Posted 6/28/2021 4:42 PM (GMT -6)
I'll do my best to give you my take; however, I don't think you posted your complete path report. First, the path staging is missing. Secondly, specimen D says "PROSTATE AND SEMINAL VESICLES: Prostatic adenocarcinoma. See synoptic report." but I see no other mention of the status of the seminal vesicles! From this little is says, it's not 100% clear to me whether the PCa involved the seminal vesicles as well as the prostate (and if, so, was it one SVor both?). I would ask about this unless you find more of your report.
Generally speaking, "...not identified," "...uninvolved," and "negative for..." all mean not seen/not present/no malignant invasion.
So some good news is that the amount of Grade 4 in your G9 (4+5) tumor was small (only 10%) and the cancer itself involved just 10% of your prostate. In addition, all 18 removed nodes were negative for metastases. So lymph node invasion negative (LNI-)
On the other hand, you may be positive for seminal vesicle invasion (SVI+) (? to be confirmed). You will know if your were SVI+ if you can find you path staging and it says pT3b.
There was growth of the cancer through the prostate capsule into some adjacent soft tissue (extraprostatic extension), so EPE+. On the bright side, it was limited to one relatively small spot ("focal", rather than "multifocal" or, worse, "non focal", which would be more extensive.) If there was no SVI+ your path staging would likely be pT3a because of the EPE+.
Lymphovascular invasion was negative (not present), so LVI-
Perineural invasion was present (PNI+), but some estimates put it as being present somewhere in the prostate in >80% of post-RP exams. So many researchers think it's not a big deal when see at RP (because we know that 80% of men don't have recurrence; others give it more weight as negative predictor for recurrence.
Surgical margins were not involved, so SM-, which is good.
Have you met with your uro yet? I imagine the recommendation will be for adjuvant therapy to complete your primary treatment (about 3/4 of G9-10 men have adverse findings post-op and benefit from further therapy after surgery). This would be the case with just your finding of EPE+. If you were SVI+ in addition, all the more reason.
Your full report may also mention if there was any spread of the PCa to the bladder neck.
A post-RP path report usually overshadows biopsy findings. In fact, as you see your Gleason score was unfortonately, upgraded, as it is for many men. I, too, was G9 (4+5), and it needs to be taken seriously.
Have you had your first post-op PSA test yet?
You can ask your docs about the value of a Decipher test on your RP tissue to learn your risk (low, average, high) of having metastases within 5-years (although again, your results of 18 negative nodes does bode well in this regard). If you are on the fence about further treatment after a healing period, the result may be useful.
Try to find your path staging in your report, for example, yours might be pT3b, N0, R0, MX. (Sometimes R0 is used, meaning Resected (surgical) margins uninvolved by the cancer. The N0 stand for no lymph node metastases, and the MX simple means that distant metastases (i.e. outside the pelvis) were not evaluated.
Keep us posted, and all the best!