Rod's Pathology Report Was Just Called In to Us

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mariateresa
Regular Member


Date Joined Jun 2007
Total Posts : 95
   Posted 10/2/2007 1:27 PM (GMT -7)   
This is what we were told:

Gleason 4 + 5

Positive margin right base of the prostate (What does this mean?)

Tumor into seminal vesicles (What does this mean?)

Negative lymph nodes (This is good news, right?)

I forgot to ask about capsule invasion. What is capsule invasion and is that another important factor to consider or is what we were told good enough? I asked that a copy of the path report be mailed to us.

The doctor said the next important thing will be the PSA which will determine the next step. He said there is a 30 - 40% chance that Rod would need additional treatment.

Overall is this good news or bad news? I have a tendency to think the worse and because of it my husband is VERY angry with me today.

Maria Teresa
Husband Age 55 Maria Teresa age 44
Total PSA 8 on 05/21/07
DRE: prostate bumpy
Biopsy on 07/16/07: 5 out of 8 cores positive, Gleason Score 8 (3+4+5)**
CT of the abd/pelvis; Bone Scan; Xrays done on 08/13/07: Normal
Robotic Surgery Scheduled for September 11, 2007 - Cancelled due to anesthesia complications
Robotic Surgery September 25, 2007

**"Report to the Nation on Prostate Cancer" published by the Prostate Cancer Foundation, page 11: "In some cases, the pathologist might identify a third pattern, which is less common but that has a higher grade than either of the first two patterns that comprised the Gleason score. The presence of this third pattern might indicate that the tumor is more aggressive than the Gleason score would otherwise imply. For example, if a Gleason 4+3 tumor also has some grade 5 cells, the cancer would be considered as being of higher grade disease overall."

Post Edited (mariateresa) : 10/2/2007 2:39:51 PM (GMT-6)


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8122
   Posted 10/2/2007 5:58 PM (GMT -7)   
Hi MT,
It sounds like your husband is staged at pT3b with aggressive disease. While these are serious developments, don't panic. There are many out there with good results and similar numbers. There was enough information the clinical pathology to accept that the surgical pathology would yield invasion outside the prostate. You need the medical records and a medical oncologist. A positive margin is proof that the capsule is breached, as is a bumpy DRE. So are the seminals involvement indication that the diseae is systemic. I had 4 positive margins and seminals involved. It means darn it that this disease has at least metastisized locally. But the Lymph nodes usually will show presence to be clasified as Stage IV. Like me, Rod is Stage III. And like me, he will be presented some options that will be tough to decide on what to do. He will likely be directed to consider hormone treatment. There are clinical studies and trials available but none appealed enough to me as they take away your control. Radiation will be an option but it is off protocol. That did not stop me. I've done them all. Your doctor is correct, monitor that post op PSA regularly. You are hoping for undetectable. And that is possible. Get there for us, and after you have chosen your oncologist, if you have any questions you know how to reach me and others here.

Tony
Age 45 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007
Post-Op Pathology was poor: Gleason 4+3=7, 4 positive margins, Stage pT3b (Stage III)
HT began in May, '07 with Lupron and Casodex 50mg
IMRT radiation for 38 Treatments ending August 3, '07
 
My PSA did drop out after surgery to undetectable.  It has not returned and I will continue HT until January '08.
 
My Life is supported very well by family and friends like you all.
 
STAY POSITIVE!


mariateresa
Regular Member


Date Joined Jun 2007
Total Posts : 95
   Posted 10/2/2007 7:27 PM (GMT -7)   
Hi Tony,

I guess I wasn't expecting this outcome. When the surgeon came out and spoke to me, he made it sound so positive and he said that he didn't think Rod would need any further treatment, but now it looks like all that has changed.

Does the pathology report mean that the cancer has metastasized into the body even though the lymph nodes were negative? Does the cancer spread through the body via other vessels such as the seminal vesicles and not just lymph nodes? Were your lymph nodes negative? The impression I got from the doctor who called today was that there is a 60 -70 % chance that Rod won't need any type of additional treatment, but based on what you said he will. No one has told us to get an oncologist or anything. The doctor made it sound that if the PSA is less than 0.2 that no further treatment would be needed.

I guess I'm going to need you to give me some positive thinking lessons because right now I really stink at it!

MT
Husband Age 55 Maria Teresa age 44
Total PSA 8 on 05/21/07
DRE: prostate bumpy
Biopsy on 07/16/07: 5 out of 8 cores positive, Gleason Score 8 (3+4+5)**
CT of the abd/pelvis; Bone Scan; Xrays done on 08/13/07: Normal
Robotic Surgery Scheduled for September 11, 2007 - Cancelled due to anesthesia complications
Robotic Surgery September 25, 2007
Post Op Gleason 4+5; Positive margin right base of prostate; tumor into seminal vesicle; lymph nodes negative
Next step is the post surgical PSA to determine need for additional treatment

**"Report to the Nation on Prostate Cancer" published by the Prostate Cancer Foundation, page 11: "In some cases, the pathologist might identify a third pattern, which is less common but that has a higher grade than either of the first two patterns that comprised the Gleason score. The presence of this third pattern might indicate that the tumor is more aggressive than the Gleason score would otherwise imply. For example, if a Gleason 4+3 tumor also has some grade 5 cells, the cancer would be considered as being of higher grade disease overall."

Post Edited (mariateresa) : 10/2/2007 8:51:49 PM (GMT-6)


puget
Regular Member


Date Joined Mar 2007
Total Posts : 237
   Posted 10/2/2007 8:17 PM (GMT -7)   
Hi, MT. I don't know enough about the pathology report to really comment. Sounds like there is some out-of-prostate involvement that will require treatment. But my reason for posting is that I wanted to comment on your husband's response to all of this -- and to you. I remember when I first learned I had PCa. I totally refused to accept it, wouldn't talk about it, got irritable if my wife and family wanted to talk about it, practically hung up on a friend who called to express her concern and best wishes, and avoided any mention of the fact that I had CANCER! "Just leave me alone -- I'm going to be fine, d*mn it!" Looking back, I know I was being naive, but it was my way of protecting myself from the hurt of knowing that I wasn't immortal, that I had come down with a serious disease and that I wasn't totally in control and needed help. Excuse me for butting in, but right now your husband needs you to be positive: "We are going to beat this thing! Sure, it's not the report we wanted, but we will get the treatment you need! I'm with you all the way!" This may not be how you feel, but to be blunt, you need to shed your tears in private and put on the brave face for hubby. He's had enough bad news. He needs a positive, upbeat partner for whatever he has to face over the next several months. And, remember, it's not a lost cause!!! Look back at the posts of guys whose post-surgery results were much worse. They're still with us and enjoying life! A wonderful anecdote: I just had dinner with Lee (Bluebird) and Buddy a couple of weeks ago. They tell a wonderful story about when Buddy first learned he had PCa. He said it made him feel like he'd been hit with a bus. Lee found a small pin she had -- a tiny pin -- of a bus. She handed it to Buddy and told him, "This is the bus. We can beat this thing!" What a great attitude! I know you're scared and feel out of control. For your husband's sake -- and your sanity -- you need to calm down and try, try to control your fear and the negative and angry feelings you're experiencing. From what you've told us, your husband is reacting just like I did. "Don't tell me about the bad news -- Tell me everything's going to be better!" Naive? Maybe. But that's his call -- give him support, not more darkness. Together you two CAN beat this thing! I apologize if I've gone over the line here. It's just that I know exactly how he's feeling . . . My thoughts, prayers and very best wishes are with you!

puget
Puget
60 years old
Dx March 2007
Pre-Surgery Gleason 3+3 = 6
Clinical Stage: T1c
Biopsy: 1 in 10 positive
Da Vinci: June 7, 2007 
Post-Surgery Gleason 3+3 = 6
   Clear at margins
First Post-PSA Sept 07 = <.01 (Hooray!!)


mariateresa
Regular Member


Date Joined Jun 2007
Total Posts : 95
   Posted 10/2/2007 8:26 PM (GMT -7)   
No, puget, you did not go over the line. This is how i know I can trust people, when they are straightforward with me.

Maria Teresa
Husband Age 55 Maria Teresa age 44
Total PSA 8 on 05/21/07
DRE: prostate bumpy
Biopsy on 07/16/07: 5 out of 8 cores positive, Gleason Score 8 (3+4+5)**
CT of the abd/pelvis; Bone Scan; Xrays done on 08/13/07: Normal
Robotic Surgery Scheduled for September 11, 2007 - Cancelled due to anesthesia complications
Robotic Surgery September 25, 2007
Post Op Gleason 4+5; Positive margin right base of prostate; tumor into seminal vesicle; lymph nodes negative
Next step is the post surgical PSA to determine need for additional treatment

**"Report to the Nation on Prostate Cancer" published by the Prostate Cancer Foundation, page 11: "In some cases, the pathologist might identify a third pattern, which is less common but that has a higher grade than either of the first two patterns that comprised the Gleason score. The presence of this third pattern might indicate that the tumor is more aggressive than the Gleason score would otherwise imply. For example, if a Gleason 4+3 tumor also has some grade 5 cells, the cancer would be considered as being of higher grade disease overall."


puget
Regular Member


Date Joined Mar 2007
Total Posts : 237
   Posted 10/2/2007 8:31 PM (GMT -7)   
Hang in there, girl! It's tough, but you can make a difference! My thoughts are with you both!
Puget
60 years old
Dx March 2007
Pre-Surgery Gleason 3+3 = 6
Clinical Stage: T1c
Biopsy: 1 in 10 positive
Da Vinci: June 7, 2007 
Post-Surgery Gleason 3+3 = 6
   Clear at margins
First Post-PSA Sept 07 = <.01 (Hooray!!)


maldugs
Veteran Member


Date Joined Jun 2007
Total Posts : 782
   Posted 10/2/2007 9:37 PM (GMT -7)   

Hi MT, hang in there, you will make it, I did not get angry when I found out I had Pca, annoyed, sad, frustrated yeah, makes you think of your mortality, my wife has been a rock, even though I know she worries, I too have stage T3a, and have a few more challenges to face, however I have the utmost confidence in my urologist, who wasted no time in making an appointment for the Radiation Onocologist and reasurred me I will be ok, I think he want's me to have the radiation even if my next PSA in 4 weeks time goes down, that makes sense.

My best wishes and prayers to you both.

Regards Mal.


age 66 PSA 5.8 DRE slightly firm Rt
Biopsy 2nd July 07 5 out of 12 positive
Gleason 3+4=7  right side tumour adenocarcinoma stage T2a
RP on 30th July,
Post op Pathology, tumour stage T3a 4+3=7, microcsopic evidence of capsular penetration, seminal vessels, bladder neck, free of tumour, lymph nodes clear, no evidence of metastatic malignancy, tumour does not extend to the apical margins.
Post op PSA 0.5 26th Sept. next PSA 26th Oct. seeing Radiation Onocologist 31st Oct


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 10/2/2007 9:41 PM (GMT -7)   
Dear Maria Teresa,
 
You and Rod have been through so much in such a short period of time.  Few of us can say we know exactly how you feel, but we can all say that we continue to support you and Rod fully!  
 
MT, I am not an expert in this area, but I can offer an opinion or just my 2 cents worth.  The way I look at this is that Rod took his first big step towards healing, and in that step discovered information about his cancer that he would not have had if he didn't opt for the surgery.  Considering this, I believe the surgery was a success because of the information you acquired.  In addition, it sounds like the surgeon removed other cancerous tissues.  Now, with your health care professionals, you are able build an educated plan moving forward by using the post-surgery pathology and future PSA readings.  These combined will help Rod toward further healing.
 
There is nothing wrong with you feeling disappointed.  Don't beat yourself up for it.  The key, like puget implied, is to find a way back up so you can get back on offense.   You have not lost a battle and you have not lost the war.  You're just digging in and building a strategy for the fight!
 
All the best,

"Idaho" ~ Barry

 

Da Vinci Surgery July 31, 2007… 54 on surgery day
PSA 4.3  Gleason 3+3=6  T2a  Confined to Prostate

1st PSA 0.04 (undetectable) 9/11/2007


GreenAcres
Regular Member


Date Joined Jul 2006
Total Posts : 474
   Posted 10/3/2007 6:10 AM (GMT -7)   
MariaTeresa - you are going to have to buck up. There, I said it. This is Rod's body and you need to focus all your energy in a positive way. We're here to provide that support so you can funnel it back into your husband.

With that said, we were in the same boat as you last year. The path report hit us like a huge boulder. We were expecting the best based on a biopsy and it just wasn't so. However, our PSAs remain undetectable and that has led us to not seek further treatment upon the advice of our doctor. And that's what your doctor is saying at this point - "wait for the first PSA results."

For our part, if at any point, those numbers begin to rise, we'll jump in and go to the next level. Our doctor says if we remain at less .01 for two years post-op, we're back to even with everyone else statistics-wise.

That is what we focus on. As I told you before - sit down, read every word of what everyone has to say here. Then, go back and read through each message again. Then, you go hug Rod, smile, and tell him that with you there to support him in every way, it will get better. You can do it.
Husband age 66
PSA on 5/1/06: 4.2 (had doubled in 13 mos. and rising monthly)
DaVinci Surgery 8/2/06 - Austin, TX w/Dr. Randy F.A.G.I.N.
T2a (at biopsy)
At pathology - cancer cell leakage into fatty tissue
Post-Surgical PSA on 10/06, 4/07 - undetectable!
Update: 11/1/06 - perhaps bladder neck involvement; 30%-50% chance of recurrence
Future: PSA tests twice-yearly for now - Next one: 10/16/07
 


sterd82
Regular Member


Date Joined Sep 2006
Total Posts : 187
   Posted 10/3/2007 6:40 AM (GMT -7)   

MT--

Another Stage III weighing in...

Here what I was told -- Its all about the PSA from here on out.  You want it to be undectable, which my DR defined as under .04 --- it can take a while to get there --- hopefully by the 3 month mark... We starting doing PSA tests at a month out.  If the PSA rises about .2, you'll want to look at additional treatment --- IF they think the cancer is still LOCALIZED in the pelvic region, radiation is usually recommended.  If the suspicion is the disease is systemic, hormone thereapy is the norm.   A lot of docs will do both even if localized cancer is suspected (that's what I did). 

At any rate, Rod needs to heal up before they'll want to do any kind of radiation.  Hang in there, for me, the post-surgery/pre-PSA rise part of my recovery was the most difficult mentally.  Plus, you do have a shot at no PSA rise EVER!


Sterd82
Age 47
Open Radical Prostatectomy 6/9/2006
Pathological Stage T3a, Positive Surgical Margin
Gleason 3+4
PSA rose to .24 in November of 2006
6 month hormone therapy initiated December 1. 2006
36 sessions of IMRT Ended Feb 1, 2007
PSA as of May 25, 2007 undetectable
Next PSA November, 2007


Tamu
Veteran Member


Date Joined Oct 2006
Total Posts : 626
   Posted 10/3/2007 7:31 AM (GMT -7)   
MT,

I guess my perspective on the path report is it could have been better and could have been worse. Your urologist appears to be on top of everything and the bone scans and xrays were clear. No involvement of the lypmh nodes is a positive. As your doctor pointed out there is a good chance the cancer was removed. There are additional treatments if it was not. Now is the time to focus on healing and the present. I am sure your doctor will place Rod on frequent PSA checks probably every three months. There is nothing you can really do now other then trust your doctor and live life to the fullest.

Tamu
Diagnosed 7/6/06, 1 of 10 core samples, 40%,Stage T1c, Gleason 3+3
Da Vinci on 11/01/06, Catheter out on 11/13/06
56 Years Old
Post Op Path, Gleason 3+3, Approx. 5% of prostate involved
Prostate Confined, margins clear
Undetectable PSA on 12/18/06
No more pads as of 1/13/07
Began injections in April '07
Undetectable PSA on 6/25/07


gtmriviera
Regular Member


Date Joined May 2007
Total Posts : 338
   Posted 10/3/2007 12:39 PM (GMT -7)   
Your husband's situation sounds similar to my uncle.  I think that he was diagnosed about 12 years ago and he is now 76 and doing well.  I will get more details from him as soon as I can.  I'm seeing Robbie or Asimov or whatever his name is tomorrow.

myman
Veteran Member


Date Joined Feb 2007
Total Posts : 1219
   Posted 10/3/2007 1:30 PM (GMT -7)   
Maria Theresa,

Don's doc has staged him at D2 or Stage IV. So what. Really, numbers can catagorize you but only you can buy into that. Numbers/letters/stages they're generalization of where a doctor thinks you are so they can treat you accordingly. That's good. But to LIVE by numbers/letters/stages...NO, NO, NO. NO.

Rod must do all he can to be treated - make it tough for pc in every way - but you do yourself & Rod no good to expect the worst. It's a sad, lonely place to be.

So, that being said, all I can offer is all of us here! And you know that's priceless, yes?

Susan

bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 10/3/2007 5:48 PM (GMT -7)   
tongue  Helping to keep the responses to this thread together....  quote taken from a new thread
What Rod said about your comments re the pathology report  started by mariateresa in response to the thread you are on right now.
 
quote:
 
Rod and I just read your replies together. I can see he feels much better now that he got your feedback. I wanted him to hear from those experienced so his attitude can focus on all of you and not my attitude. It was very helpful and inspired hope in him. Thank you for doing this for us and especially him!

SUSAN - Rod especially liked your comments! yeah

So THANK YOU for helping Rod and for putting up with me!!!

And I am working on my attitude!!! Thank you for helping me to snap out of it!

Love you's,

MT
 

jwb187
Regular Member


Date Joined Apr 2007
Total Posts : 101
   Posted 10/4/2007 4:44 AM (GMT -7)   
Hi M. T.

Sounds like Rod's PC is very similar to mine as I also had a positive margin, capsular invasion and seminal vesicle involvement. My post surgery path was upgraded from Gleason 8 to Gleason 9. To try to answer your questions (positive margin) means that cancers cells were detected at the edge of the submitted specimen. (seminal vesicle invasion) means that the tumor has penetrated the outer part of the prostate and invaded the seminal vesicle which is adjacent to the prostate. (Negative lymph nodes) means that no spread of the cancer was located in the nodes which were removed so the pathologist could examine them (this is very good!!! news). The normal course of treatment for Rod's stage would normally be IMRT treatments (radiation) and probably a couple of year's treatment with Hormone Therapy (Lupron shots or some similar drug) I am now in the middle of my radiation treatments and also taking three month Lupron shots which I will take for two years. I just had my third psa test which resulted in a reading of .08. This is good concerning the aggressive grade of pca which I was diagnosed with (stage pT3B) stage three. Tell Rod to hang in there and keep his chin up that there are many of us on the forum with the same stage of disease. Things will get better for him as he progresses into the next stages of treatment. My mind set is to be positive and to pray a lot and put myself in God's hands.

Good luck,

JWB
age: 61
PSA 4.57 - Positive DRE
Biopsy 3-19-07 - Gleason 4+4=8
Negative bone scan 3-20-07
DaVinci 4-24-07
Catheter out 5-01-07
post op pathology:
positive margin left side of prostate
left seminal vesicle involved (both removed)
No lymph node involvement
New gleason score 9
T3B....radiation consult on 5-9-07.
June 5, 2007 1st psa post surgery 0.62
June 27, 2007 second psa post surgery 0.59
June 27, 2007 started Lupron injection (24 mos)
September 6, 2007 scheduled to be marked and prepped for radiation therapy.
Start IMRT therapy on September 13, 2007.
September 26,2007 psa test .08


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8122
   Posted 10/4/2007 5:42 AM (GMT -7)   
Hi Maria Teresa,
My doctor was upbeat after the surgery as well but he did say there was suspicious tissue left behind. And he was right as attested by the post op pathology. But I press on. I am certain that what all this means will be answered soon for Rod. Again he is going to have several options and will be managing this disease for a long time. And that's what he can do is manage it. JWB pretty much hits the nail on the head with his entry. I believe I may have already mentioned this book: "Beating Prostate Cancer: Hormonal Therapy & Diet" by Dr. Charles "Snuffy" Myers. I do recommend reading it as it pertains to those with our stage of this disease. Some really positive stuff in it as well. I think it will be a great "pick me up" for Rod. Also, I had a thread I started months ago on Michael Milken, the financial guy who also has prostate cancer. He got his Gleason 9, Stage IV diagnosis in 1993 and still presses on. You can read his story at www.mikemilken.com. This is stuff that brings a ray of hope. Rod also has another ray of hope...you. As you continue to stay with us, you also give him improved prognosis. I know for me that my Ruthie is by far the best encouragement I could ever want. We have prostate cancer, and I am not left alone to deal with it. I see it in all the women here at healingwell. And I know even though their men are not posting, they are very much listening to our posts. My message for Rod is that I know what he is feeling. That emptiness and loss of control is not the lasting effect that dominates my days anymore. Sure I always get nervous when it's time for a PSA test, but I have accepted that if it comes back, then that's just it. It comes back and I have to consider more treatments. I am still having fun with my family and friends and look forward to nice weekends. This weekend it's in the RV and back to Utah riding my dirt bike in the mountains. We are going with friends and will be lighting that campfire nightly for three days. I'll be thinking of you guys and I hope you'll be thinking of me. A guy who has the same stage choosing to move on. Get that book and you will better understand what you will likely need to know.  As far as your doctors advice, I believe that he should recommend an oncologist and you should be proactive and just get one.  I have never heard of a T3b with Gleason 9 not needing an oncologist regardless of the PSA going away or not.  This does not mean you need any treatments right now, but it does make you proactive and prepared should you decide to procede with HT or radiation. 

Tony


Age 45 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007
Post-Op Pathology was poor: Gleason 4+3=7, 4 positive margins, Stage pT3b (Stage III)
HT began in May, '07 with Lupron and Casodex 50mg
IMRT radiation for 38 Treatments ending August 3, '07
 
My PSA did drop out after surgery to undetectable.  It has not returned and I will continue HT until January '08.
 
My Life is supported very well by family and friends like you all.
 
STAY POSITIVE!

Post Edited (TC-LasVegas) : 10/4/2007 6:50:40 AM (GMT-6)

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