Shocking Post Op Pathology Report

You didn't blow it. Biopsies are random. It just missed the higher grade tumor.

It happens about 1 out of 4 times. My first biopsy missed the tumor entirely... G8(4+4).

Don't blame yourself. You did nothing wrong. Don't let false guilt tear you apart.

Your status did not change in the six month you spent investigating. In reality, a typical 12 needles biopsy analysis less than 7% of a normal size prostate (25cc), therefore, missing the cancer is a possibility. Still worse is that the prostate specimen is not totally sliced and investigated fully under the microscope. I recall reading that pathologists just look at important areas such as the margins of incisions, the tissues in areas out of biopsy range and sporadic places in the inner zones. They also analyze the seminal vesicles, nerve bundles and lymph vascular and nodes, all representing about 10% of the all surface area of 4 mm slides. Here you can read details of the procedure instructions given to pathologists.

http://www.europeanurology.com/article/S0302-2838(12)00306-5/fulltext/a-contemporary-update-on-pathology-reporting-for-prostate-cancer-biopsy-and-radical-prostatectomy-specimens

The clinical stage pT2c refers to a contained case. The only missing information regards the lymph nodes that were not dissected, a common practice in RALP approaches. The PSA will be your marker of success.

 Best wishes for fast and full recovery.

VGama

My advice is that if you are waiting to have the surgery, don't postpone it any longer. Get it while the cancer is still encapsulated and save your life. Once it spreads outside the prostate gland, you are in trouble.

JS2017 said:

Surgery

My advice is that if you are waiting to have the surgery, don't postpone it any longer. Get it while the cancer is still encapsulated and save your life. Once it spreads outside the prostate gland, you are in trouble.

AZ Guy already had surgery...

GeorgeG said:

You did not blow it,

You did not blow it, reference all of the comments above. You took decisive action in a reasonable timeframe. I was also upsatged after surgery - it happens often. Just stay focused and relax as best you can. The new reality is not always fun but take s deep breath and move forward.

It's not about the cards we are dealt, it's about how we play the ones we get.

AZ Guy,

My experience was similiar. My biopsy showed only 1 of 12 cores positive, with only 5% involvement in that one.  My surgery was only a few weeks after the biopsy.

The pathology report showed that in fact it was a significant Stage 2 disease.  This is not uncommon, and is a reason I myself could never be at peace with A/S. Men who are at peace with it, may God bless you all.

PCa Staging and imaging overall are primitive and best-guesses.  I tend to err on the side of caution.

Also: I requested the biopsy because of rising PSA every year for 3 years. The rate was not terrible but steady. My GP said there was no reason to get a biopsy, but gave me a referral to a urologist, and she said as soon as she looked at my chart, "Yes, you need a biopsy." Heck, the GP didn't even believe in the annual PSA.  

On the table during the biopsy, the extractor gun attached to the ultrasound probe jammed after removal of core #11.  The doc told me to hold still while she went and got a tech to "fix" the machine.  It was fixed in a couple of minutes and she then took the last core.  The biopsy results were as follows:  1-11, no cancer. The only positive core was #12.  Exercise due diligence.  To doctors, any given patient is a statistical data pack.  Insist on being an individual instead.

max