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Friend's post RRP pathology report stage T0 ?!?

Perineum
Posts: 12
Joined: May 2011

Hello all,

A friend of mine received his pathology report three weeks after RRP, which found nothin. stage T0.
His Gleason's score before surgery was 8 in 3/12 biopsy samples.
His PSA was 9.6, Free PSA 20%.
Age 58.
Bone scan and endorectal MRI were clear (before surgery).

How could it be?
Have you heard of something like that?
Could it be that the biopsy pathology report was wrong, or maybe the post surgery pathology is wrong? Maybe they missed the tumor location (in the post RRP pathology)?

Thanks

Perineum
Posts: 12
Joined: May 2011

BTW, does anyone knows how do they examine the prostate after surgery?
I mean, they obviously can't see everything... Do they cut some peaces and look under the microscope?

Thanks!

hopeful and opt...
Posts: 1282
Joined: Apr 2009

of the biopsy slides from a qualified independent pathologist?

VascodaGama's picture
VascodaGama
Posts: 1516
Joined: Nov 2010

Hi Perineum, again.

Hopeful is right. A second opinion of the biopsy slices may disentangle the mystery of your friend’s T0.

Regarding the Pathology of the prostate, Dr. Elizabeth M. Genega, a pathologist at Beth Israel Deaconess Medical Center, says this to the following question;

“What percentage of a prostate’s surface do you actually evaluate in the lab?”

GENEGA: Well, it depends on how the specimen is processed. Are you going to submit the entire prostate gland for microscopic evaluation, or are you going to put in three or four sections from both the right and left lobes? When you submit the entire gland, people think you’re evaluating every aspect of the prostate, but you’re not. (You will, however, see more of the surface area than if the specimen is not submitted in its entirety.) When you slice the prostate for routine, non-whole-mount sections, each slice ranges from 2 to 3.5 millimeters in thickness, but from each of those slices, the histology lab takes slices that are only about 5 microns thick to make slides. [A human hair is 100 microns thick.] So there’s actually a relatively large surface area that you don’t see. If you were to look at the entire prostate, that would mean looking at hundreds of slides, and that’s not done.

In regards to Gleason score of 9 as it is your case (http://csn.cancer.org/node/220167), doctors tend to look for positive margins when analysing the prostate slices. They will have an extra attention to the borders/shell of the prostate missing inner parts.

Dr. Andrew A. Wagner, from the Surgery department at Beth Israel Deaconess Medical Center, says this;

“… the higher the Gleason score, the higher the risk that the patient has extraprostatic disease. This is the real crux of whether or not the patient might have a positive margin: how likely is it that the cancer is going to penetrate beyond the prostate borders into the surrounding tissue, and will the surgeon have cut far enough away from it? At the apex of the prostate where there isn’t much surrounding tissue, the tumor can go all the way up to the cut edge of the sample. So the higher the Gleason score, the greater the likelihood of aggressive, invasive cancer, which means the likelihood of positive margins, is higher.”

I hope this helps in your continuous search.

Regards.
VGama

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

You know, there has to be an occasional mix up in the slides at the labs. I know that there are strict controls and a chain of custody procedure but each year even a few babies get mixed up in maternity wards.

I wonder if your friend had a second opinion on the original biopsy slides.

It makes no sense to have a Gleason 8 before surgery and nothing afterward...unless the slides were mixed up.

K

VascodaGama's picture
VascodaGama
Posts: 1516
Joined: Nov 2010

Kongo, you made me laugh again with your comment “.. even a few babies get mixed up in maternity wards”. I hope I am the real one my mam and dad took home 61 years ago.
Just keep those coming. They are healthy.
VG

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