Very Confusing Pathology report

Yes, It sounds like the tumor was starting to come out of the capsule in several areas. It doesn't show how large the prostate was ex. 59g. The staging of pt3 means it was leaving the capsule.

Did you get the path report mailed to you or did your surgeon give it to you?

What I did is highlighted what I didn't understand and asked my surgeon to explain it at my next visit. I had positive margins also and I asked my doctor how he felt about the margins, chance of recurrence, etc.

I also asked for a surgical or operative report which tells you what they did to you in the operating room and in what order. They have to give you one if asked for but they usually don't give it to you as a standard procedure. It makes for some interesting reading if you want to know what they did to you when the "lights were out".

I just had an AUS installed and asked for the operative report from that surgery also.

Others will come along shortly to give you their take on it.

Bill from Florida

MY uro's assistant showed me a piece of paper on which the internal male anatomy was printed and then he drew on it with a pen to mark exactly where the cancer had been found. This was incredibly helpful.

it was a picture like this one:
www.bladderclinic.com.au/images/bladder-conditions/prostate.png
Why not ask them if they can indicate on a picture like this where things were!

I'm no expert, but the way I read your report is that I think the stuff in the rectal wall was part of the cancer that was in the prostate and not a separate bit of tumour, but that it was too risky to remove as that would have damaged the rectum. Thus you have positive margins.

The seminal vesicles can be really fiddly things to remove stuck up between the baldder and the rectum etc. I had SVI and I am pretty sure that my recurrence after surgery was due to the fact that there was a little bit of PCa left behind in that area.

Your report basically describes two things, one is how much cancer was in the prostate, which you can kind of ignore now as that's gone; the second part is what it says about the cancer that could be seen to have grown beyond the prostate and which the surgeon had to leave behind.
It is clearly not good news that there is still cancer in there, however while it means that you are almost certain to need Adjuvant RT, the RT doctors will have a VERY good idea of where to aim the beams thanks to what is in this report.

So yes you need to talk to a radiation oncologist. And I think the RT doc needs to talk to the surgeon to learn as much as possible about the exact location of the things seen, but left behind. I can imagine that the surgeon may even have pictures of the area concerned. (My uro's assistent actually sat in on the RT doc's conference when they were discussing how to proceed with my SRT! The two departments are only about 50 feet apart at the hospital)

Alf

Thanks for the replies.

I'll chase up my appointment with the RO. I was told on Monday they had sent him an email last week and would resend it that day.

I'll print out that diagram. It should help me understand the extent of the cancer.

Hi Ronnie, - To try to clarify the confusion surrounding your understanding of the post-surgery Pathology Report, let me talk directly to that point. The Pathology Report is the Pathologists dictated findings of what was seen under the microscope in directly viewing tissue available from the entire excised Prostate.

These findings, known as Pathologic, are considered to be much more reliable than those revealed from Biopsy SAMPLES (known as "clinical" findings), that are often not entirely representative of the true state of the disease existing in the Prostate as a whole. However, even Pathologic findings can only report on tissue that has been removed and examined microscopically, which allows them to see things that are not visible to the naked eye. The rectal wall reference is probably contained in the Surgeon's Operative Report that is a part of the Hospital Record.

Your Post-surgical Path report did not mention the invasion of the Rectal Wall because it was not evident in the tissue being examined, which is all that the Pathologist sees. As you report, you were told verbally by the Surgeon and confirmed in the "letter" you refer to from the Hospital, that both indicated this was a "macroscopic" observation (made by the Surgeon) during the operation, which resulted in your having known malignant tissue purposely left behind in seminal vesicles and adhered to the rectal wall. The key word is "macroscopic" which means it was large enough to be seen with the naked eye, the opposite of "microscopic".

Your post-surgical Pathology Report is certainly not what you would have wished for but at least you know what the true state of your disease is, which is only available to surgical patients who have the benefit of such precise determination by Pathologists. So you will undoubtedly have some difficult decisions to make as to where to go from here. These will need to be made in consultation with Specialists in the treatment approach that you determine to be most appropriate. I would suggest starting by getting at least consensus clarification as to whether you are Staged as T4 or T3b which could be important in your considerations.

I wish you the best in your decision making, treatment and recovery and I hope I have helped your understanding of the reported results. - [email protected] (aka) az4peaks

Post Edited (az4peaks) : 6/17/2014 7:13:53 PM (GMT-6)