Pathology Report

My husband received his path report today from his prostatectomy on the MD Anderson website. One thing I am confused about is the Perineural Invasion as well as the 3rd component of his Gleason score being Tertiary 5. He is a Gleason 7 (4+3) and now with a tertiary of 5. The surgical margins were negative, seminal vesicles negative, lymph nodes negative, organ confined, and vas deferens negative. There was also High Grade PIN listed. Should we be concerned about the tertiary 5, PIN and the Perineural Invasion since it was organ confined? We don't have a doctor's appt until 8/25.  His first post op psa test is also on 8/25.

How do I post his statistics at the bottom of each entry as I see it posted on others?  Do I post it each time or is there somewhere in the profile that  his biopsy info and pathology info can be entered just once and it appears each time I post?

Thanks in advance for everyone's help.

To post your statistics is real simple. Go first to your profile and you add them under where is says edit signature. When you crate a new post at the bottom of the post is a box you check that asks if you want to include a signature.

Good luck on you 8-25 meeting with the URO, I am sure he will have answers to you questions about the Pathology report.

Terry

Perineural invasion is a concern for high gleason men. Many doctors think that PCa cells can get out of the prostate, and into the blood stream, through the perineural nerve layer. I significant number of high gleason men (G8-10) have BCR even with a capsule contained tumor. The perineural layer is often considered that path used by the cancer cells to get out.

Hi jg, - HGPIN (High Grade PIN) is thought by many to be a precurser to Prostate Cancer (PCa) and the true significance of Perineural Invasion is mixed in Studies. But let me simplify the results for you, so that you can more logically concentrate your concerns where they belong while better understanding the remaining risks involved. You know that your husband has PCa and a fairly aggressive Gleason Score accompanying it. The finding of HGPIN is of NO clinical significance and is of no concern under these circumstances. As I said, the true significance of Perineural Invasion (PNI) has not been clearly defined, as Study results have been mixed, but in any event it is of little significance compared to the Gleason GRADES cited in the post-surgical Pathology Report.

Here is the true situation. Most of the Pathology fresults you describe, such as negative surgical margins, seminal vesicles not involved, etc, are very favorable findings and you should be encouraged by them. The finding of a tertiary (3rd in a series) of Gleason GRADE 5 is not and the Primary Gleason GRADE (pattern) of 4 is also less favorable than you would like to see. All of these factors either increase or decrease the statistical likelihoods (the odds) of successful treatment, but by themselves are not prognostically defining. So where does he stand?

He has, or PERHAPS HAD, a confirmed, relatively aggressive PCa. He has now had radical surgery at one of the outstanding Cancer centers in the world with negative margins and other favorable findings as far as visible evidence of spreading is concerned. The question now then, is did the surgery remove all the related cancerous cells from the body. Since micro-mets are not always able to be detected by todays technology, the only way to know for sure, is to monitor his PSA results in the future. After Radical Prostatectomy, the PSA should fall to clinically "undetectable" levels, which is any reading LESS THAN 0.1 ng/ml (reported as <0.1 ng/ml) on the Standard PSA assay and should REMAIN there. As long as the PSA remains "undetectable", he will be considered to be PCa free.

So, put it in perspective, it really boils down to whether the Prostate removal took with it ALL the survivable malignant cells from the body, or not. Either it did OR did not and there is little, if anything, that you can do about those eventual results. The aggressiveness is obviously not a factor, IF it has ALL been removed by the surgery. Continued PSA monitoring is the most reliable means, to confirm the continuing "PCa Free" status of his disease. I wish he and you well in the recovery process and don't let needless worry about things over which you have little or no control interfere with celebrating the favorable status he, hopefully, will enjoy in the future. Good luck! - [email protected] (aka) az4peaks

Thanks John. We are anxious to hear what the doctor has to say and the results of his first post-op PSA test. This site has been so informative and I appreciate everyone's replies.