J's Path Report

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

survivor_wannabee
Regular Member


Date Joined Apr 2007
Total Posts : 29
   Posted 6/26/2007 2:36 PM (GMT -7)   
Well, I am exactly 4 weeks out from surgery and the good news is that I am feeling great....lots of energy....maybe more than pre-surgery, but my oncologist that also serves as my hematologist says that can't be because of the cancer. The other good news is that my continence is improving. Hurray! As it seems to be the case with others though, it took me a lengthy time to get my path report, even though the surgeon read me the results over the phone. Here are the results:

Gleason: 3 + 4 (same as biopsy)
Tumor proportion: 8%
Tumor size: 2.2 cm
Stage: pT3a extraprostatic extension, no regional lymph node metastasis, distant metastasis cannot be assessed
Margins: uninvolved by invasive carcinoma
Extraprostatic extension: present
Seminal vesicle invations: absent
Perineural invasion: present
Venous (large vessel) invasion: absent
Lymphatic invasion: absent
Additional pathological findings: high-grade prostatic intraepithelial neophasia (PIN)

Now, spell check didn't do so well with some of this terminology, but Google helps to understand some of it. In essence stage pT3a does mean that cancer escaped the capsule of the prostate, which is more than worrisome. The news with the other vessels is good, but then it shows that I have clean margins.
Ordinarily I would be confused. The surgeon however could tell from the biopsy that I had a tumor that was very close to the edge of one side of the prostate. He therefore only did a partial nerve sparing procedure on that side of the prostate and full on the other. I could care less at this point about never sparing as I am worried about the cancer first, continence second, which is still not 100% and potency last.

I would appreciate any comments that might be made about this diagnosis. My surgeon says that this says he got the cancer and I don't need to do anything until my next consult in 3 months. My oncologist thinks that maybe I need radiation and hormone therapy. I bounced this back at my local urologist and he says that oncologists don't know anything about prostate cancer and I need to follow the surgeon's direction. In the meantime, I will ship the report to my local urologist, who is a super surgeon, just doesn't have a lot of DaVinci experience.

I'm trying not to be worried....do I need to be?
Age: 57
Diagnosed: 3/27/2007
PSA: 4.9
Gleason: 3 + 4
Cancer in 6 out of 12 samples
DRE: Positive
Stage: T2B
RALP Performed: 5/29/07
Partial nerve sparing one side, full on other
Prostate not enlarged, margins visually look good
Hospital stay: about 24 hours
Catheter Out: 6/8/07


veteran1
Regular Member


Date Joined May 2007
Total Posts : 133
   Posted 6/26/2007 3:26 PM (GMT -7)   
Survivor,

Your Gleason 3 + 4 looks pretty good. Some confusion regarding your path report though

Stage T3a, which you mention in the beginning of your post = Tumor extends
beyond the prostate capsule, eithther one side or both. Stage 2b is tumor involves both lobes but is contained.

If doctor wants adjuvant radiation and hormone therapy, sounds more like a positive margin.

I'm most likely confusing you even more.
Best to call doc for true path stage.

All Good Thoughts
Vet

Post Edited (veteran1) : 6/26/2007 6:03:52 PM (GMT-6)


bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 6/26/2007 3:28 PM (GMT -7)   

Hi ~ J,

Just saw your posting as I was logging off.  We have a date... but quickly wanted to send this information... I think it will help ease your mind in the area when you read "present" in your report...Let me know if this helps…. And if not I’ll be happy to delete this post…. 

In Friendship ~ Lee & Buddy 

**Excerpts taken from “Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer”

by: Patrick C. Walsh, M.D. and Janet Farrar Worthington.   Copyright 2001

 

This book gave us so much knowledge… and Knowledge is Power. 

 

Page 145

**What about Perineural Invasion?

As cancers grow, they compress normal tissue, looking for “elbow room”—spaces with less resistance, where they can spread.  Nerves are usually surrounded by some empty space; for cancer, this is the real estate equivalent of a nice suburban lot with a big backyard—plenty of elbow room.  Thus, it’s not uncommon to find prostate cancer in the spaces around the nerves; this is called ‘perineural invasion.”  Because the nerves are most common close to the surface of the prostate, the findings of perineural invasion on a biopsy suggests that the cancer is close to the edge of the prostate, and may well have penetrated the capsule.  However—this is important to keep in mind—cancer that has penetrated the capsule can still be cured.  Which makes this a paradoxical finding—because, although men with perineural invaion are more likely to have capsular penetration than men without it, perineural invasion has no long-term impact on whether or not a man can be cured.  For this reason, some noted pathologists have suggested that it should not even be commented on when found in a biopsy, because it’s not worth worrying about.
 
edited....  sad the last 16 words did not come through....on original posting!!!
 

Post Edited (bluebird) : 6/26/2007 8:51:38 PM (GMT-6)


survivor_wannabee
Regular Member


Date Joined Apr 2007
Total Posts : 29
   Posted 6/26/2007 6:21 PM (GMT -7)   
Hello bluebird and veteran1, I appreciate your responses, but want to keep this item going, looking for someone that has been through a similar diagnosis and hopefully recommended treatment (or lack thereof) as I am still a bit distressed.

First of all veteran1, Google tells me that this is the definition of my original stage per biopsy: T2b -- Tumor affects more than one-half of one lobe but not both lobes. That is in keeping with what they found in the final path report. What makes it a elevated it to my final path stage is that I had capsule penetration on that half of the lobe: T3a -- Tumor extends beyond the prostate capsule. The issue I have is that my urologist says that the clean margins is the key even though I had capsule penetration because he cut into the nerve and the cancer did not extend beyond that tissue. Its my oncologist that thinks I need radiation and hormone therapy. I will get the two together on this.

Bluebird, I read Walsh's book and remember this excerpt vividly because my biopsy showed perineural invasion. I consulted with about three or four different urologists and some said it was significant and some didn't. One of the prominent ones in Philly that I couldn't get scheduled in time told me that he wished that this never showed up in the biopsy report as it was worse than meaningless as it caused needless anxiety in patients that were already uptight just understanding they had cancer. The fact that the path report confirmed capsular penetration though causes me more concern. I agree that it is curable even then, but the question is whether radiation and hormone therapy are required. My urologist that performed the surgery says no, unless PSA rises. The oncologist thinks that I need that therapy right away.

Has anyone else been down this path with a similar path report?
Age: 57
Diagnosed: 3/27/2007
PSA: 4.9
Gleason: 3 + 4
Cancer in 6 out of 12 samples
DRE: Positive
Stage: T2B
RALP Performed: 5/29/07
Partial nerve sparing one side, full on other
Prostate not enlarged, margins visually look good
Hospital stay: about 24 hours
Catheter Out: 6/8/07


survivor_wannabee
Regular Member


Date Joined Apr 2007
Total Posts : 29
   Posted 6/26/2007 6:39 PM (GMT -7)   
Sorry to answer my own question, but here is an article dated March of this year that references a study by Walsh on T3a patients: http://www.urotoday.com/61/browse_categories/prostate_cancer/radical_prostatectomy_for_clinical_stage_t3a_disease.html. His conclusion is that radical prostatectomy with wide neurovascular bundle resection may result in excellent long-term cancer control in well-selected patients.

Here is an excerpt from another study on T3A diagnosis: Clinically advanced prostate cancer is still frequently overstaged. In a well-selected patient group with locally advanced prostate cancer, RP—with adjuvant or salvage treatment when needed—can yield very high long-term cancer control and survival rates. Margin status and cancer volume are significant predictors of outcome after RP.

Well that's all very nice, but I still feel exposed.
Age: 57
Diagnosed: 3/27/2007
PSA: 4.9
Gleason: 3 + 4
Cancer in 6 out of 12 samples
DRE: Positive
Stage: T2B
RALP Performed: 5/29/07
Partial nerve sparing one side, full on other
Prostate not enlarged, margins visually look good
Hospital stay: about 24 hours
Catheter Out: 6/8/07
Path Report Says
Gleason: 3 + 4
Tumor Proportion: 8%
Tumor Size: 2.2 cm
Stage: T3A
Seminal Vestigals & Lymph Nodes: Clean
Margins: Clean despite extraprostatic extension

Post Edited (survivor_wannabee) : 6/26/2007 7:49:54 PM (GMT-6)


bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 6/26/2007 8:02 PM (GMT -7)   

J ~

The last 16 words did not appear on my original posting.... Haste makes waste posting so fast...but I wanted to touch base with what I thought would give you what we thought would be a "positive" to pull from.  There are other things in your message that we feel are positive….  The tuggle war between doctors can cause us “extreme” distress….   Know that we care and there are so many members who will be here to support you!
We will definitely keep this thread to the top!!!
You are extra close to us in thoughts and prayers… Lee & Buddy


biker90
Veteran Member


Date Joined Nov 2006
Total Posts : 1463
   Posted 6/26/2007 8:11 PM (GMT -7)   
Hi Survivor,

Sorry about the worrisome path report. Please stay with us because, as you know, there are others of us who have pathologies like yours. Good luck...

Jim
Age 72. Diagnosed 11/03/06. PSA 7.05. Stage T2B Gleason 3+3.
RRP 12/7/06. Nerves and nodes okay.
Pathological stage: T2B. Gleason 3+4. Cancer confined to prostate.
PSA on 1/3/07 - 0.04. 
PSA on 4/4/07 - 0.00  T level - 48  Restarted T therapy.
Next PSA on 7/18/07.
 
 "I have cancer but cancer does not have me."


survivor_wannabee
Regular Member


Date Joined Apr 2007
Total Posts : 29
   Posted 6/27/2007 5:21 AM (GMT -7)   
Thanks you two. I had hoped that the journey would be coming to an end as I rehabilitate, but the beat goes on. I will update as to the final consensus.
Age: 57
Diagnosed: 3/27/2007
PSA: 4.9
Gleason: 3 + 4
Cancer in 6 out of 12 samples
DRE: Positive
Stage: T2B
RALP Performed: 5/29/07
Partial nerve sparing one side, full on other
Prostate not enlarged, margins visually look good
Hospital stay: about 24 hours
Catheter Out: 6/8/07
Path Report Says
Gleason: 3 + 4
Tumor Proportion: 8%
Tumor Size: 2.2 cm
Stage: T3A
Seminal Vestigals & Lymph Nodes: Clean
Margins: Clean despite extraprostatic extension


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8122
   Posted 6/27/2007 9:34 AM (GMT -7)   
J,
Your local urologist is giving you bad advice if he flattly states that oncologists don't know anything about prostate cancer. I would certainly consider another urologist on that one. None the less, sorry you are here. I am a pT3b, Gleason 4+3=7, pre-op PSA of 19.8 and feel I definately need the services of both my clinical and radiation oncologists. I do hope the best for you and good luck in the coming months with your decisions.

Tony

hawkfan75
Regular Member


Date Joined Jan 2007
Total Posts : 165
   Posted 6/27/2007 10:07 AM (GMT -7)   

Dear survivor

We are very similar in level of diagnosis post surgery.  As you can see by my signature, my 2 month post surgical PSA was .01, but then at 5 months I'm .08.  With those ultra-sensitive tests, the .08 is significant, but not showing biochemical reoccurance, which many experts say is .2.  However, since I had positive margins, my surgeon and oncologist wanted me to think about further treatment back at my two month mark.  There are a couple of studies showing that additional RT can decrease the possibility of reoccurance.  While I have been contemplating it since March, my .08 solidified my mind.  Like you, I'm 57, and surviving a long time is my first priority.  Therefore, I'm starting adjuvant RT in late August.  With that, there is additional controversy on whether to have hormone therapy along with it.  My situation is right inbetween yea or nea.   Both my surgeon and oncologist recommended it, and work by a Dr. Robert Lee also agree.  Therefore, I had my first Zoladex injection yesterday.  Since my first diagnosis, I have approached this disease aggressively.  I realize that there will be some side effects from further treatments, but I'll work through that with the final goal of staying cancer free for as long as possible.

My recommendation for you, is to wait until you get your post surgical PSA's before making any decision.  Do a lot of reading - Google searches work well - and hope for all zeros.


PSA 4.7 (up from 3.2 one year ago)
Biopsy November 8, 2006
1 of 10 cores positive 5% LEFT Side
2 others questionable (small gland proliferation)
Gleason 3+3
Robotic surgery January 19, 2007
Post Surgery Pathology
     Stage T3a, Gleason 3+4, positive margins and
     capsular penetration RIGHT Side
Post Surgery PSA:  March 5:  0.01
5 month PSA, June 13, 2007:  0.08
 


survivor_wannabee
Regular Member


Date Joined Apr 2007
Total Posts : 29
   Posted 7/4/2007 5:06 AM (GMT -7)   
Tony, those are good words of advice. To be on the safe side though, I have appointments with my local urologist, who is actually fairly friendly with my hemotolgist/oncologist they being right down the road from each other. I then have a meeting with my oncologist a week later. My surgeon wants to see me in September and I guess that's to how the PSA is progressing. As from the beginning I will research and consult with multiple doctors before making a decision.

It is very heartening however to hear from you hawkfan as I was looking for someone who had a similar diagnosis, albeit that we are all different individually I can imagine your decision to continue with further treatment was a hard one. My expectations had been that I would be done barring some spike in PSA. To get staged higher than expected was a tough pill to swallow. I will be following your progress and definitely wish you the best.

What I find confusing though is my path report. I am definitely staged T3a with "extraprostatic extension", which I assume means the same as capsular penetration, but under margins the description is "margins uninvolved by invasive carcinoma". I asked my surgeon at the time that he gave me the results whether this meant that I had clean margins and if he thought he got all of the cancer and he replied yes. I imagine that it really doesn't matter and one needs to watch the PSA levels as you have and then if they go up, go for further treatment. I will discuss this with all my doctors and try to make a decision.

Does this path report make any sense to anyone. I figure if you break through the capsule you should have positive margins, unless the partial nerve sparing is taken into account. Its not fun being in this uncertain state.
Age: 57
Diagnosed: 3/27/2007
PSA: 4.9
Gleason: 3 + 4
Cancer in 6 out of 12 samples
DRE: Positive
Stage: T2B
RALP Performed: 5/29/07
Partial nerve sparing one side, full on other
Prostate not enlarged, margins visually look good
Hospital stay: about 24 hours
Catheter Out: 6/8/07
Path Report Says
Gleason: 3 + 4
Tumor Proportion: 8%
Tumor Size: 2.2 cm
Stage: T3A
Seminal Vestigals & Lymph Nodes: Clean
Margins: Clean despite extraprostatic extension

New Topic Post Reply Printable Version
Forum Information
Currently it is Monday, December 11, 2017 9:51 PM (GMT -7)
There are a total of 2,904,277 posts in 318,737 threads.
View Active Threads


Who's Online
This forum has 158127 registered members. Please welcome our newest member, Ruthann.
305 Guest(s), 6 Registered Member(s) are currently online.  Details
Froggy88, MDNative, island time, OptimisTick, LivingThroughLyme, Tall Allen