Pathology results

eonore

I am nine days past a ten hour Da Vinci removal, and I received my pathology report on Tuesday along with the catheter removal.   My recovery so far has been unremarkable, except that my scrotal sack is still huge.   Here are the pertinent findings;

 

21 lymph nodes all negative

Bladder neck and smooth muscle negative for cancer

Prostate 209 grams, size 7.8 centimeters

Primary pattern four 70%

Secondary pattern three 30%

Total Gleason 7

Extraoprostatic extension present non focal

Established EPE at right base, 1 mm breadth (E26); right posterior, 4 mm breadth (E34 and E36); and left posterior, 1 mm breadth (E75) 

Urinary bladder neck invasion:  not identified

Seminal vessal invasion: not identified

Lymphovascular invasion:  not identified

Perineural invasion:  present

Margins:  Uninvolved by invasive carcinoma

Clinical stage classification pt3a

 

I received these results from the physician's assistant, I did not see the surgeon which has me a little distressed.   The assistant told me I would see the doctor at the three month point, at the first PSA.

Since receiving the report I have been reading like crazy and I was hoping I could get some opinions here regarding the need for additional treatment and timing of that treatment.   I am going to contact the surgeon in advance of three months and the more I know, the better questions I can ask.

Any comments or suggestions you can give are greatly appreciated.

 

 

 

 

 

contento

Yes it's concerning

Eonore, I too was a stage pt3a when I had my RP back in 2013. I'm sure that you read by now that there is a higher risk of reoccurrence but it's definitely not a certainty. I've read plenty of stories of Pca patients with stage 3 and they're still going years later with no reoccurrence.  I wasn't so lucky as I did have biochemical failure ( reoccurrence) about a year a half after my surgery. I had to follow up with salvage radiation which appears to have worked as i've had a non detectable psa for the last 2 years. My pathology was fully loaded as I had a gleason 8, positive margin, extraprostatic extension and lymphovascular invasion.

Bottom line Eonore, while it's concerning it's not the end of the world . It's possible your doctor might suggest adjuvant radiation as a preventive measure or no treatment at all at this point . If adjuvant is suggested I would get a second opinion as , like any cancer treatment, radiation will affect your quality of life somewhat. My advice is what you already stated above , call him and ask what are the next steps . Wish you well.

VascodaGama

The PSA will be the marker to follow

I pair Contento's comments. The pathologist report is for concern but not "the end of the world". In your shoes I would wait for the next consultation to draw conclusions. I understand your distress for not seeing your surgeon this time but he surely has scheduled your next appointment in three months based on the report. He knows about your pT3a N0 pathological stage. From now, the PSA will be the marker to follow. It should be maintained in remission levels of less than 0.06 ng/ml. You can test it by yourself at a local laboratory (or request at the surgeons office), if you think that it can give you peace of mind. At one month post surgery this marker is already reliable.

The worse elements mentioned in the report are the Gleason pattern 4 identified as primer (4+3) 7, which classifies the cancer more aggressive, and the positive Extraprostatic Extensions, which finding could signify a prognosis for future recurrence. In any case one does not know if such becomes problematic as surgeons typically dissect/vacuum the portion of tissues surrounding the gland that may include any prostatic cells in the extensions. You need to give time to verify successes.

I wonder about your initial diagnosis. What was the PSA before surgery and the clinical stage provided by the urologist?

Best wishes for full recovery from the RP.

VGama

eonore

Thank you so much for your comments and suggestions.   They are very helpful to me emotionally.   

To answer your question, I do not know my initial diagnosis stage, but my PSA immediately preceeding the surgery was 17.   MY surgeon felt that the size of the prostate had something to do with the high PSA along with the cancer.