AZ Guy said...
My RALP was last Thursday. Today was my post-op and the surgeon gave me the report from pathology-
* Now Gleason 4+3
* bilateral disease
* Pathologic staging pT2c
* Right apical margin positive.
* Focal prostate margin positivity, right anterior lobe.
* Negative for extraprostatic extension
* Negative for seminal vesical invasion
* Negative for lymph-vascular invasion
* Positive for perineural invasion
* lymph node sampling not performed (given my low-risk biopsy report)
* dominant tumor nodule 1.2 cm
Can't believe its so much worse than my biopsy pathology in February. I am wondering if I blew it by waiting six months to consider my options and have the surgery. Once I decided to have the surgery I spent the summer by dropping 8 pounds, doing planks and kegels. I thought I was doing everything I could to make the surgery recovery easier.
How does one go from low-volume Gleason 6 to bilateral Gleason 4+3 in six months? Can the biopsy miss that much? I like to think I'm an analytical person and did my due diligence. Even had the biopsy Gleason 6 confirmed at Mass General. Now I'm feeling shocked at these results.
Yes, the biopsy can miss that much and more, not uncommon. Sometimes it shows no cancer in guys who turn out to be hi risk. The needles can not sample every area of the prostate, anything they do hit and show is just mainly blind luck. Main thing is: that report is worse than you thought it would be, but still not too bad at all.
Really, seems to me, it matters not about
it being in both lobes or about
perineural invasion. ( Y'all correct me if I'm wrong) You would worry more about
those things if they showed during the Bx because it might indicate an increased risk of you having EPE, SV or lymph node invasion. But you are negative in all of those very important areas(but LN not sampled?), so any increased risk for for being positive in them doesn't seem to matter a lot.
The main thing is you have gone from a 3 to a 4(4+3=7), which bumps you up from the lowest risk but still not considered high risk. And you have those focal ( are they all focal?) positive margins. But Y'all correct me if I am wrong, I still don't think that constitutes a big bump in risk, knocking you into the hi risk. Some one else will know for sure, better than me.
There is no telling how many years that cancer has been lurking and growing inside you. I doubt that 6 months made much difference, and it probably made no dif on your Gleason score. More likely the Bx needles simply missed the G7. It is a blind shot trying to spear some tiny cells. Easy to miss. Hang in there, Brother!
PSA 10.9 ~112013
Bx on 112013 at age ~65yrs, with 5 of 12 pos with one G9(5+4), 1 PNI, T2B.
RALP with lymph nodes at Vanderbilt 021914. (nodes clear, SV+, G9 down graded to 4+5, cut wide, but 1 tiny foci right at the edge of margin ) Pros. 106.7 gms!
At 15 months, not wearing a pad most days, mostly dry
PSA <.01 on 6/14 and all until 9/15 = .01, still .01 9/16, .02 on 3/17,6/17