Posted 8/23/2021 1:05 PM (GMT -7)
Hi Debralyn and welcome! The major dverse features as I understand them are the following, which indicate in all but one case that the prostate cancer (PCa) is no longer confined to the prostate:
Extraprostatic (or extracapular) extension (EPE): the cancer has grown into or through the prostate's thin capsule--for example into the fat just outside the prostate. This can be microscopic growth or growth that can be plainly seen,
Positive Surgical Margin(s) (SM or PSM): The surgeon has to make several cuts to free the prostate. If the tumor extends into a structure that can't be (or isn't) cut out with the prostate, there will be cancer cells at that margin(s). The pathologist can identify these margins because the surgeon inks the surfaces of the prostate, usually in different colors. (A small percentage of positive margins are caused by errors by the surgeon. That's why you want a very experienced surgeon if RP is the treatment choice.) Bladder Neck Invasion is a related adverse finding: the cancer extends into the neck of the bladder, where the urethra connects.
Seminal Vesicle Invasion (SVI): The cancer extends into one or both seminal vesicles. It can range anywhere from a tiny amount of partial invasion to complete invasion. It's usually contiguous -- it rarely "skips" along the way. The seminal vesicles are removed along with the prostate, but this is still an adverse finding.
Lymphovascular Invasion (LVI): This the one finding that is observed entirely within the prostate itself. The pathologist has verified that cancer has grown into the fine blood or lymph vessels as seen microscopically. It's believed that one way PCa cells leave the prostate, possibly leading to metastatic PCa, is via the lymphatic/circulatory system.
Positive Lymph Nodes: The pathologist identifies malignant tissue in one or more of the sampled (removed) lymph nodes. This is the one adverse finding that is metastatic in nature, although the spread could be a small as one node that happed to be sampled.
These adverse findings increase the risk of recurrence and, if found after a RP, may indicate the advisability of additional therapy (radiation and/or ADT) soon after surgery (adjuvant therapy) or some time in the future if there is a significant PSA rise (salvage therapy). If the treatment is surgery, the post-op pathology report should list the above and state, for each, either something like "not identified" or, if present, describe the extent (e.g. number of positive nodes); type of EPE -- focal (one point), multifocal, non-focal (= more extensive); thickness or length of a positive margin in millimeters, etc.
So Jeff's 35.8% is a number generated by an algorithm and IMO shouldn't be read as 35.8% as opposed to, say, 35.9% or 34.2%, but rather it looks like the chances of his having one or more of these findings are a little above one-third.(Before genomic tests, the Gleason score was the only "measure" of the risk of metastases. We now know that low, average, and high risk of metastases cuts across all Gleason scores.
Generally speaking (a) the greater the number of adverse features and (b) the higher the genomic risk of one's cancer to metastasizing, the greater the chances of recurrence after primary treatment.
For those choosing radiation as their primary treatment, imaging estimates the likelihood of some of these adverse features being present (e.g. enlarged lymph nodes, EPE, etc.) and a few are sometimes already indicated in the biopsy report. Knowledge about adverse findings is a bit less critical for RT men, since the irradiated area is larger than the prostate, whereas for RP men, these findings can mean some benign or malignant prostate tissue was left behind.
I'm not a doctor, so please verify anything that interests or concerns you with your docs or your own reading/researching/questioning.