cancer outside the gland

chagen58 Member Posts: 1
My husband, age 51, was diagnoised with prostate cancer in March 2011, gleason score 7. Had a biopsy, 6 from each side, one came back positive. He had robotic surgery to remove his prostate last week. We got the results today. They said cancer was worst than they thought and it was stage III, found cancer on both sides of the gland, changed the score to 3+4. All contained, BUT what was uncommon and they had not seen before was there was cancer outside the gland, but did not penetrate from the gland. Has anyone seen this and is this cancer outside the gland still considered prostate cancer and what are his risks? Should we request a body scan to see if there is any more cancer?


  • VascodaGama
    VascodaGama Member Posts: 3,491 Member
    Pathologist do not usually evaluate every millimetric piece

    Sorry for the present status of your husband’s disease.
    Unfortunately it is common to read reports of different diagnosis, obtained from analyses on core biopsy (before surgery) and from those obtained through analysis of the post-op prostate slices. Nevertheless, both diagnoses are considered true evidence in analysis but diagnosis can be erroneous.
    We can understand it if one considers the microscopic work performed by the pathologist in laboratory. Biopsy cores are very tiny portions taken from a large area (possibly missing a more aggressive type of cancer cell), and the pathologists do not check every millimetre piece of the slices but the areas where cancer is known to hide or the areas where the presence of cancer could indicate possible causes for future recurrence.

    Doctor Elizabeth Genega, a reputable pathologist, comments this when asked;
    “What percentage of a prostate’s surface do you actually evaluate in the lab?”

    “..When you submit the entire gland, people think you’re evaluating every aspect of the prostate, but you’re not. (You will, however, see more of the surface area than if the specimen is not submitted in its entirety.) When you slice the prostate for routine, non-whole-mount sections, each slice ranges from 2 to 3.5 millimeters in thickness, but from each of those slices, the histology lab takes slices that are only about 5 microns thick to make slides. [A human hair is 100 microns thick.] So there’s actually a relatively large surface area that you don’t see. If you were to look at the entire prostate, that would mean looking at hundreds of slides, and that’s not done.”

    The indication of cancer found outside the prostate gland but with negative extra capsular extension and negative surgical margins could be due to the poor analysis of the prostate slices (unchecked capsular portion).
    "Contained” is not a proper term used in such diagnosis.

    You have not posted here info about the PSA test or that on image studies such as MRI, CT and Bone Scintigraphy scan, done before surgery. That data is important to guide you in what you should do next.
    However, I believe that the cancer found “outside” is from the prostate. The Gleason grade and score of 3+4=7 is of an intermediate risk case. If the metastases are considered localized then Salvage Radiotherapy is recommended (with or without HT). But if the metastasis are found to be “distant” (in bones, etc.), then hormonal treatment (HT) is the way to follow.

    It all indicates that you will find a treatment proper to handle his case and that he will be fine. Do not be anxious.

    Wishing a successful recovery from surgery to your husband.