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Pathology report - bahhhhh :/

Posted by surftohealth88 @surftohealth88, Aug 17 1:29pm

Ok - here we go, of course it can not be simple with us - ever !!! Sheeeeshhh ...

I mean there is nothing simple with PC, but still, having report stating "margin status can not be assessed" is just mind-blowing ... Further explanation : tumor glands focally extend very close to the inked margin, but no tumor glands are definitely identified at the true margin.
*sigh You know what - I will take it as "clear margins" LOL, I have to survive this report somehow.

Second - Gleason UPGRADED - I am not surprised, happens , especially with cribriform and IDC. Let this be warning to anybody with cribriform glands and/or IDC - you are in separate group and understand that you have very aggressive cells in your gland that multiply FAST and CHANGE fast. You do not have typical PC that moves slowly and "can take years" to advance. This was 5 mos from 4+3 to 4+5 !!!

Gleason 4+5 - Luckily, only 6% of the whole gland has that finding.

PNI - present inside the gland, nothing outside

All other tissue surrounding gland - negative

All in all, gland was taken out in the last moment, literary. I am aware that this puts my husband in increased risk for BCR , but we shell see. It is what it is... We are super happy that we had RP since the source of emitting further mets is out and because cribriform are resilient to radiation. If he ever needs some extra zapping - we will deal with that when and if that time comes.

My husband who is super optimist is happy with findings - I am bummed. Talking about Yin and Yang. XP

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

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peterj116 | @peterj116 | Aug 17 4:34pm
In reply to @topf "There is supposed to be a DVD of all prostatectomies?" + (show)
Profile picture for topf @topf

There is supposed to be a DVD of all prostatectomies?

Jump to this post

Can you imagine the DVD commentary.

OMG... would it hurt him to lose a bit of weight?

What's that gross thing?
I dunno.... just chop it out. He won't miss it.

Oops.. I dropped my contact.

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Profile picture for surftohealth88
surftohealth88 | @surftohealth88 | Aug 17 4:40pm
In reply to @peterj116 "Can you imagine the DVD commentary. OMG... would it hurt him to lose a bit of..." + (show)
Profile picture for peterj116 @peterj116

Can you imagine the DVD commentary.

OMG... would it hurt him to lose a bit of weight?

What's that gross thing?
I dunno.... just chop it out. He won't miss it.

Oops.. I dropped my contact.

Jump to this post

Peter 😆, thanks for cheering me up ... God knows I need that 🥲

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jeff Marchi | @jeffmarc | Aug 17 4:52pm
In reply to @topf "There is supposed to be a DVD of all prostatectomies?" + (show)
Profile picture for topf @topf

There is supposed to be a DVD of all prostatectomies?

Jump to this post

My understanding is that they video all of them. I was given the DVD of my prostatectomy 15 years ago. Not the greatest video you ever saw!!!

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surftohealth88 | @surftohealth88 | Aug 17 5:04pm
In reply to @jeffmarc "My understanding is that they video all of them. I was given the DVD of my..." + (show)
Profile picture for jeff Marchi @jeffmarc

My understanding is that they video all of them. I was given the DVD of my prostatectomy 15 years ago. Not the greatest video you ever saw!!!

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Jeff- you are PC info champion !!! You should get some official recognition here - honestly 🏆 !!! 👍

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jeff Marchi | @jeffmarc | Aug 17 5:20pm
In reply to @surftohealth88 "Hi Jeff - thanks for giving me some advice for going forward 😟. Do you have..." + (show)
Profile picture for surftohealth88 @surftohealth88

Hi Jeff - thanks for giving me some advice for going forward 😟. Do you have any idea of how and where to send the whole gland for examination ? I guess it would be very difficult

Yes - it could be possible that cribriform made it to 5 level, and this also shows that biopsy is not so precise as we would like to think. It is often said that only when gland is out and on the table to be examined as a whole by pathologist the real and whole picture is known.

Pathology report was sent this morning without doctor's comments ( directly from pathology) so we will try to get hold of doctor tomorrow and possibly get some more info and explanation about findings.

My husband is not on any ADT , his initial findings pointed to intermediate unfavorable with no extensions and very small tumor burden. Out of 14 samples only single one had 4+3, and 2 others were 3+3 , all the rest clear. PSMA clear on everything but that one spot on the right side of prostate and he had detailed TRUS in July which also confirmed that all was contained in a gland.

We will ask about possible ADT and ARSI, thanks for telling me about that possibility.

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I wish I knew a specific place you could send that. I did do a search on the web with this search “ after a prostatectomy can the tissue and the video of the surgery be sent to a second doctor for analysis”. There was quite a bit of information starting off with this.

Yes, it's generally possible and often recommended to have the tissue from a prostatectomy (and potentially the video of the surgery, though less common) sent to a second doctor for review and analysis. This is especially relevant in cases like prostate cancer, where accurate staging and grading are crucial for determining the best course of treatment.

If you do the search in quotes above, you can find a lot more information. They start off recommended you talk to your doctor About having this done.

I can imagine how frustrating it is to be told they don’t know about the margins. They tell you the tumors are not extending beyond the margins, I sure would like to know why they can’t say the margins are clear. Is there something they are not addressing in the report?

Dr. Epstein does a lot of secondary analysis of biopsies. He may also do analysis of Prostatectomy tissue. You should contact his office, if your doctor can’t give you satisfactory answers. If nothing else, their office can probably refer you.
https://advanceduropathology.com/

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johndavis60 | @johndavis60 | Aug 17 6:08pm
In reply to @surftohealth88 "Thanks for the info John - do I ask my doctor to do FoundationOne test ?..." + (show)
Profile picture for surftohealth88 @surftohealth88

Thanks for the info John - do I ask my doctor to do FoundationOne test ? Is that somatic test for genetic changes in cancer cells ?

Jump to this post

My Medical Oncologist wanted it done. I worked with her nurse to fill out the application and foundationOne told me my out of pocket for the test was $0, which was kind of surprising. The foundation one test analyzes the biopsy/prostate tissue and is looking for biological mutations within the tumor. It is not looking for dna mutations that are inherited. Once the mutations (if any) are known, it will give your doctors a better idea of what’s going on and if the treatment plan can be tailored more precisely to fit your husbands needs. Depending on what your doctors plans are, and what the somatic test shows, they may not change plans, they might just go with SOC and see how that goes. My test did not change treatment plans. Not sure if that’s a good thing or a bad thing, but I don’t think pluvicto will work in my case due to the findings of the test. Maybe my doctor knows of some other drug that I can eventually take, but for now it’s Firmagon, zytiga and radiation. I asked for Chemo after radiation but Dr said no. Anyway, the point is that somatic testing can give you more insight to the cancer cells, and that added knowledge can eventually be used to help fight against them. 🙂

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Profile picture for surftohealth88
surftohealth88 | @surftohealth88 | Aug 17 6:08pm
In reply to @jeffmarc "I wish I knew a specific place you could send that. I did do a search..." + (show)
Profile picture for jeff Marchi @jeffmarc

I wish I knew a specific place you could send that. I did do a search on the web with this search “ after a prostatectomy can the tissue and the video of the surgery be sent to a second doctor for analysis”. There was quite a bit of information starting off with this.

Yes, it's generally possible and often recommended to have the tissue from a prostatectomy (and potentially the video of the surgery, though less common) sent to a second doctor for review and analysis. This is especially relevant in cases like prostate cancer, where accurate staging and grading are crucial for determining the best course of treatment.

If you do the search in quotes above, you can find a lot more information. They start off recommended you talk to your doctor About having this done.

I can imagine how frustrating it is to be told they don’t know about the margins. They tell you the tumors are not extending beyond the margins, I sure would like to know why they can’t say the margins are clear. Is there something they are not addressing in the report?

Dr. Epstein does a lot of secondary analysis of biopsies. He may also do analysis of Prostatectomy tissue. You should contact his office, if your doctor can’t give you satisfactory answers. If nothing else, their office can probably refer you.
https://advanceduropathology.com/

Jump to this post

Thank you Jeff, will do !!! 👍

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surftohealth88 | @surftohealth88 | Aug 17 7:09pm
In reply to @johndavis60 "My Medical Oncologist wanted it done. I worked with her nurse to fill out the application..." + (show)
Profile picture for johndavis60 @johndavis60

My Medical Oncologist wanted it done. I worked with her nurse to fill out the application and foundationOne told me my out of pocket for the test was $0, which was kind of surprising. The foundation one test analyzes the biopsy/prostate tissue and is looking for biological mutations within the tumor. It is not looking for dna mutations that are inherited. Once the mutations (if any) are known, it will give your doctors a better idea of what’s going on and if the treatment plan can be tailored more precisely to fit your husbands needs. Depending on what your doctors plans are, and what the somatic test shows, they may not change plans, they might just go with SOC and see how that goes. My test did not change treatment plans. Not sure if that’s a good thing or a bad thing, but I don’t think pluvicto will work in my case due to the findings of the test. Maybe my doctor knows of some other drug that I can eventually take, but for now it’s Firmagon, zytiga and radiation. I asked for Chemo after radiation but Dr said no. Anyway, the point is that somatic testing can give you more insight to the cancer cells, and that added knowledge can eventually be used to help fight against them. 🙂

Jump to this post

Thanks for detailed information and explanation 👍- I will ask doctor if it is possible to do that for my husband .

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topf | @topf | Aug 17 7:16pm
In reply to @jeffmarc "My understanding is that they video all of them. I was given the DVD of my..." + (show)
Profile picture for jeff Marchi @jeffmarc

My understanding is that they video all of them. I was given the DVD of my prostatectomy 15 years ago. Not the greatest video you ever saw!!!

Jump to this post

Thanks! I will ask for a copy on my follow-up visit. Though I do not intend to watch it….

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heavyphil | @heavyphil | Aug 18 7:20am

Surfer, in your own words “it is what it is”…
And now that you know what it is, you and your husband can move forward.
You’ve both gone thru a lot just getting to this point so take a deep breath and take a victory lap for getting over a HUGE hurdle.
Hopefully, another look by a different pathologist will give you both more clarity on the margin issue. Best,
Phil

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