Path report back ... disappointing!

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Regular Member

Date Joined Dec 2010
Total Posts : 94
   Posted 2/21/2011 11:38 AM (GMT -6)   
The surgery was Feb 10th and although the doctor thought everything went well I guess you can never be too sure.
The path report came back --- parents were somewhat confused by all the big terms the doctor used on the phone. The jist of what I understand is:
-Although it appeared localized path report shows it broke outside the capsule and invaded the seminal vescile.
-One side of the surgical margins (cant remember which side) was free of cancer
-The side that was invaded was diagnosed/classified as a G9
-Staging --- T3 (not sure of any further details)
-Current plan -- follow up with radiation and most likely hormone therapy (not sure what the outcome will be?)
-Lymph node invovlement @ the time of surgery = Negative
-Current status --- catheter until at least Friday-- then they have to do some test to make sure it's ready to come out. He's currently had a fever since last week --- highest has been 101.5 --- on call doctor wasn't worried --- however, his surgeon said if its not gone by tomorrow he'll need to see him .... possible infection in the catheter.
We had a little over a week to feel cancer free and normal again--n ow we are back to worry about what this new "staging" means... and where this "aggressive cancer" might be hiding in his body!
So frustrating!

Veteran Member

Date Joined Sep 2009
Total Posts : 3172
   Posted 2/21/2011 11:53 AM (GMT -6)   
Concerned4You said...
We had a little over a week to feel cancer free and normal again--n ow we are back to worry about what this new "staging" means... and where this "aggressive cancer" might be hiding in his body!
Thanks for sharing your update.  You did receive some mixed results from the pathology lymph node involvement, but seminal vessicle involvement (SVI).  Although, with your pre-surgery Gleason results of 4+5 (upgraded in a Johns Hopkins 2nd opinion to 5+4), it was unlikely from the outset that a single treatment mode was going to completely resolve his issues.
You didn't really ask any specific questions in this post, so let me suggest to you buying he Dr Patrick Walsh book "Guide to Surviving Prostate Cancer" as an invaluable resource for men at all stages of PC.  This book is often recommended to the newly diagnosed because it is considered "the bible" of PC and has extensive descriptions of surgery, but it also has outstanding sections on men with recurring and advanced prostate cancer.  You expressed "worry" about understanding his situation...I highly recommend this book to ground your current understanding and various other sources of inputs with "the bible" of resource books.  Order online and for less than $20 you can have it before the end of the week.  LINK
best wishes...
edit:  typo

Post Edited (Casey59) : 2/21/2011 10:06:47 AM (GMT-7)

Regular Member

Date Joined Dec 2010
Total Posts : 94
   Posted 2/21/2011 12:14 PM (GMT -6)   
Thanks. We have the book. He found it depressing to read... probably because he views his cancer as the "aggressive" type and that's all he really thinks about.

They did say the lymph nodes were negative --- We will be getting a copy of the path report to review ourselves today... hopefully that will help clarify.

You bring up a good point - with his Gleason a 4+5 , 5+4 I guess we shouldn't have been so hopefully to think surgery would have got it all.

You're also right...I guess I didn't really have a question --- just looking for thoughts/support. I guess I'm hoping other men (or wives/daughters) will tell me they went through the same thing and the outcome was favorable for them/their loved one (PSA undetectable after radiation...etc).

You read all this literature which talks about 5 year survival rates ... I'd like to think we have more than 5 years with him!

Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 2/21/2011 12:21 PM (GMT -6)   
i remember the whole day that my surgeon told me that we have Stage 3b disease. I knew it meant a lot of work ahead. But I can tell you that we have been proactive and I have done well. It's been 4 years for me and I am still stringing the undetectable PSA's. I am certain the adjuvant therapies we added shortly after surgery were the right thing for me to do and you should start looking into them as well. Of course I am assuming that your PSA will come down to undetectable like mine did after surgery. If not then you have a clearer path of select salvage therapies and they too can work well.

Stay positive. From here you have no reason to believe that you won't still do well.

Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.


Regular Member

Date Joined Jan 2011
Total Posts : 42
   Posted 2/21/2011 12:33 PM (GMT -6)   
I had kind of the same disappointing news with my post-surgery pathology. Besides getting 'upgraded' to a gleason 9, my margins were positive. Hence, I'm starting adjuvant radiation this week. The good news was the 6 week PSA was <0.1 since surgery. good luck, <bobr>
Age: 54
Routine Physical on 10-20-2010 DRE Normal
PSA 4.3, up from 0.6 5 years prior
PSA 0.6 on 10-25-2005
PSA 0.4 on 7-30-2004
PSA 0.5 on 5-9-2002
Followup with Urologist on 11/10/2010 after elevated PSA; DRE noted slight bump
November 30th, 2010 had prostate biopsy.
December 9th, 2010, Biopsy results 3 of 12 cores positive.
LLB: Gleason's 4+3=7, 11 MM Tumor Length/15MM Core Length (73%)
LLM: Gleason's 4+4=8, 12 MM Tumor Length/15MM Core Length (75%)
LM: 0.1 MM Tumor Length (1%)0.1 MM Tumor Length
Urologist recommended robotic removal using da Vinci method.
RALP Surgery 12/27/2010 Released: 12/30/2010
Thunderbird Banner Hospital, Glendale, AZ
Post-Surgery Pathology: GS 4+5=9
Pathologic Staging: pT3a, N0, MX; location: Left Side; Volume: 10%
Margins: Left posterior inked margin focally involved
Extraprostatic Extension: Observed
Seminal vesicles: Not observed
Lymphatic/Vascular Invasion: Not observed
Catheter: Removed 15-days after surgery
Post-OP Followup on 1/11/2011; Catheter/Staples removed
Adjuvant IMRT 8 Weeks Post-OP.
No exercise for 4 Weeks Post-OP.
Radiation Oncologist Initial Consultation on 1/18/2011
Calypso Procedure on 2/17/2011; PSA <0.1; Bone Scan Clear
341 Testosterone

CT Simulation on 2/24/2011.

Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 2/21/2011 12:37 PM (GMT -6)   
Yes, can't sugar coat it, its a serious pathology report, but not the worse by any means. But also there are still available secondary treatments for your husband. Tony's case is a good one to follow in your case. Some men, with bad pathology, still don't automatically go into recurrance, just so many variable with PC. Wish the both of you all the best, as your forge ahead to the next step in this journey.

We are always here for advice and/or if you need to vent and blow off steam.

David in SC
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

Regular Member

Date Joined Nov 2010
Total Posts : 143
   Posted 2/21/2011 12:48 PM (GMT -6)   
I am praying for you both both but it's kind of bad news not so bad news. The bad news was it's outside the prostate the not so bad news so far is it not in the lymph nodes. You may have hit bunt to third base with a runner on third. They took  seminal vessel if they got it all there and the surrounding tissues and a little radiation you may be good to go.

Veteran Member

Date Joined Apr 2008
Total Posts : 831
   Posted 2/21/2011 6:22 PM (GMT -6)   
I don't know how old your father is, but we just lost a member that was Gleason 9 in 1999. He lived 12 years and did not die of PCa. Not bad for advanced PCa at dx. I hope your father will do better with todays medicine...

Post Edited (ChrisR) : 2/23/2011 11:05:33 AM (GMT-7)

Cajun Jeff
Veteran Member

Date Joined Mar 2009
Total Posts : 4119
   Posted 2/21/2011 6:41 PM (GMT -6)   
What a mixed bag of news. You will notice that there are many G9 guys that are doing very well. Sure it means that he will have a battle to fight but in many cases it is very possilbe to have a norman life with T3.

Cajun Jeff
9/08 PSA 5.4 referred to Urologist
9/08 Biopsy: GS 3+4=7 1 positive core in 12 1% cancer core
10/08 Nerve-Sparing open radicalSurgery Path Report Downgrade 3+3=6 GS Stage pT2c margins clea
r3 month: PSA <0.1
19th month: PSA <0.1
2 year PSA <0.1
Only issue at this time is ED but getting better

Regular Member

Date Joined Jan 2011
Total Posts : 42
   Posted 2/21/2011 10:18 PM (GMT -6)   
I'm a T3a Gleason 9...ran 8 miles yesterday. I'm gonna kick this cancer's ass. Starting adjunct radiation Thursday. good luck, <bobr>

Ed C. (Old67)
Veteran Member

Date Joined Jan 2009
Total Posts : 2461
   Posted 2/22/2011 8:05 AM (GMT -6)   
Concerned, sorry for the your pathology report. I wish the best for the next step in your journey. Hang in there and be positive.
Age: 67 at Dx on 12/30/08 PSA 3.8
2 cores out of 12 were positive Gleason (4+4)
Davinci surgery 2/9/09 Gleason 4+4 EPE,
Margins clear, nerve bundles removed
Prostate weighed 57 grams 10-20% involved
all PSA tests since (2, 5, 8, 11, 15, 18, 21 months) undetectable
Latest PSA test (2 years) <.008 ?

Regular Member

Date Joined Dec 2010
Total Posts : 94
   Posted 2/22/2011 1:25 PM (GMT -6)   
Thanks everyone...Brampy --- it's comforthing to know you ran 8 miles yesterday!!! I'm glad to hear you're doing so well!

ChrisR - my father is 65 --- we're hoping for more than 12 years... we're pretty sure he's had this for awhile and just ignored symptoms as he didn't realize they were so serious!

The doctor said he won't check his PSA for 3 months... is this normal? Someone above mentioned theirs being checked @ 6 weeks.

He's recovering slowly -- very slowly -- very tired --- lightheaded etc.


Forum Moderator

Date Joined Jan 2010
Total Posts : 7084
   Posted 2/22/2011 3:01 PM (GMT -6)   
I had the first PSA at 7 weeks and a few days (7, according to my surgeon, would be too early to be reliable, but 8 would have been on Christmas ). So, all things considered, 3 months may be OK.
More so when you consider the margins - if he (as I was) is already expecting IGRT, then a few weeks is not significant. It is more important to focus on healing and regaining as much continence as possible.
My surgeon was pretty upliftingly brutal in the "day after" meeting - he said everything looked ok, but the in-OR pathologist had some doubts from some lymph node tissue, so they took more tissue. He explained that you can't tell much of anything by looking at the tissue, and that any pathology-related information had to wait. His "looks ok" meant I didn't bleed out, and that nothing was reeking of rotten. Then he pulled out my drain. shocked
I am also a G4+5.
DaVinci 10/2009
My IGRT journey (2010) -

Veteran Member

Date Joined Jul 2009
Total Posts : 1267
   Posted 2/22/2011 11:27 PM (GMT -6)   
Hi Concerned, bummer news, but as others have said while surgery may not be the get-out-of-PCa-jail-free card we all want it to be, there are other cards to be played which can still give your dad a good outcome and many years ahead. I've got you and your family on my prayer list tonight.

As concerning as all this news may be, the first step on the road to recovery isn't the pathology and what treatments may lie ahead, it's getting up off that hospital bed and getting in shape to pace brampy on one of those eight mile runs. Or, at least a brisk walk around a few blocks. It's the old, drink, walk, pain meds, drink, walk, pain meds, routine. A strong body is a fighting body.

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
From "knock out" to wake up in recovery less than two hours.  Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
First post op PSA Sept 09  less than 0.02
PSA on Oct 23, 2009 less than 0.02
PSA on Jan 8, 2010  less than 0.02
PSA on April 9, 2010 less than 0.02 
PSA on July 9, 2010 (one year) less than 0.02

Regular Member

Date Joined Nov 2009
Total Posts : 212
   Posted 2/23/2011 12:16 PM (GMT -6)   
My father was also stage 3 with SV involvement, Gleason 9 and 10.
He didn't have surgery, his primary treatment was ADT and IMRT radiation. Knock on wood, his PSA 9 months post treatment is undetectable.
So hopefully the salvage radiation treatment that may be ahead of you will catch the rest of it.

Regular Member

Date Joined Nov 2009
Total Posts : 254
   Posted 2/23/2011 12:43 PM (GMT -6)   
Best of luck. I know this wasn't what your family was hoping for but as others have said there are avenues stil l open to beat this ray

Regular Member

Date Joined Dec 2010
Total Posts : 94
   Posted 2/23/2011 6:08 PM (GMT -6)   

Thanks again for all the support.

My other question is how long does it take for him to really start feeling better? We are starting to get really concerned. He is 13 days post surgery and doesn't seem to be making much progress. They are going to do the dye test on Friday to determine whether or not the catheter comes out. His surgeon said some of the doctors have been pulling the catheters out too early leading to complications. Apparently the dye will help determine if there are any clots or other items to be concerned about.

It seems like he has one good day... then one bad. I'm not sure if depression is setting in or what. We have about 10 inches of snow so getting outside to walk isn't an option. He's pretty much stuck indoors in a smaller house.

He says he feels "sluggish". His fever is gone and he's still on antibiotics so I'm not sure what's going on.

His friends were all telling him about being back to work 10 days after the surgery. He can barely take a shower and then he's worn out. Is this normal at this stage post op?



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