FOCI SUSPICIOUS FOR LYMPHOVASCULAR INVASION? Anyone know much about this?

jmikew

Found out I had prostate cancer in February...had just turned 50 and went in for a physical..one thing led to another and after the biopsy I found that I had cancer in 8 out of 12 biopsy...initial report showed mostly 3+3 on one half and 3+4 on the other...had robotic surgery 4 weeks ago to remove the prostate.

After removal they changed the grading...

DIAGNOSIS
(D) PROSTATE AND SEMINAL VESICLES:
PROSTATIC ADENOCARCINOMA, GLEASON SCORE 7 (4+3) WITH TERTIARY GLEASON GRADE 5.
(SEE COMMENT)
TUMOR CONFINED TO THE PROSTATE.
MARGINS OF RESECTION FREE OF TUMOR BUT TUMOR EXTENDING FOCALLY TO LESS THAN 0.1 MM
FROM THE MARGIN.
Right and left seminal vesicles, no tumor present.
Segments of right and left vasa deferentia, no tumor present.
PERINEURAL INVASION PRESENT.
FOCI SUSPICIOUS FOR LYMPHOVASCULAR INVASION.

I don't know what the last part means but it doesn't sound good...anyone else run into this?...also, right before surgery they had be do a "rectal balloon" MRI...yes, it is exactly like it sounds...I had two pretty cute nurses administering it...one told me to drop my pants the other said she was going to insert the probe in my rectum and inflate it...I told them this really wasn't the threesome I had envisioned...the MRI results were negative...but it did make me wonder why I couldn't have gotten knee cancer or elbow cancer...tired of people poking me in the rear.

Sorry to digress...but I'm concerned that my cancer is more aggressive than originally thought...they did test several lymph nodes and all came back negative.

Thanks for all the support everyone provides here!...sorry to have had to join your group but glad not to be in it alone....all the best.

hunter49

elcome aboard. It appears
elcome aboard. It appears the disease was organ confined which is a very good thing. However, there were G5 present that is not. It indicates the cancer cells were starting to become poorly differentiated and much more aggressive. I would get a second opinion. PNI is a way the less differentiated cells escape via micro metastisis. Vascular invasion I not very familiar with. I would also find an Oncologist familiar with PC. Where you located?

Kongo

Threesomes and PCa
jmikew,

Welcome to the forum and I hope you're rapidly recovering from your recent surgery. I enjoyed your humor on the threesome you were not envisioning. After more than two years down the PCa highway I'm getting used to bending over for strangers too.

Lymphovascular invasion is the presence of cancer cells in the lymph systems. Since the post surgical pathology report you wrote didn't mention any lymph nodes per se, I am guessing the pathologist is using the "suspicious" adjective to cover it based on the tertiary Gleason score of 5 and perineural invasion. Prostate cancer spreads through the blood stream, the lymphatic system, and by direct contact with adjacent tissue. As you surmised, the "lymphovascular invasion" is not good since it is associated with a very high likelihood of recurrence. (You will know this is happening if your PSA scores begin to rise after surgery)

The tertiary Gleason Score of 5 identifies your Gleason 7 as a more much more aggressive cancer than normally associated with a Gleason 7 and is also associated with high rates of recurrence.

Perineural invasion means that the cancer was found among the tiny nerve bundles that surround the prostate gland.

While the report did note that the tumor was "contained" within the prostate it was right up against the margin (<0.1mm). It's hard to believe how it could get any closer to escaping the prostate than it did.

I think your suspicions are right about your cancer potentially being more aggressive than you may have originally thought. While you're waiting for your post surgical PSA tests you may want to start researching follow-on treatment options. I hope you never need them but it is good to be a well educated and assertive patient. Consultations with prostate cancer experts in addition to your present urologist would seem a prudent step as well.

Best of luck to you.

k

jmikew

Kongo said:

Threesomes and PCa
jmikew,

Welcome to the forum and I hope you're rapidly recovering from your recent surgery. I enjoyed your humor on the threesome you were not envisioning. After more than two years down the PCa highway I'm getting used to bending over for strangers too.

Lymphovascular invasion is the presence of cancer cells in the lymph systems. Since the post surgical pathology report you wrote didn't mention any lymph nodes per se, I am guessing the pathologist is using the "suspicious" adjective to cover it based on the tertiary Gleason score of 5 and perineural invasion. Prostate cancer spreads through the blood stream, the lymphatic system, and by direct contact with adjacent tissue. As you surmised, the "lymphovascular invasion" is not good since it is associated with a very high likelihood of recurrence. (You will know this is happening if your PSA scores begin to rise after surgery)

The tertiary Gleason Score of 5 identifies your Gleason 7 as a more much more aggressive cancer than normally associated with a Gleason 7 and is also associated with high rates of recurrence.

Perineural invasion means that the cancer was found among the tiny nerve bundles that surround the prostate gland.

While the report did note that the tumor was "contained" within the prostate it was right up against the margin (<0.1mm). It's hard to believe how it could get any closer to escaping the prostate than it did.

I think your suspicions are right about your cancer potentially being more aggressive than you may have originally thought. While you're waiting for your post surgical PSA tests you may want to start researching follow-on treatment options. I hope you never need them but it is good to be a well educated and assertive patient. Consultations with prostate cancer experts in addition to your present urologist would seem a prudent step as well.

Best of luck to you.

k</p>

thanks for the replies
Thanks Hunter and Kongo for addressing my question...after doing additional research I'm afraid I will need to look at further treatment options as you suggested Kongo...still holding out that there is a chance they got it prior to it escaping...if not...well that will be a kick in the....knee...as I might have reconsidered the surgery...but too late for that know...I'm actually recovering quite well...

no/very minor issues staying dry...I will admit that I do think twice before passing gas...also no issues with ED...and since it has only been 4 weeks I feel very good about it...I meet with my Doc on the 14th to review the results of the pathology report...it will be interesting to get his take on it...good news is I'm going to MD Anderson and feel good about their approach...well it's date night...time for a test drive..thanks again and all the best...

BTW...is it typical to have radiation only...or do they use HT with it if my PSA rises?...hoping to avoid HT if at all possible.

Kongo

jmikew said:

thanks for the replies
Thanks Hunter and Kongo for addressing my question...after doing additional research I'm afraid I will need to look at further treatment options as you suggested Kongo...still holding out that there is a chance they got it prior to it escaping...if not...well that will be a kick in the....knee...as I might have reconsidered the surgery...but too late for that know...I'm actually recovering quite well...

no/very minor issues staying dry...I will admit that I do think twice before passing gas...also no issues with ED...and since it has only been 4 weeks I feel very good about it...I meet with my Doc on the 14th to review the results of the pathology report...it will be interesting to get his take on it...good news is I'm going to MD Anderson and feel good about their approach...well it's date night...time for a test drive..thanks again and all the best...

BTW...is it typical to have radiation only...or do they use HT with it if my PSA rises?...hoping to avoid HT if at all possible.

Treatment Options
I think a combination of HT and radiation is the preferred method but I would defer to your medical team's expertise. Good luck sorting it all out.

Best

jmikew

Kongo said:

Threesomes and PCa
jmikew,

Welcome to the forum and I hope you're rapidly recovering from your recent surgery. I enjoyed your humor on the threesome you were not envisioning. After more than two years down the PCa highway I'm getting used to bending over for strangers too.

Lymphovascular invasion is the presence of cancer cells in the lymph systems. Since the post surgical pathology report you wrote didn't mention any lymph nodes per se, I am guessing the pathologist is using the "suspicious" adjective to cover it based on the tertiary Gleason score of 5 and perineural invasion. Prostate cancer spreads through the blood stream, the lymphatic system, and by direct contact with adjacent tissue. As you surmised, the "lymphovascular invasion" is not good since it is associated with a very high likelihood of recurrence. (You will know this is happening if your PSA scores begin to rise after surgery)

The tertiary Gleason Score of 5 identifies your Gleason 7 as a more much more aggressive cancer than normally associated with a Gleason 7 and is also associated with high rates of recurrence.

Perineural invasion means that the cancer was found among the tiny nerve bundles that surround the prostate gland.

While the report did note that the tumor was "contained" within the prostate it was right up against the margin (<0.1mm). It's hard to believe how it could get any closer to escaping the prostate than it did.

I think your suspicions are right about your cancer potentially being more aggressive than you may have originally thought. While you're waiting for your post surgical PSA tests you may want to start researching follow-on treatment options. I hope you never need them but it is good to be a well educated and assertive patient. Consultations with prostate cancer experts in addition to your present urologist would seem a prudent step as well.

Best of luck to you.

k</p>

Thanks for all you do here Kongo
As a follow up...met with my urologist this week to review my pathology report and review any side affects from surgery...and my first PSA...when I asked the doc about the FOCI SUSPICIOUS FOR LYMPHOVASCULAR INVASION listed in the pathology report...his comment was "I wouldn't worry about that at all"....and the way he said it was very much...not a big deal. But hey...first PSA was undetectable, I'm not wetting the bed and I'm able to keep my very attractive wife happy...so I'm going to go with the "don't worry about it".

jmikew

jmikew said:

Thanks for all you do here Kongo
As a follow up...met with my urologist this week to review my pathology report and review any side affects from surgery...and my first PSA...when I asked the doc about the FOCI SUSPICIOUS FOR LYMPHOVASCULAR INVASION listed in the pathology report...his comment was "I wouldn't worry about that at all"....and the way he said it was very much...not a big deal. But hey...first PSA was undetectable, I'm not wetting the bed and I'm able to keep my very attractive wife happy...so I'm going to go with the "don't worry about it".

2 years!

It's been two years since I started down the journey....and I recently received the news that  my PSA is still <.01.  There are so many people on this forum that provide such great insight and advice...couldn't thank them enough!...don't spend to much time here myself as I try to never think about my cancer until I have to be tested...but when I need information and encouragement this is a great resource for it...but now it's time for 3514684 glasses of wine and alone time with the wife!

hopeful and optimistic

jmikew said:

2 years!

It's been two years since I started down the journey....and I recently received the news that  my PSA is still <.01.  There are so many people on this forum that provide such great insight and advice...couldn't thank them enough!...don't spend to much time here myself as I try to never think about my cancer until I have to be tested...but when I need information and encouragement this is a great resource for it...but now it's time for 3514684 glasses of wine and alone time with the wife!

Congratulations

You just missed the bullet that was aimed at you....you zigged or zagged at just the right time. 

Keep on getting those PSA's

I hope that you will stop by, before another two years, hopefully to give some insight and encouragement to the new giuys.

Enjoy the alone time with your wife.

Best,

H 

VascodaGama

Lovely celebrations

Jmikey, 

Five years is used by doctors as the milestone to declare cure. You are already closer and doing well. Best wishes for continuing remission.

Congratulations,

VG

dandrews

Thanks for following up
Hi jmikew et al, My surgery was 4 days ago and I was feeling good about everything but had the dreaded late Friday night lab resaults e-mail show up with the Path results. That somehow brought me to your thread which has brought me a bit out of the black hole my spirit had sunk into. I have the follow-up with the Doctor on Tuesday.

My results were a tad different but you can see what was similar. PROSTATE AND SEMINAL VESICLES, RADICAL PROSTATECTOMY (46 G): Prostate adenocarcinoma, Gleason score 3+4 = 7, involvingbladder neck and present at the inked margin at this area Perineural invasion identified Areas suspicious for lymphovascular invasion identified

I'm literally still reviewing and haven't started into the details section yet. The initial blow was to see the mention of the bladder as I was hoping it wouldn't have come into play. It doesn't help being fresh out of surgery and my imagination now playing a scene wherein I am told that they have to go back in. Anyway, thank you for your follow-up posts, that made the thread special for running across.

Doug A