My urologist feels that I should have been graded a pT3a because of the positive surgical margin (focal) and the extraprostatic extension. Here is the text of the pathology report:
A. Prostate, radical prostatectomy (44 grams):
Bilateral well-differentiated prostatic adenocarcinoma, predominantly right lobe with a small amount in the left lobe; involving about 20% of the total gland; Gleason score 6/10 (3+3); showing perineural invasion , but no definite lymphovascular invasion; showing focal extraprostatic extension; showing wide involvement of the posterior surface of the right lobe; no evidence of seminal vesicle involvement.
B. Preprostatic tissue, excisional biopsy:
Adipose tissue with no evidence of tumor or lymph nodes.
C. Right pelvic lymph node, excisional biopsy:
One lymph node showing no evidence of mestastic tumor (0/1).
D. Left pelvic lymph node, excisional biopsy:
Two lymph nodes showing no evidence of mestastic tumor (0/2).
- Pathologic staging: pT2cpN0
- Specimen: Prostate and seminal vesicles (44 gm)
- Procedure: Radical prostatectomy and lymphadenectomy
- Prostate size: 3.2 x 3.5 x 3.0 cm
- Lymph node sampling: Bilateral pelvic nodes negative (R 0/1, L 0/2)
- Histologic Type: Adenocarcinoma
- Histologic Grade: Well differentiated
- Primary Pattern: 3
- Secondary Pattern: 3
- Teritary Pattern: N/A
- Total Gleason Score: 6
- Tumor Quantitation: Bilateral, approximately 20% of total gland
- Extraprostatic Extension: Focally present
- Seminal Vesicle Invasion: Not identified
- Margins: Right posterior surface, rest of margins clear
- Lymph-Vascular Invasion: No identified
- Comments: EPE is difficult to judge because tumor extends to the outer surface of the specimen. The right side of the prostate shows infiltrating small to medium sized glands, extending to the posterior surface of the right lobe and focally appearing to extend beyond the prostatic capsule. There is local slight involvement of the left side. Preprostatic tissue and lymph nodes are free of tumor.
I agree with you that RT is a lot like shooting a needle in a haystack; that's what scares me so most about it. I was under the impression that Gleason 6 has a difficult time surviving outside of the prostate so I'm hoping that my two recent PSA tests of .03 are the result of benign prostate tissue left behind as both of my nerves were spared.
I guess there is really nothing I can do about it and just ride it out. I know I should not be so hung up on this as there are folks that are far worse along than me, but it does weigh heavily on my mind. I am a serious control freak and not being able to put a handle on this drives me crazy.
· Age at diagnosis: 49
· PSA: 04/2007, 3.5; 03/2011, 4.5
· Biopsy, 12 cores: 04/13/11
· Dx: Gleason 3+4=7, 04/19/11
· DaVinci: 06/09/11; cath removed: 06/17/11
· Post-Op Report: pT2cpN0, Gleason downgraded to 3+3=6, Margins+, PNI+, SVI-, LNI-
· PSA: 07/2011 - <.01 | 10/2011 - .01 | 01/2012 - .01 | 04/2012 - .03 | 07/2012 - .03