1. < Prostate Cancer

RARP Pathology II: Looking for direction

Posted by 1912berg @1912berg, Jun 27 10:40am

Ok. Quick summary is I was diagnosed this year with PC. May 12 had RARP. Post surgery doc (extremely well qualified DP surgeon and head of a major medical university urologicial department) stated he had no cancer concerns at that point and was quite positive. 6 week post-op 06/26/2025 yesterday and in looking at the surgical pathology, and the imaging results of prior MRI as part of my visit, the MRI did not show EPE that was added to surgical pathology. Good news: first post-op PSA test came back undetectable = ≤0.01. Below I am providing the surgical pathology findings. The reason is because the doc stated I may or may not need radiation down the line. States 3 out of 4 with my pathological findings do not. I'll have another appointment with my local urologist (I used a university doctor for DP because of his skill level and qualifications) in 3 months so I'll discuss plan with him going forward, but I'm curious what others may think of the findings and what your various thoughts look like on the report. Overall doc didn't seem overly concerned.

Radical prostatectomy
TUMOR
Histologic Type: Acinar adenocarcinoma, conventional (usual)
Histologic Grade
Grade: Grade group 2 (Gleason Score 3+4 =7)
Minor Tertiary Pattern 5 (less than 5%): Present
Percentage of Pattern 4: 11 - 20%
Intraductal Carcinoma (IDC): Not identified
Cribriform Glands: Not identified
Treatment Effect: No known presurgical therapy
TUMOR QUANTITATION
Estimated Percentage of Prostate Involved by Tumor:
11 - 20%
Greatest Dimension of Dominant Nodule (Millimeters): 21 mm
Location of Dominant Nodule: Left posterior
Extraprostatic Extension (EPE): Present, focal
Location of Extraprostatic Extension: Right posterior
Urinary Bladder Neck Invasion: Not identified
Seminal Vesicle Invasion: Not identified
Lymphatic and / or Vascular Invasion: Not Identified
Perineural Invasion: Present
MARGINS
Margin Status: Invasive carcinoma present at margin
Linear Length of Margin(s) Involved by Carcinoma:
Less than 3 mm (limited)
Focality of Margin Involvement: Unifocal
Margin(s) Involved by Invasive Carcinoma: Right posterior
REGIONAL LYMPH NODES Regional Lymph Node Status: All regional lymph nodes negative
for tumor Number of Lymph Nodes Examined: 7

Thanks in advance for any thoughts on the findings and glad to answer any additional questions some may have if it helps them.

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topf | @topf | Jun 27 10:46am

Focal EPE is not that important if margins are negative. You have some small positive margins, which should slightly raise your recurrence risk. But, overall, its a fairly good pathology. I wonder if they can determine if the margins are pattern 3 or 4.

REPLY
jeff Marchi | @jeffmarc | Jun 27 12:39pm

While the EPE is concerning the invasive margins are more immediately concerning issue. Frequently, under these conditions, they would do radiation on the margins to make sure they don’t metastasize. Your doctor has already talk to you about that. He may wait to see you in if your PSA rises before doing anything.

Ask your doctor if invasive margins were on the side of EPE or in another area? Was the area near the EPE cleared?.

EPE can result in the cancer getting into your bloodstream, which means it could spread anywhere. A PSE test can detect if there is still cancer in your bloodstream though the PSA test also does that. It could be a PSE test could detect the possibility of metastasis better than a PSA test, You could discuss it with your doctor. Episwitch, who makes the PSE test, claims it’s also useful for after surgery to detect cancer in the bloodstream.

REPLY
1 reply
1912berg | @1912berg | Jun 27 2:26pm
In reply to @jeffmarc "While the EPE is concerning the invasive margins are more immediately concerning issue. Frequently, under these..." + (show)
@jeffmarc

While the EPE is concerning the invasive margins are more immediately concerning issue. Frequently, under these conditions, they would do radiation on the margins to make sure they don’t metastasize. Your doctor has already talk to you about that. He may wait to see you in if your PSA rises before doing anything.

Ask your doctor if invasive margins were on the side of EPE or in another area? Was the area near the EPE cleared?.

EPE can result in the cancer getting into your bloodstream, which means it could spread anywhere. A PSE test can detect if there is still cancer in your bloodstream though the PSA test also does that. It could be a PSE test could detect the possibility of metastasis better than a PSA test, You could discuss it with your doctor. Episwitch, who makes the PSE test, claims it’s also useful for after surgery to detect cancer in the bloodstream.

Jump to this post

This was the clinical note, in totality, added to my record after our visit. I don't know that I can discern anything else from the pathology and notes.

We discussed his pathology and his EPE and positive margin status, both right posterior prostate. This is an interesting finding as it did not correlate with his MRI and biopsy, however we are pleased that his PSA is undetectable today and his leakage is non bothersome. He will plan on seeing his local urologist for continued surveillance and will contact our office should any issues arise. He voiced his understanding and is
agreeable to the plan.

Appears to be on same side.

REPLY
1 reply
jeff Marchi | @jeffmarc | Jun 27 3:04pm
In reply to @1912berg "This was the clinical note, in totality, added to my record after our visit. I don't..." + (show)
@1912berg

This was the clinical note, in totality, added to my record after our visit. I don't know that I can discern anything else from the pathology and notes.

We discussed his pathology and his EPE and positive margin status, both right posterior prostate. This is an interesting finding as it did not correlate with his MRI and biopsy, however we are pleased that his PSA is undetectable today and his leakage is non bothersome. He will plan on seeing his local urologist for continued surveillance and will contact our office should any issues arise. He voiced his understanding and is
agreeable to the plan.

Appears to be on same side.

Jump to this post

You are now beyond the expertise of a urologist. They do the surgery and they love to give you drugs because they make a lot of money off of them.

If you need radiation, you need a radiation oncologist. In some cases, they even replaced the urologist for all treatment.

For optimal treatment you should look into a center of excellence or a Genito urinary oncologist To help guide your treatment from now on. There are many different drugs you may need and a specialist in prostate cancer like a GU oncologist can make treatment decisions easier for you. They really understand the options and can explain them to you.

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