Pathology Report Question

Helena101

Good afternoon,

My father had robotic surgery to remove the prostate following a PIRAD 5 Prostate MRI (No lymph involvement) and a postitive biopsy showing Gleason 3+3 and Gleason 3+4.

Surgery on 9/23/24, deceived the unfortunate news last week that there were positive margins. Conversation with the surgeon was a 2 minute phone call in the middle of my daughters 3rd birthday so it difficult to process and my dad had no questions at the tine.

The next day his catheter was removed and the surgeon was not there to anawer quetions. He has a follow up appointment in January where they will check his PSA levels.

As a cancer survivor myself, I want him to be as proactive as possible in this and have made another appointment for a second opinion.

Correct me if I’m wrong the positive margina, although microscopical made this surgery not a success correct? Leaving him at high probability of future recurrence? We have a lot of questions for our next appointment.

Attached path report, any insight of questions to be asked at oir next appointment would be appreciated.

Wheel

Helena, Having a positive margin after the prostatectomy is not uncommon and does not make the surgery unsuccessful, as the main cancerous part, the prostate is out, however be aware that having a positive margin and extracapsular extension (ECE) are considered adverse and they might recommend Adjuvant Radiation Treatment (ART). ART is often given along with hormone treatment to patients after a prostatectomy that have a higher Gleason of 8,9, or 10, because it is considered advanced or aggressive cancer and has positive margins and (ECE). Having a Gleason 7 favorable (3+4) it might just be a recommendation to keep from having a recurrence, however I don’t know because of the margin and ECE. Also be aware that cribform pattern is sometimes not as susceptible to radiation and that is definitely a question to inquire about for future treatments. His upcoming PSA is important as it will become a baseline to watch how quickly it rises, if it does. Having a positive margin with ECE certainly infers the possibility of cancerous microscopic fibers having infiltrated outside the prostate and the PSA test will help determine the extent. Remember though the actual prostate gland is what produces most the PSA so what is remaining likely should not grow as fast as if the prostate was still there and a Decipher test of the tissue would help in learning about the cancer. If the decipher test was low You might decide to hold ART in abeyance and watch the PSA for growth and doubling time for a short time and then decide on Salvage Radiation Treatment (SRT). This leaves time, the amount unknown to have more quality of life time before starting Radiation treatments, with their side effects. It’s positive for your father its not in the lymph nodes, seminal vesicles nor bladder neck. You definitely want to ask about a Decipher test. How old is your father? If they watch the PSA rising at some point they probably would want to do a PET scan to see if they can identify where the cancer is to focus the radiation. Definitely ask the Surgeon’s office now about having Pathology send the tissue out for Decipher testing to see how low, intermediate or advanced the cancer tissue is considered. If it were considered low, that is important to how you would look at future treatments, especially at age. I WOULD want your surgeon to send the tissue off now, as it can take a month for results and that would be helpful when you sit down in January with the surgeon. For the time being let your father heal from surgery.

Helena101

Thank you so much for such valuable information. It gives us very important questions to ask and move forward.

Will defnitely move forward with the Decipher testing.

My father is 69 years old. He had no symptoms, just a PSA of 6.7 in his annual exam.

Can I ask exaclty what ECE mean? Does it mean the cancer was outside of the prostate?

it was quite a suprise since the surgeon said surgery went great, bo surprises and he was certain he had gotten it all.

Thank ypu so much, you have been beyond helpful.

He has not had a PSA test post surgery by the way, first PSA will be in January, 3.5 months post surgery.

Is it worth it to send the pathology for a second opinion to a specialized center? (Pathology and surgery done at University of Miami).

Wheel

Helena,

Yes, ECE refers to the cancer extending outside of the capsule, it can also be referred to as extra prostatic extension. There is no need at this point to send off the tissue for a second opinion. That is sometimes done after the initial biopsy to confirm Gleason grade on the cores. Decipher testing is done by a specialized laboratory, and Medicare will pay. You can google about the Decipher testing. It will actually be good for them to get biopsy tissue from the prostate and not from just a biopsy core. The Gleason given from the true prostate is also more accurate than from a biopsy so your father’s favorable Gleason 7 is good (3+4). I am 71 and just had my surgery in mid August. My first PSA is due in a week, two months post surgery. My Surgeon was totally surprised when Pathology told him I also had positive margins with ECE, when my tissue was sent to pathology while I was in surgery. Since I was in surgery then let my Surgeon go back in to cut more and ultimately I later learned that second time eliminated the positive margin. My having ECE is still considered adverse so I am apprehensive about my first PSA. I am also evaluating all my scenarios in advance, as certainly after having gone through surgery the last thing anyone wants is to think they need the second treatment of Radiation when you are imagining you are done after surgery. Best of luck.

Helena101

Again, thank you so much, you could not have explained it better. Gives us a lot of information for our next appointment.

Best of luck to you on your first PSA. We know how you feel, we thought surgery for Gleason 3+4 would be done and we would put this chapter behind for good.

Very appreciative to this forum and for your valuable information.

Steve1961

wow my pathology report was not detailed at all I also hear of surgeries lasting 678 hours my surgery and it was salvage surgery was less than two hours. It just goes to show you really no 2 prostate cancer are anything like at all from the surgery to pathology report to biopsies to treatments to side effects, but all in all it sure is messed up ..best of luck to you