Pathology report question

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compiler
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Date Joined Nov 2009
Total Posts : 7203
   Posted 3/5/2010 10:52 AM (GMT -6)   
In another thread, it was noted that there is a difference between extraprostatic extension and extracapsular extension (the latter appears to be worse).
 
Here is part of my pathology report:
 

focal extraprostatic extension; right anterior/anterolateral region with

Gleason score 6 (3+3).

location and extent of extraprostatic extension: left posterolateral base

(established) and right posterolateral mid (focal).

location and extent of positive margin: right posterolateral base; focal

(linear length = 0.5 mm).

 

Now, it seems that in one area, it is not extracapsular?True? Of course,with a positive margin, there MUST be extracapsular extension. Right?

Anyway, comments are welcome.

Mel


63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms. 

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry, was  using 1 pad at night for security, but pretty much dispensed with that most nights. Update: no pads at night. No pads while at home, but still very uncomfortable. Use 1 pad for out-of-house activities.

Next Event: First post-op PSA on 3/9/10


MaxBuck
Regular Member


Date Joined Jan 2010
Total Posts : 75
   Posted 3/5/2010 12:18 PM (GMT -6)   
Not a doctor, but I believe the two terms are used essentially interchangeably.
Dx at age 56: Oct 09; PSA 5.8, followed up by 9.9 two weeks later (reproducibility of test - ?)
Biopsy ind cancer in 8/12 cores: Gleason 8 (4+4)
open radical retropubic prostatectomy Dec 4 09
Post-op pathology: 56 g weight, cancer in 21%, Gleason 7 (4+3, tert 5); margins clear, no lymph node involvement (0/9), perineural invasion present, T2c N0Mx (but showed clear from distant metastasis in pre-op bone scan and CT scan)
Continence data: essentially no incontinence 9 weeks post-op
ED pretty complete: some erection possible but current non-functional


Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 3/5/2010 3:13 PM (GMT -6)   
MaxBuck said...
Not a doctor, but I believe the two terms are used essentially interchangeably.

 
I'm also not a doctor, nor am I a pathologist, but I've learned a bit along the way...so the usual caution applies to take everything you read off chat sites like this with a grain of salt.  Mel, you already know that, I'm sure, since you are a regular poster and you have seen the wide variety of "knowledgeable" responses.  It's amazing how many different responses to the same question show up here
 
Nonetheless, I will put my own understanding of positive margins into meaningful, layman's wording...maybe more than you want/need to know.
 
For starters, note the term "surgical margins"; this is the outer edge of the tissue removed during surgery.  During surgery, the surgeon attempts to removes the prostate and some normal tissue surrounding it...the surgical margin is what is around the outside of all of what was removed.  The area of normal tissue is important because any stray cancer cells may be included in this.  If the edge (or margin) of what was removed contains PC cells, then there may have been PC cells left behind in the corresponding spot in the prostate bed.  The goal of surgery is to achieve a "clear margin", that is, to remove all the cancer...even if a little normal tissue is removed along with it.
 
The prostate and the other tissue that was removed are sent to the lab where the pathologist coats it with an ink.  The ink coloration and penetration help the pathologist to determine how close any cancer comes to the edge.  The ink stains appears different when PC cells are present on the margin.  
 
Those patients with positive surgical margins are at an increased risk of cancer recurrence.  The pathologist will note in his/her report the number and location of positive margins.  Patients with more than one positive margin are more likely to have cancer recur compared to those with a single positive margin.  Also, patients with a large area of positive margin are more likely to have recurrence of PC compared to those with a small area where the cancer just touches the edge.  It is important to note that most patients with positive margins are "cured."  Depending on the number and extent of margins, post-operative radiation may be recommended to decrease risk of recurrence.
 
You've probably heard discussion about the pros and cons of open and laparoscopic surgery having to do with this same concept.   open surgeons use their fingers to feel the prostate (they certainly can't see much through all the blood); cancer cells are firm.  In laparoscopic surgery, obviously the surgeon doesn't have the same tactile sensation, but instead has magnified visual cues to follow to improve outcomes; specifically the color of tissue, signs of inflamation, etc.  In each case, an experienced surgeon would likely be better tuned-in to the tactile (open method) or visual (robotic method) cues, and would know to adjust the amount of normal tissue removed accordingly to increase the likelihood of a negative margin.  Important reason to have an experienced surgeon...either open or robotic (laparoscopic).
 
Hope this helps explain the big picture...
 
 

Post Edited (Casey59) : 3/5/2010 2:30:19 PM (GMT-7)


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2458
   Posted 3/5/2010 3:27 PM (GMT -6)   
Mel,
Casey59 has explained it well. I'm one of those who had EPE but negative margins. As my pathology report indicates, I had EPE of 3mm in circumference but the surgical margins was 5mm beyond the prostate capsule.
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Pathology report:
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm in circumference.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 4 months
8 weeks PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1
8 months PSA test 10/9/09 result <0.1
11.5 months test 1/21/10 result 0.004


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7203
   Posted 3/5/2010 4:00 PM (GMT -6)   
Interesting. Casey, I have appreciated your knowledgeable responses.
 
I suspect most of us regularly posting here have become quite knowledgeable about this disease thanks to HW
 
Mel

63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms. 

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry, was  using 1 pad at night for security, but pretty much dispensed with that most nights. Update: no pads at night. No pads while at home, but still very uncomfortable. Use 1 pad for out-of-house activities.

Next Event: First post-op PSA on 3/9/10

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