Post Radical Prostatectomy Pathology Report – Good/Bad, Who Knows?

Friends,

Got my pathology report yesterday and greeted my results with mixed reviews. As you may remember, and from my signature block below, my pre surgery pathology was Gleason 3+3=6, two of 12 cores positive, PSA hovering between 4.6 and 5.6. Surgery 8 days ago went pretty good and with exception of an issue detailed in another thread, I am recovering well.

Here is the jist of my post surgery pathology report:

A. Apex (excision): Skeletal muscle negative for carcinoma and prostate glandular tissue
B. 2 left lymph nodes negative for carcinoma
C. 3 right lymph nodes negative for carcinoma
D. Prostate with bilateral seminal vesicles (robotic assisted laparoscopic prostatectomy)
1. Prostatic adenocarcinoma
2. Carcinoma involves the right posterior mid-gland to base
3. Gleason grade 3+3 score 6
4. Carcinoma involves 10% of gland volume
5. Apical margin is negative for carcinoma
6. Bladder base margin is negative for carcinoma
7. Right posterior lateral margin is focally involved by carcinoma
8. Seminal vesicles are negative for carcinoma
9. Extraprostatic extension is focally present
10. Perineural invasion is identified
11. Lymphatic space invasion is not identified

My surgeon said that he spoke to the pathologist and that she only saw a tiny shred of cancerous tissue a the margin and that she struggled to make a decision on whether or not to label it as a positive margin; however, in the end, she made the decision to label it as “Positive”. My surgeon then proceeded to ask me whether or not I wanted to proceed with plans for adjunct RT to ensure that if anything remained in the prostate bed, we would kill it. I asked him what he thought; what was his opinion and recommendation – Answer: “you could go either way”. That’s it, nothing more, nada. I told him, I think I want to wait and get the initial PSA to see where we stand. He said “great, that’s what we will do then”. He seemed to lean slightly towards RT but didn't try to sway me either way....didn't really submit any for consideration either...Wow.

I may have some faulty reasoning here, but when my initial biopsy came back as a Gleason 6, I’m pretty sure there were medical professionals out there who believe in their hearts that treating a Gleason 6, with my PSA, etc…is over treating a problem that likely may never manifest itself any further than an elevated PSA. Now that the majority of my cancer is guaranteed to be gone via surgery (the tumor in the prostate), and both the seminal vesicles and lymph nodes were clear, any slight cell or cells that may be left behind outside the margin are still a Gleason 6 and may likely never manifest themselves further. In fact, from reading Dr. Walsh, any cells left behind may have already been killed by the procedure alone.

So, I can’t believe that based on all the facts of the case, that anyone would promote immediate RT (after healing from the surgery of course) without more evidence (elevated PSA) to confirm that something was left behind and it is growing again. What think you?

Thanks
Brewer

I was a pT3a with gleason 7 and I haven't had to do any radiation.

Not to suggest that what your surgeon suggests is odd for a Gleason 6 with a single focal positive margin but it is always a good idea to get second opinions. You should definitely talk to another doctor before you make any decision about radiation. If you tell us which part of the world you are in we might know someone in your area. You previously said you were in the Navy but I don't remember where you are stationed. Big place, the Navy.

Just saying...

Wait for recurrence , which probably will never happen, and recover, keep std psa test, go live a long healthy life. If it recurs, deal with it, if you break a leg in the next few years deal with it, if you……. You ain't gonna die from a gl 6, low psa, whose focal cells are probably long gone into pca hell. Rejoice!! Don't get into needless angst. Eat well , keep fit and I say again Rejoice

Hi Brewer

This is just my opinion as a patient. I am not a medical professional. But if it were me with your stats I'd wait for clear signs that I was on the way to BCR -consecutive rising PSA measurements to a level greater than 0.1 --and only then consider salvage radiation.

www.ncbi.nlm.nih.gov/pubmed/20553253

I was Gleason 7 and T3b and went 7 years before I elected to have SRT (with a PSA of 0.4). And now 3+ years later have no measurable PSA. Your stats, so far, are better than mine were, and you are also quite young. If I were in your position I'd hesitate to take on the possible near-term and long-term risks of radiation without some more convincing evidence that it is warranted.

Jim

I think you should listen to logoslidat and most importantly believe what Walsh said.  Your path is really pretty good.  Staying 3+3=6 is the best you could hope for.  Also, remember the part in Walsh's book about how sometimes a positive margin is not a positive margin.  Due to the fact that when a surgeon cuts accross and area of tissue he/she sometimes drags PCa cells into an area that did not originally have them.

I would do nothing until you have established BCR.....

Dx @ 42 PSA 2.76 GS6
open RP 10/2008
pT2 Organ Confined GS6
4.5 Year PSA <0.03

Brewer,

Your path report doesn't sound bad at all, and statistically you are looking pretty good. My urologist told me to just keep on watching the PSA and if it starts to climb and hits 0.2 then salvage radiation to the prostate bed has a great chance for a cure.