Pathology report - bahhhhh :/

hang in there surftohealth
part of the battle against cancer seems to be' find it and kill it' over and over again. I -like you and your husband maybe- have taken a stand against PC- throw away the prostrate and much of the cancer with it. If more emerges we go after it as best we can. The science is evolving which is really good. maybe down the line 30 and 40 year olds can get fantastic treatment that eliminates PC in its tracks. However, we are still way ahead of the generations before us. I think it is good that science is on the hunt for pc and has better tools to do this than it did a few decades ago.

a long road, hang in there

Ed

Thanks Phil 💗- it is exactly THAT !
You covered every single trail of thoughts that one has in this chaotic situation and every possible emotion 😟. We all are just pawns of destiny moved here and there, back and forth and kicked off the board of life the moment "all seeing eye" blinks, it seems. It is all so random that it is maddening. I guess PC truly represents a life in a nutshell, or shall we say in a "life in a gland capsule" 🤨. It all can go this or that way on its own whim. As a person who never acts on a whim and has everything thought over multiple times (perpetual Libra) curve-balls are disheartening and scary to no end. 🥺 I feel like somebody pushed me back under the water the moment I climbed on very fragile tiny boat that I hardly constructed out of information scraps collected for 5 months.
Thank you Phil for finding time to write, means a LOT 🤗

"As a person who never acts on a whim and has everything thought over multiple times..."
I would never have guessed!

Seriously, though, we're right there with you, feel your pain and frustration, and are hoping for the best for you two.

(I'll be enjoying my own RARP in about five weeks...whee--ee!)

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.

Hi @surftohealth88 : I am sorry to hear that the final pathaolgy report upgraded the grade of the cancer but was inconclusive about the stage, though your husband's recent negative PSMA PET scan is somewhat rassrruing (even though we know this tool is not 100% perfect in every scenario).

With repect to second opinion on patholgy, the gold standard is the Epstein Lab of John Hopkins which has done thousands and has established protocols for the transfer of tissue specimens and patholgy slides. You may want to look into that.

I also recommend Parick Walsh's book entitled "Gude to Surving Prostate Cancer" to everyone since it is the most comprehensive, and most undertandable with each chatpter starting with a summary, It has been updated recently. As you well know Dr Walsh of John Hopkins is the father of radical prostatectomy, is a big believer of second opinion on pthology, and Epestein is the pathologists whom he recommends.

Epestein was the gold standard for prostate biopsies and reportedly read about 12,000 slides a year. He was affiliated with John Hopkins for 40 years but left this year for private practice after some disagreements. Since Epestein was no longer affiliated with John Hopkins, I chose to go to a City of Hope urologist for second opinion and as part of that second opinion, I asked him to have his pathologist review the slides from Keck Medicin USC. The City of Hope pathologisrt re-read the slides and arrived at the same conlcusion: cancer found in one out of 18 cores, Gleason score 3+4. (By the way, my insurace paid for the second opinion test and consulations)

3+4 puts me in the intermediate risk category, but with a PSA of 14.5, it pushes me into the unfavorable intermeidate risk group of the NCCN classification. Since this group is so heterogeneous, my uroglogist ordered a GPS genomic test to assess the aggressiveness of my cancer. The score - unfortunately - was above 40 suggesting a more aggressive form of cancer. Given that, I am worried what my final pathology report will show after my surgery which is scheduled next week. Will the final pathology report discover a higher Gleason score cancer somewhere else in the prostate? Is the margin positive or negative? Has the cancer spread to the lymph nodes?

Lots of questions, but few answers at this point.