Pathology Report Question

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.

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.