Path report question

I bet someone here will know this. My pre-surgical Bx report showed that I was the "bad" G9 (LOL!) i.e. 5+4.

I just came in from a several mile hike off trail through the woods with a pack, doing a lille map and compass practice. So it was already a good day, because I peed myself very minimally. Any hiking like that is the worst, I usually soak my pad, and did so just earlier this week matter of fact. And I finally remembered to get Vanderbilt to fax me my OR path report, which I forgot to pick up at my 4/7 1st post-op visit. And I am trying to figure out if I see a smidgin of good news. Of course, I pretty much knew all of the bad stuff that was on it, such as bilateral seminal vesicle invasion (pT3b). 107 gm prostate with 20% tumor, and still G9, and unifocal positive left base margin.

Plus some of the good stuff: though totally crazy, 1 place says 3(0/3) possible lymph nodes, one place says pN0 # examined 12, one place says 9(0/9), so I have no idea except all say no lymph met or involvement. So that is great, whatever the # actually was, though quite confusing.

But on histological grade it says: "Primary Gleason 4, secondary 5, tertiary N/A". So does that mean I have been downgraded to a 4+5? Don't know what the tertiary is.

Oh never mind, I just saw in the summary near the beginning, saw it as I was finishing typing the above: "Gleason score 4+5=9".

So whoohooo, in your face PC! Party! I've been downgraded to the "good" G9! We are going out to eat tonight with friends, and I may just have a meal considered risky for PC! To celebrate and take a deep breath. Here all this time I was worried about a 5+4, when I am a mere 4+5!

Bill, in celebration mode, whether I should be or not!

Break60 said...
Billy
I hate to rain on ur parade but there is no good gl9. I also am gl9 (4+5) with SVI EPE and pos margin. SVI is nearly as bad as lymph node positive. Gl9 and SVI are very high risk factors.
So like me you must monitor ur PSA every three months and if it starts to increase and gets to .2 twice in a row, additional treatment with HT and SRT is warranted.
I'm not being a jerk just being realistic.
Bob

No problem Bob,
Once again- as my wife always warns me about and the internet even makes worse- my dry humor, or attempt at it, and sarcasm, has been missed! I thought all the rolling eyes and winky faces would have shown I was being silly, but there you go. Although, I'll still take it as a "smidgin" of good news.

And I know you are not being a jerk, you are just looking out for me. Clearly there is no good G9, especially with SV involvement and even with a focal margin invasion. I think I am going to party anyway tonight! Who knows, maybe tonight is the night my Trimix works perfectly!

BillyBob,

Another Bill here, just wanted to congratulate you any way on your "downgrade" to 4+5=9. Hey, we have to celebrate any milestone we can! I have celebrated using only 2 pads a day instead of the usual 3 or 4 pads. Or remember your first bowel movement after surgery?
C-E-L-E-B-A-T-E!!

Hey, I am a 3+4=7 with positive margins and I have to be tested every 3 months also so you are no different than a G7.

If you like your path report copy, ask for a copy of your operative report! It makes for some very interesting reading. It tells what they did to you when you were in La La Land. From being placed on a memery foam mattress on top of a bean bag then placed in a surpine position to them finally yanking out your prostate, that had been placed in a bag, out of the main camera port incision above your belly button like woman giving birth with a "c" section. Was it a boy or a girl prostate? How much did it way? 106.7 gms!

I didn't ask for it until 1 year after my surgery but they didn't hesitate to print one off for me.

Over all, your path report sounds pretty good for a G9, not much worst than mine and I am undetectable almost 2 years later.

Party on BillyBob!

Bill from Florida

BillyBob, Bob, and Bill,
PDa is wrong once in his life--BillyBob's humor is called "English Humor" or that's what my dad would say when my English mother had him befuddled or in stitches; I love your humor or whatever. Only 1 G9 so I hope that you celebrated. The "other Bill"; always love your upbeat attitude and support to newbees and oldies alike. Bob, I know that you are going through "heck" and I wish you well. Without some humor here this would be a "dire" place.
Have a great Memorial Day weekend guys!
Bill

gunfighter said...
BillyBob, Bob, and Bill,
PDa is wrong once in his life--BillyBob's humor is called "English Humor" or that's what my dad would say when my English mother had him befuddled or in stitches; .........

Hey, "English Humor", you may be on to something there! I think I know exactly what you mean. But it also makes me think of Monty Python, do they exhibit English humor I mean I know they are English...........

"The tenants are transported by conveyor belt in extreme comfort past murals depicting Mediterranean themes towards the rotating knives.....
Excuse me, but are you proposing to slaughter our tenants?..
Does that not fit in with your plans?".. etc

Post Edited (BillyBob@388) : 5/23/2014 10:40:33 PM (GMT-6)

kukukajoo said...
hey there- my fiancée is newly dx and we are using gallows humor to get through this. Good to see your post and I laughed when I read it. Keeping a good attitude is important and I hope you enjoy your bad bad meal!

My man keeps insisting all he needs is a good grapefruit spoon and a chefs knife to fix this and rid himself of that rogue walnut he has!!

We live in Atlanta area and are very recently relocated so no real support network or friends here so difficult for us in that respect, but we are coping okay for now. Meltdowns occurred before biopsy as we knew what was coming.

Anyhow cheers!!

Talk with Dr.Critz or Merlin or associates in Atlanta ASAP. Just to keep your options open.

kukukajoo said...
Do you have any more info on them?

If you decide on a non-surgical approach, such as radiation, they are well known in your area and nationally. I am over in MS and I know several folks who have used them and are so far happy with the choice. I talked with Dr. Merlin twice, they were great to return my calls. I would have given a lot to have been able to use them. In the end, I was barely able to make a choice in favor of surgery, and I don't think I will ever feel for certain it was the right decision. Other folks, of course, with my exact same situation would have chose surgery and felt very certain about it. I ended up choosing surgery because:
1: The doc FELT like( a hunch based on his DRE) it was probably contained, and if it was he could offer me a cure. It was NOT contained, which was a pretty good likelihood with my PSA 10.9 plus G9 and PNI on Bx. Still, he felt there was a good chance was contained.
2: I felt like I needed to know. We could not know if it was out and in the lymph nodes and seminal vesicle except with surgery. As my doc said, with the G9 we would not know for maybe several years if the radiation got it or not, if it was out in the nodes.

So, the rock and the hard place: almost guaranteed serious side effects( and I have certainly had them) for a possible cure and being able to know. So, I have the side effects, and what is it I know? That there is a good chance I am not cured, theI have a focal point in the margin and seminal vesicle(SV) involvement and I am likely going to need radiation and/or hormone therapy anyway, again for a maybe cure. Well, would I have been any worse off just going for the maybe cure hoping the radiation would get it all to start with? Maybe even better off? I suspect my % odds were roughly the same either way, but I got the almost guaranteed side effects up front. The guys I know here who went the radiation route have so far done well ( though none of them were G9s with 10.9 PSA like me) and have had only minimal side effects- or even none- so far.

Still, I rolled the dice, and after all it was possible that it could have been contained and I would probably be cured. Maybe I'd feel different about the effects of the surgery if that had happened. As it is, I'm not so sure.

And that is the same decision Y'all have to make, no one can make it for you. You have to figure out what are your odds that it is already out of the prostate shell. And if it is out, then surgery will most likely not give you a cure. So you will need radiation anyway. So, another argument for the surgery if it does not work, you can always have radiation, although maybe with worse complications. So the question is: if you knew it was out of the prostate ( and you probably don't know either way) should you just have radiation and/or hormone block to start with? Why start with the surgical trauma if the odds of cure is low and you are likely to need all the other stuff also?

I don't know the answer with certainty even now. I have seen some recent studies where G8-G10s had some pretty decent longevity following surgery, with only about 15% needing radiation. That made me feel better, since I know a lot of those were probably positive margins and/or SV involvement, like me. But if you decide radiation is your best bet, you are lucky they are close by. They were frank with me about my odds and that I would need some hormone up front to shrink my giant prostate, and certainly did not try to influence me to use them. You should give them a call before you commit one way or the other. http://www.prostrcision.com/qa