Post Op Pathology

I just got my post op pathology report and the Dr. seemed very happy and said I was "cancer free" but I just want to be sure I should be so excited. He said it had broke through, and it was good I did the procedure when I did, but with the negative margins at the area where it had broke through, it meant he got it all and I was good to go. So here is what it says:

A: Peri-prostatic fat, excision
Mature adipose tissue with no specific pathologic change
Negative for carcinoma

B: Prostate and bilateral seminal vbesicles, radical prostatectomy:
Invasively poorly differentiated adenocarcinoma. Gleason score 3+4 7 Gleason grade 4 component is
prominent
The carcinoma involves both the r ight and left lobes and has a greatest nodular diameter of 1.6 cm.
The carcinoma shows focal extracapsular extension in the left posterior baes of prostate
Bilateral seminal vesicles are free of carcinoma
All examined surgical resection margins are free of carcinoma
Pathological stage pT3aa NO Mx

C: Left iliac internal/external obturator lymph nodes, excision:
No evidence of carcinoma in nine lymph nodes examined

D: Right iliac internal/external obturator lymph nodes, excision:
No evidence of carcinoma in nine lymph nodes examined

The tumor was approximately 20% of the prostate with the greatest dimension 16mm

Extraprostatic Extension - Present, focal left posterior base

Seminal Vesicle Invasion: Not Identified

Margins: Margins uninvolved by invasive carcinoma

Treatment Effect on Carcinoma: Not Identified

Lymph-Vascular Invasion: Indeterminate, focus suspicious for angiolymphatic invasion noted

Perineural Invasion: Present

Lymph Nodes: Examined 18 Number Involved 0

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DX 07/17/17
Age 40
PSA 4/27/17 6.56
PSA 6/23/17 7.59
6 Cores Positive of 12 Gleason 7 (3+4)

So far, so good. Of course, the EPE is a risk factor - hopefully cells have not gotten away. You'll know more in 3 months when you get your first uPSA. How are you faring?

If you enter your numbers in a nomogram /www.mskcc.org/nomograms/prostate/post-op and compare w/wo EPE you get the following:

PROBABILITY OF REMAINING RECURRENCE-FREE AFTER SURGERY

With EPE:.......2 YR 95%, 5 YR 88%, 7 YR 84%, 10 YR 78%
Without EPE:...2 YR 97%, 5 YR 92%, 7 YR 90%, 10 YR 86%

The of risk BCR is a bit higher.
I also had EPE and negative margins and are still recurrence-free at 3 years. Hopefully you will be too.

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Age at detection: 60
PSA 4.1 2014-02-25
Biopsy 2014-04-24, 4 of 10 cores positive, G: 3+4,4+3,4+3 EPE,4+3. PNI+
Bone scan negative
DaVinci 2014-08-31, nerve sparing right side
Prostate 35 g, 46x37x38 mm
Tumor dorsal PZ, SV-, 14 LN-, SM-, pT3a, G7 (4+3), EPE+ left side
PSA:
2014-10 <0.05
2015-03 <0.05
2015-09 <0.05
2016-03 <0.05
2016-09 <0.05
2017-09 <0.1

Post Edited (Gemlin) : 9/19/2017 2:03:47 PM (GMT-6)

Hey MrBaseball,

That sounds like great news. I see a lot of people upgraded after the post op so it could be much worse. Negative margins I think is a good deal, and the doc seems pretty confident in results. Celebrate! No sense in sweating that other stuff unless they give a real reason. Glad to see you're feeling good in recovery. Awesome!

Frosty

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Diagnosed age 39, June 2017
PSA 5.1
Biopsy UMichigan and Epsteins lab 2nd
4of12, T1c
L Apex (3+3), 1%
L Horn (3+4), 95/5, 70%
L MMid (3+4), 80/20, 30%
L Base (3+3), 90/10, 30% PNI

Decipher Test Score .27

SBRT scheduled - September 2017 - UCLA Dr King

Good Report!

---

Male 61 DX age 60
Father had PC
2002. Psa. .08. Enlarged Prostrate
2014. Psa. 3.8
2016. Psa. 19
3-08-17 RP Mayo Clinic Mn
Path Report: Gleason 9, Seminal vessels and one nerve removed, negative on margins, 35 lymph nodes removed no cancer, tumor was pt3b. Prostrate 45 grams
4-20-17 Incarcerated Umbilical Hernia repair
6-13-17 1st psa check 0.13
7-19-17 psa 0.12 MRI clear
8-29-17 shoulder replacement

but, what would you do about it right now?

nothing.

Even if, big if, more treatment is needed, it will be months before you even have to think about it.

Error on the side of good news, rest, heal, start living life.

The first PSA test will confirm/deny if there is a further problem. Then, you'd start planning the next step.

Don't search a sunny sky for clouds - well, except for ones that look like bunnies or doggies.

Andrew

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I'll be in the shop.
Age 57, 52 at DX
PSA:
4.2 10/11, 1.9 6/12, 1.2 12/12, 1.0 5/13, .6 11/13,
.7 5/14, .5 10/14, .5 4/15, .3 10/15, .3 4/16, .4 10/16, .4 5/17
G 3+4
Stage T1C
2 out of 14 cores positive
Treatment IGRT - 2/2012
My latest blog post

MrB-

There is a difference in language that patients use and that doctors (should) use. I consider myself to be "cured" and "cancer free." My doctor would say that I am long-term "recurrence free" or "no evidence of disease." Doctors state objective facts, but as patients, we infer subjective meaning from those facts. As a fellow patient, I suggest you consider yourself to be cured and cancer free. It's a useful attitude to take because it reduces anxiety and enables you to get on with and enjoy your life fully. As far as you or anyone else knows, it is true at the present moment. It will continue to be true unless the objectives facts change, which they may never do. You gain nothing by worrying about it.

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Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 9 yr onc. results •SBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

MrB,

I had RP a little over a month ago and have the same pathology as you (see my signature). Per the nomograms, the odds of recurrence for us are relatively low. A little higher with EPE but lower than they would be with positive margins or higher grade, so I feel fortunate overall. They had only ever found Gleason 6 in me over three biopsies so it wasn't clear whether I should treat or not, but now with my pathology results, I'm very happy I did.

We should be fine. Good luck with your recovery.

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Age 56
PSA 3.9=>7.4 2012-2016
5/13-1st biopsy 1 of 14 cores G6 at <1%; 7/13-1st mpMRI all clear
4/14-2nd biopsy 1 of 17 cores G6 at 5%; 8/15-2nd mpMRI all clear
4/17-3rd mpMRI one 19mm PIRADS 4 lesion in transition zone
5/17 - fusion biopsy 5 of 21 cores G6 at 20% to 90%; all 5 positive in target TZ lesion, 16 other benign
8/17 - RRP Surgery, margins-, EPE+, SV-, LN- Gleason 3+4=7

As others have already said, it sounds like a good report. I think the docs wait about 90 days before they do a PSA test. That will tell you more and you will be able to discuss further treatment if necessary.

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11/13 psa 240
DX 10/2013 PSA 187.5
PSA HIST 07/11,3.31;3/10,1.87,3/06,.87
Biopsy 10/28/13; 11/12 cores positive gs 9 (4+5)
BNSCN 12/09/2013 2 hot spots in spine
ADT 12/17/2013 22mg lupr, 50 mg Cas
BN biopsy 01/09/2013 neg
RALP 2/19/14 NN,LVI,Path T3BNX,MX, pros size 4.2 X 4 X 3 cm, 31 grm.Post Op PSA 3/14 .6, 6/14<.1;9/8,;.6;12/8, 1.2;3/9/15 3.9;6/2/15 23
12/14 CT SCAN; 1/15 BNSC

listen to your surgeon.

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I'll be in the shop.
Age 57, 52 at DX
PSA:
4.2 10/11, 1.9 6/12, 1.2 12/12, 1.0 5/13, .6 11/13,
.7 5/14, .5 10/14, .5 4/15, .3 10/15, .3 4/16, .4 10/16, .4 5/17
G 3+4
Stage T1C
2 out of 14 cores positive
Treatment IGRT - 2/2012
My latest blog post

Halbert - are you saying trust my local uro? If so, no I don't. I was pissed when I left his office and called my surgeon who I have full confidence in. I only went to him today because he is local and I didn't want to drive the 2 1/2 hours just to have the cath. pulled out. Maybe a bad decision on my part, but once I talk to my surgeon, I'm sure he will have a different story.

RickTrin said...
MrB,

I had RP a little over a month ago and have the same pathology as you (see my signature). Per the nomograms, the odds of recurrence for us are relatively low. A little higher with EPE but lower than they would be with positive margins or higher grade, so I feel fortunate overall. They had only ever found Gleason 6 in me over three biopsies so it wasn't clear whether I should treat or not, but now with my pathology results, I'm very happy I did.

We should be fine. Good luck with your recovery.

RickTrin,
Just curious how you are doing with progress on incontinence and ED. I ask because, I believe my pre surgery diagnosis is very similar to yours. Just had my 3rd 3TMRI yesterday over a 3 1/2 year period. One 14 mm lesion in transition zone. Would expect my URO to advocate biopsy after consultation next month. Up to this point I only have 1 G6 (1% of sample) that currently isn’t even visible on new MRI from a previous biopsy. The 14 mm lesion was HGPIN 3 1/2 years ago. My concern however is that the location of this 14 mm lesion is in an area prone to post op ED & incontinence. Really would like to know how you are progressing with the post op side effects. I would assume that if if I am advised to vacate AS and move the surgery I will be at high risk of ED & Incontinence.

Excuse me for being blunt. Is all your stuff working yet?

Thanks,
PC Legacy

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Age 52. Slow PSA rise 2006-2017. 2.9 to 7.43. Prior Neg 12 core bx in '06. Dx 6/6/14, G6, 1 of 9 cores, Right Apex, 1% volume. 1 addt'l core HGPIN, Anterior Mid. 3TMRI, 5/16 neg. 3TMRI 12/17. 1, 14mm lesion, Anterior Mid Transition Zone (was HGPIN in MRI 3.5 years prior). Prostate 31 cc (same as last MRI). Family history of Terminal PC.

I was also a pT3a... going on 7 years ago! Best of luck!

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Diagnosed in February 2011 at 47
Clinical Report: PSA 3.7 Gleason 7, 3+3 and 3+4, T2C, 8 out 12 cores positive
Davinci Robotic Surgery in August 2011 at University of Ky
Path Report: pT3a, 3+4 and 4+3, no radiation
Negative Lymph Nodes, Margins and Vesicles
Extensive Perineural Invasion
Both nerves spared except 15% on one side, still some ED
Undetectable PSA since at <0.03