What is next after a final pathology report of T3bN0MX cancer stage ?

For patients with pT3bN0Mx prostate cancer, margin status, capsular invasion, and PSA were not statistically significant risk factors for disease progression.

Gleason score and major Gleason grade were the only statistically significant variables that predicted disease progression. A specimen Gleason score of greater than 7 and major Gleason grades greater than 3 were associated with an increased rate of disease progression in this patient group.

So could you tell us your age, Gleeson Score & Grade.

Thanks Peter.

Age 72 with very healthy diet, and daily excrcises and yoga.

On the final pathology report, it says Grade Group 2, Gleason score 7 with pattern 4 : 21-30%.

You didn't ask for it, but I had a GPS genomic score of 47 (way above the cutoff of 40 for aggressive cancers). I see that as an additonal high risk factor.

Hi Soli, sorry to hear that you had SVI since otherwise you would have great findings. If your margins (which you did not mention) are negative, and you have no other aggressive features like cribriform or IDC etc, you still have pretty good scenario there, especially if cells in you seminal vesicles are gleason 3, and yes, they can see that ( I mean your pathologist can see that). If your doctor does not have good insight of what pathologist saw exactly, you may ask for app. with pathologist (we talked to pathologist ).

Regarding further treatment, I hope other members who had this scenario will jump in. As far as I know no treatment is prescribed until first post op PSA results come in. So far what I read is that if PSA is not detectable, margins negative, patient does not have very high Decipher nor high gleason score, immediate treatment is often not necessary.

Hope I was of some help, I am still learning about all of this pathology nonsense and implications where it all can be "something" and at the the same time "nothing" depending of a study or year of publication etc. and many other factors.

I am pretty sure that your doctor will say that you should wait for PSA and it might come back undetectable 🍀🍀🍀 :). If you were gleason 9 , and had large cribriform and positive margins, THAN it would be possibly real problem. BUT again, with PC all can be a problem ....eventually ... *sigh

Wishing you the best of luck in your recovery and undetectable PSA in 3 mos 😊👍🍀

Thank you @surftohealth88 for helping me better understand my pathology and diagnosis.

Pathology report found acinar not cribform cancer. Then it says "all margins negative for invasive carcinoma". It also says "All regional lymph nodes negative for tumor". But they only examined 1 lymph node, so I have some questions for my urlogist about this.
I do not see IDC or aggressive fetures like cribriform anywhere in the report.
On the flip side it says: "lympho vascular invation present". "Perineural invation: present".
Also, I have a GPS genomic socre of 47 which predicts a very aggressive cancer.

So, it appears to be a mixed bag (which is often the case) that needs to be sorted out with my doctor, but any input you have on the diagnosis and treatment optionss (if needed) will be invaluable to me so I can ask my doc the right questions next week.

Hi there soli, I was 74 when they found seminal vesicle invasion and pelvic lymph node infestations. I had 28 sessions of RT. Plus ADT therapy. No prostate removal. Today my PSA has been less than .01 for over two years now- I started with Gleason 9 on 12 biopsies. No more ADT shots since Jan. 2025. Lying in bed one night I felt the growth fall off my seminal vesicle- sounds crazy but I think the RT cooked it into oblivion. lol. Told the MO, but he just looked at me. lol. Today I m waiting for my testosterone to come back, it’s only 20 two months ago, but it’s rising. I can tell by the hair growth on my face and my Peter size. Hope you enjoyed this discussion. Only telling you what I EXPERIENCED. Take care, relax a bit.

Thanks for sharing your experience.

I might be wrong on this, but I think that GPS is used exclusively to decide on AS vs. treatment. Given that you clearly needed treatment, that’s a moot point now. You should inquire about getting a Decipher dcore on your specimen to assess long-term risk.

This is great advice, I did not know that you could make an appointment with the pathologist.

I will be meeting with my uroloigst who did the surgery last week, not with the pathologist. The urologist will explain to me what the pathoogy report says in some detail Then I expect we will discuss next steps (further treatments if needed, PSA testing schedule, referal to pelvic floor clinic etc)

My understanding is that the GPS score indicates the biological aggressiveness of a prostate cancer on a scale of 0-100, predicting the risk of future events like cancer spread, prostate cancer-related death, and adverse pathology (aggressive disease elsewhere in the prostate) within 10 years.

On the scale 0 to 100, below 20 is very low risk, 20 to 40 is intermediate risk, and 40 to 100 is very high risk. Unfortunatelyh my score is 47, So I have a cancer with a very aggressive biology. I will consult with my urologist how this may factor in determining next steps, oe maybe if it doesn't as you suggested.