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Radical prostatectomy 9 days ago. Need help with the pathology PLEASE
Hello everyone, thank you for taking your precious time to help. I previously wrote about my partner and his information, trying to figure out what should be done. We came to the conclusion that a prostatectomy was our next step. It was a tough decision between the choices given by our surgeon of radical prostatectomy, radiation or continue to wait and watch (which in our mind was a no-go). He wanted it gone.
His pathology report has concerned us a bit but we really don’t know how concerned 😟 we should be. This is where the honesty on this board of experience is so very invaluable.
I will post the highlights and if more information is needed, please let me know:
FINAL PATH DX on 1 of 2 tumors
Acinar adenocarcinoma, Gleason score 4+3 with introductal carcinoma of the prostate (IDC-P), limited extraprostatic extension, negative margins. L and R seminal vesicles with no tumor. One lymph node and associated fibrodipose tissue, negative for tumor.
Grade group 3. Approximately 4 small additional foci of tumor (gleason score 3+3)
Type of Gleason Pattern 4 present (including cribiform) Fused gland and expansile cribiform types.
Extraprostatic Extension (EPE) present, limited
Urinary bladder neck invasion not identified.
Approximate percentage of Gleason pattern 4:60%
Approximate percentage of Gleason pattern 5: 0%
Lymphovascular invasion not present
Perineural invasion: present
Pathological Stage Classification (pTNM, AJCC 8TH EDITION): pT3aN0
Googling is just making us have some concerns. Can anyone lay this out for us? Is further treatment of any kind warranted? His clinical history listed was Gleason score 3+4 and a PSA of 4.56. We were told that treatment was elective but we chose to proceed. Now it seems it was a bit more serious than we thought? His follow up is weeks away. Catheter comes out tomorrow.
A million times 🙏.
Di
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Hello Di,
First, I know how terrifying it is to get that path report back and it is not what you had hoped.
10 years ago my husband received a very similar report, including perineural invasion.
I did a lot of research and bottom line, the presence of PNI means that the pathologist has seen prostate cancer cells surrounding or tracking along a nerve fiber within the prostate. It's presence on the biopsy signifies a high likelihood that the cancer has escaped the gland. We knew from the surgical summary that my husbands tumor was located in the Apex of the prostate which is the narrowest section of the prostate gland and shaped like a teardrop.
In our follow up with the doctor, we had so many questions. We knew that my husband's margins had been invaded, thus the presence of perineural invasion, and were VERY WORRIED about the "wait and watch" approach of our doctor in light of these findings. We were also concerned that because my husband's nerve bundles had been spared, there was a greater likelihood that cancer was left behind. Again...so many questions and concerns, much like you and your partner.
In the end, we wished we had chosen to follow through with our instincts to seek opinions from an oncologist. We did not and exactly two years later, my husband's cancer returned and he ended up having to have an aggressive round of salvage radiation treatments.
Our only suggestion is to honor your instincts., even if it includes a second opinion, and only then can you make a decision that feels comfortable for you both.
God Bless you and sending PRAYERS for a peaceful heart in the days ahead.
~Carla
What is tour PSA?
Maybe get on Cosodex for 30 days then Zolodex injections ever 23 moths to stop testosterones the fertilizer for PC
Postop stage the same pT3aN0.
However, G 9 w/ nonfocal EPE.
EPE postop is the presence of cancer cells outside the prostate and w/in the surgical boundaries and is a negative indicator for future recurrence (BCR). As is G 9.
1st postop PSA, and tests thereafter, will be determinative.
If PSA is less than .1, then you proceed with life (and PSA testing).
My 1st postop PSA was .19 ; meaning BCR.
8 wks Salvage radiation and 4 mos short course ADT completed 2 mos ago; PSA test in November; hoping/praying/expecting undetectable PSA.
For me, the Q will be "for how long"?
Best wishes for a good 1st postop PSA.
Note: Layperson here.
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3 ReactionsYou need to wait until you receive your first PSA results 3 months after surgery. You then need to monitor your 1/4ly PSA's to see what the doubling time is.
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1 ReactionHi Carla,
Thank you so much for your response and education. My SO’s nerve bundles were spared as well. We followed our instinct and went ahead with the RP. Our surgeon told us he could choose to remain in wait and watch. We strongly felt otherwise. We weighed radiation and surgery very carefully and had consults regarding both. In the results, that were different than we expected, I’m glad we did the removal as first line treatment. I think surprise pathology is important to be aware of, particularly in our case and yours.
Today his catheter comes out so that is certainly a ray of sunshine for him!
I’m very sorry about your husband’s reoccurrence. How long ago was his radiation and how is his health now?
We will see what his first PSA test looks like postoperative. What was your experience with PSA after surgery leading up to radiation and what is it now? There shouldn’t be any now, correct?
Thanks again for your kindness and openness.
Di
I will certainly try to educate on this. Thanks for sharing more information! His PSA history before Surgery was only 4.56. We have not had the postoperative sensitive PSA test yet. It’s only been 11 days since surgery.
Di
Wow, Mr. Layperson 😏
Your results do lineup closely. Did you have perineural invasion also?
I am sorry that you were off to the radiation races, following so closely after surgery. I know that a lot depends on that first PSA test.
Cancer seems to be a chronic condition more than the death sentence of decades ago. Every time it pops up, we beat it back down. Praying you remain NED the rest of your days.
Thank you for taking the time to respond.
Di
Thank you for more PSA info following surgery. I know it is the first clue to work off of. My next question is, how high would it need to be to be indicative of immediate follow up treatment or is it just how quickly it starts doubling between tests?
I don't believe there is any need for immediate follow up treatment. My first PSA in July 2018 was undetectable at
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1 ReactionAsk if they took and lymph nodes to test
I was clear but they still put me on Cosodex for 30 days and then Zolodex shots every 3 mos for 18 months