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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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Time for an update! Partner's first SPSA came back at .015 at 8 weeks post surgery. We are thrilled with that!
We really hope we can ride that number for a long time. Although he never experienced any incontinence, he has not regained sexual function yet. He's aware it's still considered early days but it does make him a bit anxious.
Is there data on the timeline that is considered the average healing time to recover an erection?
As always, thank you so much for your time.
Di
Here is a good summary of erectile dysfunction after radical prostatectomy, including rehabilitation, management, and treatment.
https://www.hopkinsmedicine.org/health/conditions-and-diseases/prostate-cancer/erectile-dysfunction-after-prostate-cancer
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1 ReactionThank you, trusam1. That's very helpful!
@di341 Very best wishes for your husband's continued recovery.
May I ask what Dr. did the surgery and where?
Thank you.
Di,
You can Google yourself till you're blue in the face and it won't tell you how to diagnose a Pathology report. Nor will you get that information from this board. That professional diagnostic ability takes years of experience once you are a physician. My wife was involved in cancer diagnosis, she was recognized as one of the best and after 30 years experience she says she was still learning. You are unnecessarily wasting time and energy. If you want answers to Pathology diagnoses get opinions from other Pathologists. Take your results for second and third opinions. You will then have a good idea of what is happening.
Dr. Peter Carroll at UCSF in San Francisco. Among the top tier surgeons for prostate surgery in the world.
Hello Dpcarriere,
I'm sure you didn't intend to come off as condescending but your message did read that way, in part, and I assure you that I did NOT unnecessarily waste time nor energy here.
In today's world, we have access to our reports via MyChart before our scheduled follow up with our surgeon. It can be scary, especially upon finding out that staging has jumped from I to III, upon surgical pathology.
Being new to Prostate cancer and surgery, looking to others to share experiences and knowledge has been invaluable. Of course a professional diagnostic is sought and no one here has claimed to have those abilities.
Everyone has been so kind to share what they have experienced and learned. It helped me to form the important questions for our surgeon during our follow up appointment. It was also reassuring to communicate with others in our same boat. This board has been a very valuable resource in our education.
I appreciate your time in responding in any regard. I am curious as to what being here on these boards has helped you with?
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2 Reactions@di341 Thank you so much for the information.
I am trying to find the best people I can to treat my newly diagnosed partner.
Hi Di,
Thanks for the update, sounds like overall good news. My husband's surgery was a few weeks later and you asked me to report back. He is a young 72, has had an easy recovery. Very long surgery because of enlarged prostate issues, but nerves were spared. No pain at all, only minor discomfort from the yucky catheter. Now back to most activities w/only minor leaks and nice signs of erectile function.
Path report was not perfect but surgeon did not seem concerned. T2 contained, downgraded from G8 to G7 (4+3) w/ clear lymph nodes. But PNI was present as well as one positive 'micro margin'. Meeting with doc/first post-op PSA coming up in two weeks. Husband is in good spirits, confident that RP was the right decision (he was adamant about no ADT which would have been required with any kind of RT for G8). I will continue to do the worrying for both of us.
Please keep us updated on your SO. Best wishes and good luck to you both.
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1 ReactionI'm new to this and on tenterhooks. If you haven't had a PSMA Pylarity CT, you could request one. And if you haven't had genetic testing of the tumor itself (somatic) it should still be available for somatic testing. It will give you direction on what type of chemo or immunotherapy you might pursue.
Praying for the best for you and your darling.
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