Anyone want to interpret this path report for me?

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James C.
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Date Joined Aug 2007
Total Posts : 4463
   Posted 10/2/2007 9:55 PM (GMT -6)   
Got my post-op path report today.  Here is the details:
A. Lymph nodes, bilateral external iliac, hypogastric and obturator areas, resections:
  Four fatty lymph nodes, no metastatic tumor is identified.
B.  Prostate, prostatectomy
Histologic type: Acinar type of adenocarcinoma
Histologic grade:   Gleason grade=3+3=score of 6
Margins:  Probable, microscopic involvement of the left apical margin:
             Remaining margins clear.
Extraprostatic extensdion:  Not identified
Seminal Vessel invasion:  None
Regional lymph nodes:  See A above
Distant metastasis:  Cannot be assessed
Perineural invasion:  Microscopic intraprostatis perineural invasion is present (see guide to sections)
Venous invasion:  None identified
Lymphatic invasion:  None identified
Pathologic staging:  pT2c, pN0,pM0 (pathological state II, AJCC, 2002
Accompanying the report was a drawing from various views of the gland, sectioned off, with shaded areas, representing the tumor, I suppose.  I sorta have read enough to get a feel for it, but wonder if someone with more expertise wants to take a crack at it.  I don't particularily like the workds "probable", "microscopic" or perineural invasion".  Doc said we would discuss it Friday when the catheter is removed.  I will confess that I was still pretty drugged when he called, and that I sorta blanked out when he said the microscopic involvement deal and didn't hear much of what he said after that. 
James C. 
Help support the forums so they can support you: 
Age 60 
4/19/07  PSA 7.6 , referred to Urologist
4/26/07  Urologist prescribes 3 weeks of antibiotics/anti-inflam. due to past history of Prostatis.  DRE- nothing detected but 'gross enlargement"
6/5/07    Recheck of PSA: 6.7, biopsy scheduled.
7/11/07   Biopsy- 16 core samples, ultrasound size of gland around 76 cc. Staging pT2c
7/17/07   Pathlogy report:  3 of 16 cancerous/ 5% involved, left lobe top, center, bottom, Gleason 3/3:6. 
8/3/07     Decision made for conventional RP surgery, scheduled for Sept. 24.
9/24/07  Conventional  Radical Retropubic surgery performed 
9/26/07 Post-op Path Report: Gleason unchanged 3+3=6 Staging pT2c,
Prostate 110 gms, 2.2"x2.2"x1.75"

Regular Member

Date Joined Mar 2007
Total Posts : 237
   Posted 10/2/2007 10:19 PM (GMT -6)   
I'll let others with more expertise comment, except to say that I thnk a Gleason of 6 is a good sign.
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!!)

Veteran Member

Date Joined Oct 2006
Total Posts : 626
   Posted 10/3/2007 10:07 AM (GMT -6)   

I certainly am not versed in the pathological verbage. The probable microscopic margin involvement sounds like they are talking on the cell level. The probable part is vague which to me means they are getting there based upon some indicator not the actual seeing of cells on the margin. The perineural invasion (PNI) indicates that the cancer was found in the nerves located within the prostate. There are conflicting opinions on the significance of PNI. These range from some medical opinions that the nerves could provide a pathway for the cancer to get out of the prostate to others that say there is no significance. I believe in your case that since all the tissue examined outside of the prostate was negative and you Gleason was confirmed at 6 then you have a high percentage that the cancer was contained and removed.

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

Veteran Member

Date Joined Apr 2006
Total Posts : 1732
   Posted 10/3/2007 11:09 AM (GMT -6)   
"Microscopic" finding refers to less than 5...yes, less than 5 cells, could be seen upon examination under a microscope. Considering how very "microscopic" a cell is its a wonder so few can be counted at all. This is a pretty good pathology report all in all. Those remaining few cells may have just died off from the truama of surgery itself. Hope so. Modified Citrus about it.


James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4463
   Posted 10/3/2007 2:51 PM (GMT -6)   

Ok, 2 things you folks mentioned triggered my memory. 

1.  Doc said that microscopic most likely meant only one or 2 cells showed.  He said the sample could just as easily been contaimiated during the removal of the over-large gland and it may have sloughed off some cells.  Funny how I had forgotten that until you triggered my memory.  He said they had a heck of a time stuffing it into the specimen container, which had the same sized opening as a male urinal spout.  eyes

2.  He also said that the tumor was larger internally than expected or revealed by biospy and had begun to grow up the nerve route out of the gland.

I will confess I had put a more serious interpretation, especially the perinueral part.  I thought maybe that meant it had excaped outside along that route and was now in the abdomen.  I'll relax a little more now, then, I think.  Thanks loads for your unofficial, non-doctorly,non-pathlogist evaluation.  You guys have surely heard most or all of what we new ones put here and it's good to have a quick source of experienced information to access.  Thanks

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