 12/31/2009 11:00 AM (GMT -6)   
Hi guys, thank you for all your help. I am really struggling to come to terms with all that has happened. It all seems so surreal. My dad is 62 years old and his pre-treatment open radical prostatectomy PSA was 4.17. Three months earlier the PSA was 3.71. We are considering moving to adjuvant radiation therapy. I am not sure how long we need to wait between the surgery and radiation.
Also, I wish we had a medical doctor involved (along with the surgeon/radiation oncologist) that could talk to us about all the other treatments like Hormone therapy or possible chemotherapy. It is getting difficult reading all these articles online and trying to formulate a plan of action. I feel like we need someone who understands the whole spectrum. Thank you all for all your help. I really appreciate it so much.

Veteran Member

Date Joined Jul 2009
Total Posts : 504
   Posted 12/31/2009 12:45 PM (GMT -6)   

Hang in there,

1st the right thing was that the prostate was removed. You now have a definitive pathology, could not have occurred any other way

2nd, look at getting a PSA for yourself, 62 is on the young side to have this severe PC

3rd a regular medical Dr, like a General Surgeon ? A regular Dr would actually know less than the Urologist and Radiation Docs

4th, the 15% sounds way off, maybe if the PC was still untreated inside your dad, which it is not

You took the right course of action, do not look back, forward is where you need to be focused
Age: 52
PSA (2008)=1.9
Biopsy on Jan 09, 2009
One (1) out of twelve (12) cores was positive, plus external nodule found
Gleason Score = 3+3
Surgery (Da Vinci, robotic prostatectomy): 4/7/09
Removed Catheter: 04/19/09
100% bladder control - Pad free 7/09
PSA 7/09 undetectable, under .0

Regular Member

Date Joined Dec 2009
Total Posts : 97
   Posted 1/1/2010 4:30 PM (GMT -6)   
LUV,My urologist Who was My surgeon recomended radiation for me shortly after My surgery.The next time I visited him Hgave Me a lupron injection right in his office.He also got me on the ball to get Me ready for My radiation.They know just about every aspect of the journey.Just try to relax and not run yourself ragged,if you get all run-down you will be able to support him like you want and need to.good luck to you and him.

age 55dx 12-2008,psa at biopsy 8.6
biopsy 12/12 gleason 3+4=7
da vinci surgery 6-09 nerve sparing by DR. John W. Scott (my hero)
Hospital 3 days cath 7days still leaking from cough(bad lungs)
still have ed may be the hormones.
9-09 psa 2.2 hormone inj
10-09 nuclear bone scan no results yet I will have gold markers placed 12-29-09
start rad 1-10-10
organ confined
extracapsular seminal vesicle involvement
lymph node involvement

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