HealingWell
Search Close Search
☰

biopsy results

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 9/9/2009 3:03 PM (GMT 0)
well! here we are. A little over a month after dad's first diagnosis. Several little panic attacks on my part and a prostatectomy later (on his) we finally got some good news...

The doctor called me yesterday with the biopsy results. He summarized them and then said they were 'better than he expected'. He was in fact a bit surprised. I gathered a long time ago this doctor is the aggressive/alarmist/worst case scenario type, which is exactly what me and my dad respond to. We have a 'hope for the best, plan for the worst' kind of mentality. We never wanted anything sugar coated, just the bittersweet reality, which this particular doctor is always inclined to give. Which is why I found reassuring the results came back 'better than he expected'. In fact, yesterday I was elated. Today, after actually reading the pathology report myself, I've come down a bit from the high. Let's get on with it..

pre-op PSA 5.26
pre-op Gleason 3+4 = 7
6 of 12 scores positive, mostly right side, 40-90%

Bone scan, CT scan negative.
open radical prostatectomy on september 2nd. No post surgical pain or nausea. 4 days on dad's already walking around, taking showers by himself, and generally being a pest he he.

Pathology Report:
Lymph nodes clear
prostate gland 34.6 grams
Gleason the same at 3+4 = 7
Tumor confined to prostatic capsule (this is the part that surprised the doctor)
Negative margins
'several areas' of perineural invasion noted.
'small focal area' of vascular invasion noted.
right seminal vesicle positive for neoplasia.
urethral margin/apex free of neoplasia.

pathologic staging T3b, N0, MX-stage III


Doctor suggested aggressive radiation therapy.


Ok ok, so clearly I plan to research the hell out of every single sentence in that pathology report, but what do you guys think so far? Based on your signatures, his stats seem fairly average among men who went down to undetectable PSAs after radiation. Do I have a reason to be optimistic? And just like the good Dr. Lykins, don't sugarcoat it anything turn
Posted 9/9/2009 3:29 PM (GMT 0)
Your father and I have a lot in common. My suggestion is to talk to a big name oncologist if possible. Your dad can do well but he should keep the best care available. Radiation is a good step at this point, but should he add hormonal therapy? should he look into a clinical trial? These questions may be important.

So far, he does have a serious case, but he still has many options on what to do next. My Email address is open in my profile. I would be glad to work with him or you in lending my experience with a very similar pathology result...I am on year three...

Tony
Posted 9/9/2009 3:45 PM (GMT 0)
I have a question to all of you guys. T3b means seminal vescicals invasion, but pathology says neoplasia. That's benign, right? How do you square this?
Posted 9/9/2009 4:42 PM (GMT 0)
Student,
You now have partial information.
In determining a treatment you have to answer 3 questions:
Is the PC indolant or agressive? Indications are that your Dad's is moderately agressive.
Is the PC contained in the Gland, localized to the bed or matastized? You don't have enough information to make ths decision. Your doctor seems to think it was not contained if he is recommending radiation.
Is the PC acting normal or is it a devient? Only a Prostate Oncologist can determine this.
Tony's recommendation to seek an opinion from a top name oncologist should be your next step.
JohnT
Posted 9/9/2009 9:42 PM (GMT 0)
well i think the reason why the doctor suggested radiation is because they noted on the pathology report a small focal area of vascular invasion, and radiation seems the next logical step.

@ John T-
The path. report says negative margins, and tumor confined to prostatic capsule. Doesn't this mean it's either localized to the bed or contained in the prostate? What am i missing?
Posted 9/9/2009 10:02 PM (GMT 0)
It seems to me that your dad's case is right on the edge. Do you pull the trigger now and start radiation or do you wait for a post surgical psa?
Given that the path suggests some escape beyond the prostate it is easy to see why your doc is for radiation now. You might plug your dad's figures into the nomograms and see the percentages. With my extra prostatic extension my chances of being progression free are still over 60% and, based on this, my doc recommended watching the PSA rather than do what was more likely to be unneeded treatment. This agreed with my reading that delaying radiation in marginal cases did not increase risk -- but you should do your own research

This PCa is a tough call every step of the way. A further consult with an oncologist sounds like a good course.
Posted 9/9/2009 10:45 PM (GMT 0)
I looked at different nomograms and the results give 80-89% 10 yr. chance of no recurrence. I personally favor radiation soon. I don't like to take chances, specially with this.

I also followed your advice and got the phone number for the Emory Winship Cancer Center, will set up an appointment tomorrow for a second opinion with a prostate oncologist.
Posted 9/9/2009 11:15 PM (GMT 0)
Student,
It's a very good queston and don't have the knowledge or skill to answer it. There must be a reason your doc recommended radiaton.
Posted 9/9/2009 11:28 PM (GMT 0)
Sounds like you have received some very good advice.  I'd see the prostate oncologist and go from there.  Thanks for being such a good daughter! I'm sure your Dad appreciates it.  David

Posted 9/10/2009 5:49 AM (GMT 0)
Every time you read a post here at HW, you learn more and more, well I certainly do.

Q. Stage T3 my understanding tumor has left the capsule ! So why then does this path report state - tumor confined to prostatic capsule eyes . This is confusing to me, help please Tony or someone.............cheers Kev

 

Posted 9/10/2009 7:05 AM (GMT 0)
Student25,
I made a mistake looking at your fathers stats on the final pathology. I believe that this report is questionable. The first order of business is to have a second opinion on the pathology. I it were me I would have this prostate be sent to Johns Hopkins University attention Jon Epstein. Before any further action. The guys here raised some great points and I looked only at the 3B stage and the neoplasia (which btw should not be present in the seminals).

This pathology is not properly described in the report.

Tony
Posted 9/10/2009 10:43 AM (GMT 0)
I must say you guys know some stuff!!!!!! I am blown away you your knowledge.

Jeff T
Posted 9/10/2009 4:05 PM (GMT 0)
Tony....correct me please if I am wrong here.

But neoplasia is abnormal growth of cells...which may or may not be cancerous. The pathologist may not have been able to distingish the type of cells accurately due to the sample size or sample condition after surgery. And because of them being located within the seminal vesicles, it would lead to staging of a T3 as the seminal vesicles are not clean and free of any abnormal cell growth. I would think that the staging and followup radiation recommendation would be correct in this instance. And I also agree regardless of the questionable seminal vesicle...a second reading by another pathologist is in order.
✚ New Topic ✚ Reply