Got Pathology report but don't understand it

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Viperguy
Regular Member


Date Joined Nov 2010
Total Posts : 259
   Posted 3/18/2011 8:39 AM (GMT -6)   

Got the snake off Junior yesterday and leaking like a Japanese reactor.  However, I did get my hands on the post op pathology report.  Unfortunately the doctor was tied up in surgery and we could not discuss.  I typed out the final diagnosis if some would like to weigh in.  I don't have a clue what this terminology means in the way of future treatments probability of reoccurrence etc. 

 

Final Diagnosis:

 

  1. Right obturator Lymphadenectomy:  One lymph node negative for metastasis (0/1).
  2. Left obturator Lymphadenectomy:  Two lymph nodes negative for metastasis (0/2).

 

Procedure:  Radical prostatectomy, robotic assisted

      Prostate size: 24 grams, 4.0 x 2.5 x 3.2 cm.

      Lymph node sampling:  Obturator lymph nodes (See A and B)

      Histologic type:  Adencarcinoma/acinar, not otherwise specified.

      Historical grade:  Gleason Grade 3 + 3 = 6, with tertiary pattern 4

      Tumor quantitation:  Overall, about 1.6% of the prostate tissue submitted is positive for adenocarcinoma, with about 2.2% involvement of the right prostate lobe

 

Extraprostatic extension: Not identified

Seminal vesicle invasion: Not identified

 

Margins:  Tumor is focally present at one capsular margin (right posterior aspect)  All other margins are clear.

 

Lymphovascular invasion: Not identified

Perineural invasion: Not identified

 

      Extraprostatic extension:  Not identified

      Perineural invasion:  Not identified

Pathologic Staging (AJCC Tumor Staging, Seventh Edition) pT2a pNO pM not applicable.

 

One right obturator and two left obturator lymph nodes examined.  All lymph nodes are negative for metastasis (0/3).

 

Additional pathologic findings:  Focal chronic inflammation.

Ancillary studies:  Not done.

 


2009 PSA 2.2
2010 PSA 3.2
Biopsy 24 cores 3 positive
Gleason 3 plus 3
Robotic Surgery March 3, 2011 @ 6 am
At home recovering
Cath removal scheduled 3/17/11
Pathological report confusing, no seminal invasion Gleason 6 but margins not completely clear.

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 3/18/2011 9:12 AM (GMT -6)   

Viperguy,

You will, of course, get the best feedback from your doctor, but many guys would have probably liked the opportunity to vet their results at a place like HW before meeting with their surgeon so that they better understood it during the relatively short face-time in the office. 

I’ll offer my comments, hoping that they will be helpful in advancing your understanding.

 

First, a couple of nearby lymph nodes were sampled during surgery and a separate pathology test was run on them.  No sign of cancer was found.  It would have been highly improbable for someone with low Gleason score to have lymph node metastasis, and none was found in your case.  Good news.

Second, your prostate size was rather average.  Your Gleason score of 3+3 showed that the most common and second most commonly found cells when the dissected your prostate showed a pattern of prostate cancer which is at the lowest level of aggressiveness (they don’t call “2’s” or “1’s” prostate cancer; only “3’s”, “4’s” and “5’s”.  The third most commonly (i.e., tertiary) found cell pattern (but less than 5%) was the next level up in aggressiveness at a “4”.  At 1.6% and 2.2%, only a small amount of tumor was found to be present (in what they examined…they don’t dissect every bit).  Good news.

No seminal vesicle invasion (SVI) or extraprostatic extension (EPE) or perineural invasion (PNI) are also good news (because they would have been possible early indicators of movement and increased concern over the possibility of eventually finding prostate cancer cells outside of the prostate capsule), but the small amount of tumor you did have was at the edge of the prostate (more specifically, at the “surgical margin”) which offers a possibility for escape of cancer cells.  If (and this is a BIG if), cells escape, they have the possibility of continued growth which might eventually become detectible with a future PSA test…termed “Biochemical Recurrence (BCR).”  But, a single focal positive margin in the absence of other unfavorable pathological features (like EPE, SVI or high Gleason) indicate a relatively low probability of BCR.  Something to be aware of, and probably a trigger for your doctor to have you follow-up with the ultrasensitive PSA test in the future (lower detection limits); it's a BCR risk factor, but not a high likelihood of it being a problem for you.

 

Hope this helps when you meet with your surgeon, but do write back if you have other specific questions...


Post Edited (Casey59) : 3/18/2011 9:19:19 AM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 3/18/2011 9:53 AM (GMT -6)   
It's bad that you had any cancer, of course. But, that's a very good pathology report. Gleason 6, you are on the lower side of Stage 2, very low cancer volume, lymph nodes good, no PNI noted. All in all. You should be in good shape with these stats, but certainly make sure your surgeon goes over the whole thing with you in detail. Take notes if needed.

Good luck.

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 2/11 1.24
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 9/10,

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7205
   Posted 3/18/2011 9:59 AM (GMT -6)   
It's an excellent report.
 
Mel

Highwayman
Regular Member


Date Joined Sep 2010
Total Posts : 148
   Posted 3/18/2011 10:16 AM (GMT -6)   
Viperguy,
sounds like a good report. Take care of yourself and do the keggels.
we'll keep a seat open for you at the zero club and see you soon.
Mike

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 3/18/2011 10:38 AM (GMT -6)   
Congratulations!
Want to trade ?
Jeff

Viperguy
Regular Member


Date Joined Nov 2010
Total Posts : 259
   Posted 3/18/2011 10:39 AM (GMT -6)   
Your comments are most encouraging and very well explained.  I thought I was a dead man walking when I read:
 

Margins:  Tumor is focally present at one capsular margin (right posterior aspect)  All other margins are clear.

 

Nobody wants a "tumor focally present", whatever that means.  Once again, I apoligize for my ignorance on this disease.  I had no idea what I was reading on this path report. 

 

Thanks again for helping me understand this.  I now have some insight when I see the doc in a couple of weeks.   

 
 
2009 PSA 2.2
2010 PSA 3.2
Biopsy 24 cores 3 positive
Gleason 3 plus 3
Robotic Surgery March 3, 2011 @ 6 am
At home recovering
Cath removal scheduled 3/17/11
Pathological report confusing, no seminal invasion Gleason 6 but margins not completely clear.

Magaboo
Veteran Member


Date Joined Oct 2006
Total Posts : 1210
   Posted 3/18/2011 12:07 PM (GMT -6)   
Congratulations! Very good report. I wish that I could could have been like that.
 
Mag
Born 1936
PSA 7.9, Gleason Score 3+4=7, 2 of 8 positive
open RP Nov 06, T3a, Gleasons 3+4=7, Seminal vesicles and lymph nodes clear
Catheter out 15 Dec 06, Dry since 11 Feb 07
All PSA tests in 2007 (4) <.04
PSA tests in 2008: Mar.=.04; Jun.=.05; Sept.=.08; at SRT Start=0.1,
Salvage RT completed (33 days-66Gy) 19 Dec 08
PSA: in Jan 09 =.05, all tests to date (Jan 11) <.04
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