Prostate Biopsy Pathology results

LvGuy1 · January 2017

Hey all. Here is the Pathology report from the Surgery (open) done 12/20/16

Radical Retropubic Prostatectomy Procedures and Findings.

Left Pelvic Lymph Node, excision : No evidence of Malignancy

Right Pelvic Lymph Node, Excision : No evidence of Malignancy

Prostate, Prostatectomy : Adenocarcinoma, NOS

Histologic Grade (Gleason Pattern) : 3 + 4 = 7

Extent of Involvement : Left Lobe and Right Lobe

Prostate Size : 6.0 X 5.4 x 4.8 CM

Prostate Weight : 61GM

Tumor Quantitation : 85 % of Prostate involved by Tumor

Extraprostatic Extension : Absent

Seminal Vesicle Invasion, Right : Free of Tumor

Seminal Vesicle Invasion, Left : Free of Tumor

Margins

Apical : Uninvolved by Carcinoma

Bladder Neck : Uninvolved by Carcinoma

Anterior : Uninvolved by Carcinoma

Lateral, Left : Uninvolved by Carcinoma

Posterior: Uninvolved by Carcinoma

Treatment effect on Carcinoma : Absent

Lymph-Vascular Invasion : Absent

Perineural Invasion : Present

AJCC PTNM CLASSIFICATION (7th Edition)

PT2C NO

*******For All you interested in the actual Procedure not that i can understand *******

After informed consent was obtainedthe patient was identified in preoperative holding and taken to the operative suite where he successful indication of general anesthesia the patient waws prepped and draped in the usual style fashion. A foley Catheter was placed in the field. An incision was made in the approximately 20 cm and the dissection was taken down sharply to the rectus fascia. This was divided in the midline sharply and the pyramidalis was taken down the rectus muscle was spread and the trnsverse transversalis fascia was entered in the space of Retzius was entered and developed bilaterally. A Bookwalter was deployed and a left pelvic lymph node dissection was performed from the node of cloque to the bifurcation of the iliac vessels and is deep as the obturator nerve. Care was taken to spare the obturator nerve. The node packet was sent off labled left pelvic lymph nodes. The right pelvic lymph nodes were dissected in a similar fashion. Attention was then directed to the endopelvic fascia which was divided on either side of the prostate. The dorsal venous complex was then controlled by passing a Vicryl stitch around it and centimeters plexus was controlled with a Coker clamp. The dorsal venous complex was then divided with the Bovie and the neurovascular bundles were then swept off the urethra bluntly. The right angle was passed around the urethra and an anterior incision was made in the urethra followed by a posterior incission with a banana blade. A Foley Catheter was then delivered into the field. THe Rectourethralis was divided sharply and the lateral pedicles were taken with the harmonic scaple. The base the seminal vescles was challenging and therefor the bladder was entered anteriorly at the bladder neck and the dissection was taken around circumferentially until only the seminal vescles and the ampulla of the vas elbow specimen. These were then dissected from the anterior approach secured with clips as necessary and divided.

Both ureteral orifices were identified and were seen to efflux clear urine the bladder neck was then everted with chromic and 3 anastomic sutures were placed at the 481 and 11 oclock position and then placed into the corresponding location in the bladder neck with care not to injure the ureteralorrifice or to entangle the sutures. A Foley Catheter was placed under direct visualization and passed into the bladder 40cc was placed in the balloon the retraction was then taken down and all of the anastomosis as well. THe wound was irrigated to insure there were no blood clots and no leak was appreciated at hte anastomosis as well. The wound was irrigated the JP drain was placed and externalized in the right lower pelvis. The rectus fascia was closed with #1 looped PDS in a running fashion after irrigating between layers the skin was closed with skin staples. A Dressing was applied patient was awakened and escourted to recovery in a stable condition without evidence of complications.

Thanks Guys

Max Former Hodgkins Stage 3 · January 2017

Excellent

This report very strongly suggests that you are now cancer-free, Luv.

No cancer noted in the nodes, seminal vescles, bladder neck, and no postitive margins. You had a whopper of a large gland, and a large volume involved with the tumor (85%). It did mention perineural involvement, which very likely means nothing; some cancer was in the lining of the nerves in the gland, but this does not by itself indicate any esacape. It sounds like your erectile nerves were successfully spared from the write-up. Apparantly the doc had a challange getting the vescles out, and had to manipulate the bladder a little to accomplish this, but that is irrelevant also.

Rest and expect PSA tests in a few months stating "Undetectable." No one can absolutely guarantee this, but it seems extremely likely. Congrats !

VascodaGama · January 2017

Very good report

No extracapsular extensions, clean margins and negative lymph nodes. Remission can be expected from the above. Best wishes and peace of mind.

VG

LvGuy1 · January 2017

Dont know if i feel safe saying Cancer free BUT...

Dont know if i feel safe saying i will be cancer free but am going to say Cancer is in Remission as because from reading about other peoples journeys that even if all the cancer is gone it can spring its ugly head anytime without much warning. This does not mean tho that i am going to let this run my life tho but i will treat it as the enemy it is and keep close tabs on it at all times. I had a great Surgeon with whom i trusted completely and have done everything that he requested. He has discharged me back to my pcp at the VA already but he will be getting reports every year for the next 5 years and the VA has me seeing the Cancer Dr. at the VA starting in 2 months (Thats 3 months after surgery). I have learned a lot from this site and plan to be able to help others as they start their journey in this club. I have also been talking to my wife and due to the little amount of information at our VA here in Las Vegas and my Psychiatrist at the VA i have been thinking of starting a Prostate Cancer support group for Newly diagnosed PCa patients where information and support can be received and given as there is just nothing available at the moment. And making informed decisions are a key to survival and getting the best treatments for yourself.

hopeful and optimistic · January 2017

.

Don't know the Las Vegas area, but there is a support group that meets at San Martin Hospital 8280 Warm Spring Rd. Las Vegas, NV 89113 Downstairs Meeting Rooms, 3rd Wed. 7- 9 pm (Except July & Dec), Contact : Tony Crispino tcneclv@gmail.com 702-917-7779

http://www.ustoo.org/Support-Group-Near-You

Old Salt · January 2017

Great report

It appears that your story has a happy ending. We can certainly use that!

Thanks and best wishes for a complete and uneventful recovery from the surgery.

LvGuy1 · January 2017

hopeful and optimistic said:
.
Don't know the Las Vegas area, but there is a support group that meets at San Martin Hospital 8280 Warm Spring Rd. Las Vegas, NV 89113 Downstairs Meeting Rooms, 3rd Wed. 7- 9 pm (Except July & Dec), Contact : Tony Crispino tcneclv@gmail.com 702-917-7779

http://www.ustoo.org/Support-Group-Near-You

local meetings

Thanks Hopeful. very useful.

Swingshiftworker · January 2017

LvGuy1 said:
Dont know if i feel safe saying Cancer free BUT...
Dont know if i feel safe saying i will be cancer free but am going to say Cancer is in Remission as because from reading about other peoples journeys that even if all the cancer is gone it can spring its ugly head anytime without much warning. This does not mean tho that i am going to let this run my life tho but i will treat it as the enemy it is and keep close tabs on it at all times. I had a great Surgeon with whom i trusted completely and have done everything that he requested. He has discharged me back to my pcp at the VA already but he will be getting reports every year for the next 5 years and the VA has me seeing the Cancer Dr. at the VA starting in 2 months (Thats 3 months after surgery). I have learned a lot from this site and plan to be able to help others as they start their journey in this club. I have also been talking to my wife and due to the little amount of information at our VA here in Las Vegas and my Psychiatrist at the VA i have been thinking of starting a Prostate Cancer support group for Newly diagnosed PCa patients where information and support can be received and given as there is just nothing available at the moment. And making informed decisions are a key to survival and getting the best treatments for yourself.

Too early to say . . .

Congrats on your apparently successful surgery.

However, it's really too early to say if you're in remission (let alone "cured") yet or not. "In remission" would generally refer to someone who is cancer free for 5 years or more. You will need to get your PSA measured regularly -- usually once @ 3 months for the 1st 3 years and then once every 6 months for the next 2 years. If there is no increase in PSA (3 or more times in a row) and no other evidence of recurrence, then you can consider yourself in remission (and resume just annual PSA testing) but not before then.

There have been many men who here have had surgery and later reported increased PSA levels reflecting a recurrence that had to be treated subsequently with radiation and ADT medication (or castration) in order to stem the renewed growth and spread of the cancer.

Hopefully, that will not happen in your case but, if you aren't already, you need to be aware of (and prepared for) that possibility.

Good luck!

Josephg · January 2017

Cancer Free

As Swingshiftworker indicated, a large amount of time with undetectible PSA readings needs to pass by, before you can state that you are cancer free. As such, the more appropriate word that you should be using after a good first PSA reading is 'undetectible'.

I'm not trying to rain on your parade, I just want to give you some sound advice regarding setting and maintaining your expectations. In the meantime, take one day at a time, and enjoy and celebrate your current condition, and your life in general. You will respect your life and what it means to you and your loved ones much more, after your initial bout with PCa. For a series of outstanding philosophical perspectives, look up the posts by Rakendra in this PCa discussion board, as he states them much better than I ever could.

I wish you the best of successful outcomes on your journey.

LvGuy1 · January 2017

Swingshiftworker said:
Too early to say . . .
Congrats on your apparently successful surgery.

However, it's really too early to say if you're in remission (let alone "cured") yet or not. "In remission" would generally refer to someone who is cancer free for 5 years or more. You will need to get your PSA measured regularly -- usually once @ 3 months for the 1st 3 years and then once every 6 months for the next 2 years. If there is no increase in PSA (3 or more times in a row) and no other evidence of recurrence, then you can consider yourself in remission (and resume just annual PSA testing) but not before then.

There have been many men who here have had surgery and later reported increased PSA levels reflecting a recurrence that had to be treated subsequently with radiation and ADT medication (or castration) in order to stem the renewed growth and spread of the cancer.

Hopefully, that will not happen in your case but, if you aren't already, you need to be aware of (and prepared for) that possibility.

Good luck!

Thanks Swingshift

I agree with what you say Swingshift. I just said remission because i have a hard time accepting the "Cured" label, Cured is too strong for my taste and it has at least to me not been proven yet that a person is cured of cancer, no matter what type. Right now tho i am taking it one day at a time and am not taking anything for granite and will continue to see my team of Drs. and discuss the next step as it arises. Anyways it has only been a month and its too early to say what my body has in store for me.

LvGuy1 · January 2017

Josephg said:
Cancer Free
As Swingshiftworker indicated, a large amount of time with undetectible PSA readings needs to pass by, before you can state that you are cancer free. As such, the more appropriate word that you should be using after a good first PSA reading is 'undetectible'.

I'm not trying to rain on your parade, I just want to give you some sound advice regarding setting and maintaining your expectations. In the meantime, take one day at a time, and enjoy and celebrate your current condition, and your life in general. You will respect your life and what it means to you and your loved ones much more, after your initial bout with PCa. For a series of outstanding philosophical perspectives, look up the posts by Rakendra in this PCa discussion board, as he states them much better than I ever could.

I wish you the best of successful outcomes on your journey.

Cancer free

Josephg,

Thanks i agree that it is way too early to predict anything when it comes to PCa, I do follow Rakendra and Vascodagama along with a couple of others on this post and from what i have been reading that VascodaGama is proof that this beast can rear up its ugly head at any time reguardless of amount of time with what he is fighting at the moment.

LvGuy1 · February 2017

6 week post op PSA results

Just got my PSA results todday as it is the 6 week result as my Dr. says to give us a PSA marker post sergery. it is 0.01 he said that is considered as undetectable and that we will start to do the PSA test every 3 months for a year then go to every 4 months for a year then every 6 mos for two years. but if it starts to raise that we will start doing it every 6 to 8 weeks. Is this the normal protocol ? anyways i am very happy and optimistic but in the back of my mind is wonder how long it will be before it starts raising again as my Kidney levels are in the high zone and we want to figure out what is going on with that next. He did a full kidney panel test and the EGFR was raised again at 117.5 guess normal is about 60 or so . He said it might just be high due to the prostate cancer and also due to the Gallbladder surgery and stents they put in and just removed.

VascodaGama · February 2017

LvGuy,

This levels of PSA=0.01 ng/ml after RP indicates remission. This is to celebrate with a series of fireworks to be seen even by those riding the International Space Station. Congratulations. I promise to commemorate this result with a glass of my red wine though I am now on the restrictive approach to alcohol intake, due to kidney issues. For those interested in your story of events they can read it here; https://csn.cancer.org/node/306011

A note to your numbers on kidney health, goes to the term "EGFR" which I think that you meant to write "eGFR" (estimated Glomerular Filtration Rate). To such extend, the value of 117.5 should represent a good result as the bad one is considered a rate lower than 60 (mL/min/1.73m2). I wonder if your doctor was in fact referring to the Clearance of creatinine in urine at 24 hours. Your comments in this respect are important to me as I was found with CKD (chronic kidney disease). Can you substantiate any detail regarding your doctors opinion that "... it might just be high due to the prostate cancer and also due to the Gallbladder surgery and stents they put in and just removed". My kidney issue is here; https://csn.cancer.org/node/307433

Note: EGFR is a gene commonly associated with lung cancer.

Best wishes for remission forever.

VGama

LvGuy1 · February 2017

comments not showing up

When i replyed to VascodaGama above why didnt it show up ? or did i make a mistake using the reply and accidently sent him a email. if so i am sorry

tpelle · February 2017

LvGuy1 said:
comments not showing up
When i replyed to VascodaGama above why didnt it show up ? or did i make a mistake using the reply and accidently sent him a email. if so i am sorry

One of My Comments Didn't Show Up Either

A couple of weeks ago I posted a brief comment to an original post, but it didn't show up either.

LvGuy1 · February 2017

Answer to VascodaGama regarding results

VascoGama, I am very sorry, I made a mistake he was talking about my Liver NOT my Kidneys. I found out when i was re-reading my notes. Your correct about the eGFR it has to do with lung cancer but the VA states also that "All individuals with GFR <60 ML/MIN/R(1.73m2)R for 3 months are classified as having chronic kidney disease, irrespective of the presence or absence of kidney damage. All individuals with kidney damage are classified as having chronic kidney disese, irrespective of the level of GFR. EGFR results >60 ML/MIN/R(1.73m2) are imprecise. Many variables affect the calculated result. Interpretation of eGFR results >60 ML/MIN/R(1.73m2) must be monitored over time. EGFR is calculated from patient creatinine value, age, gender and race. " I copied and pasted directly from the Test results page and when we were talking about my Gamma-GTP results was when i ment about the surgery's and stent removal having a reason why it was High. Again i am so sorry and will be better the next time i post about results as i know how important some information is

Max Former Hodgkins Stage 3 · February 2017

tpelle said:
One of My Comments Didn't Show Up Either
A couple of weeks ago I posted a brief comment to an original post, but it didn't show up either.

glitches

tpelle,

We all encounter those glitches here, as at virtually all electronic forums today. It happens to me fairly regularly. I am sure it is nothing sinister.

Most cases, it will just show up later spontaneously. Also, if I post something and then check for it later without logging back on, it will virtually never be there for at least a few hours, if not the next day.

All forums have monitoring policies and differing software systems that do these sorts of things. This is especially true for any post that includes Links.

max

Prostate Biopsy Pathology results

Comments

Discussion Boards