Interpreting Surgical Pathology Report

lesjanes

I have my follow surgery discussion with my surgeon 9/4. He did call me after he got the report and said he had good news , clean margins, clean lymph nodes, etc…everything looked good. But I want to make sure I can ask proper questions regarding my report.

My initial Gleason score in February was 3+4+7, intermediate favorable. After surgery in July, my Gleason score was 4+3, intermediate unfavorable. So it makes me feel a little more comfortable about my decision to have surgery.

I have included my Surgical Pathology Report below. One of the notes that caught my attention was "Cribform glands are present" . I have read other people's comments on Cribform Patterns in a biopsy and how that is more problematic. Are Cribform glands and Cribform Patterns the same thing?

If anyone is interested in glancing at the report below and giving me your impressions, I would be most appreciative.

Thanks,

Les (now Gleason 4+3 or should that be was)

Wheel

seems like a good report, although understand your concern about going to the unfavorable 7, but I would agree with you moving ahead with your surgery was clearly the right call not surveillance. We are now both in the unfavorable 7, however I dropped from Gleason 8 to the 7. We are both with the cribriform glands and I think pattern might refer to glands. I did read where large cribriform glands is a more aggressive pattern and should be distinguished from small cribriform glands. My report makes no mention of large or small. I am just happy I went with surgery after learning now I have the cribriform. Not knowing or that it was not found in my prostate core biopsy, hypothetically I might have chosen a Radiation treatment protocol and we are all aware now cribriform does not respond well to Radiation.
I for now do not plan adjuvant Radiation and hormone treatment to go after anything microscopic that might have been missed since I have no positive margin. There clearly is no rush into an adjuvant protocol since it might not be effective anyway. My plan now is watch my psa and not until something is seen go forward with then the necessary salvage radiation. Again with the possibility of the Radiation therapy not being effective I would be less likely to just start Radiation because my PSA just went over a threshold number. I would want to how it is progressing, slowly or rapidly. I definitely would be under some surveillance for awhile since once I jump in and undergo the salvage radiation still a chance it’s ineffective.

Clevelandguy

Hi,

I would be concerned about the Perineurial invasion, cribriform and extra prostatic extension. Have the doctor team recommended any additional things like ADT or radiation therapy? It said that you had EPE but your margins are negative? I am confused! Unless there are serious concerns just keep monitoring your PSA which should be the indicator on reoccurrence.

Dave 3+4

lesjanes

https://csn.cancer.org/discussion/comment/1717731#Comment_1717731

Thanks for taking the time to review my report. I appreciate you highlighting those areas of concerns. My Dr was very optimistic that the chance of reoccurence is extremely small. So I find that reassuring. But you pointing out those areas of concerns will allow me to have a better disccusion with him next week. I do not want to assume everything is perfectly fine if there are things I need to watch out for.

Just got the results of my first PSA test since the Prostatectomy. It came out as less then .04. So that is good, but somewhat expected.

Wheel

Did not waste any time on that first PSA test. No word on when my first PSA is. One note on it being present in the Perineurial. That is still at least considered localized. Good luck on your post op visit. My post op is also that day.

lesjanes

Today I had my first follow-up with my surgeon since surgery on 7/11. We discussed the pathology report, especially the EPE and Perinural. The surgeon described my tumor as being not in the center but towards the outside with a slight pimple toward the outide. He was suprised by the EPE, but felt validated by taking as much margin as he did. Since the margins were negative, fatty tissue was negative and lymph nodes were negative, he feels pretty good that he got everything. But wouldn't give the 100% that it is gone and won't comeback. Because statistically 1 out of 5 patients get BCR regardless of treatment. But i think I already knew this from other posts on this board.

Since the tumor was less than 10% of the prostate and my Gleason is 7, not 8,9 or 10, margins negative, and first PSA was basically undetectable, he feels good about my chances

I will be monitoring PSA every 3 months for a year or 2. If stable, then every 6 months.

I feel better but still a little wary because if EPE and Perneural found. But I need to feed off my surgeon's confidence so that I am not obsessing on this every day

Thank you everyone for sage advice

Marlon

That's great news lesjanes. My first PSA was non-detect as well, so thats as good as it gets.

lighterwood67

Well, looks like you are on top of it. Staying positive is always a good thing. And being comfortable with your surgeon. A lot of the folks on this site are very knowledgeable and give exacting advice. I drew off their experiences. I had my RALP back in March 2018. My Gleason was 4 + 3 =7. Anyway best of luck on your journey.

Clevelandguy

Hi,

Good luck on many undetectables in the future. I was a 3+4 with PNI and ten years later after my robotic surgery I am still undetectable @.05. Keep on keepin on…………..

Dave 3+4

lesjanes

Thanks Clevelandguy (aka Dave 3+4),

Your experience is encouraging to me . I have found your advice very helpful and measured.

Best of luck to you.

lesjanes

Thanks lighterwood67. Sounds like you are doing well 6 years post surgery.

lesjanes

Thanks Marlon!