Pathology is In

Went to the surgeon today to see about the catheter and drain coming out and to receive the pathology report.

The drain and catheter have to stay in for another two weeks. They did a dye scan before we saw the doctor and it shows that it is still leaking a bit so the two stay in for awhile longer.

Then the pathology ..

No lymph node or seminal vesicle involvement (yaaaa!)
However, we knew that there was perineural invasion on the left side so that was still identified, as was a margin at left posterior aspect. The doctor said he wasn't certain that the margin was a true positive because he said sometimes when they pull it away, they can expose it themselves when it really isn't. Regardless, after my husband heals from the surgery he will have to have radiation and then just watch the PSA numbers.

Still a 4+3=7 so somewhat aggressive which the doctor said they knew because of the perineural invasion.

The prostate weight 35.8 (good/bad???)
Carcinoma involves approximately 10% of tumor
Carcinoma involves both lobes of prostate
took 14 lymph nodes - eight from the right, six from the left - all negative for cancer
Extraprostatic Extension not identified
Seminal Vesicle Invasion not identified
Findings correspond to pT2c pN0

All in all, if we have to have an outcome I'll take this for now.

Thanks for all your prayers and thoughts. All of them helped as did your words of encouragement along the way.

Looks Good ! If it were me, I think I would hold off on the radiation until a PSA test proves it to be necessary...Best of luck to you !

JayMot,

The surgeon classified the 4+3=7 as aggressive and because of the perineural invasion he says it has shown its aggression. That being said, I believe that if radiation happens it will be 6 months down the road. That was the number we were originally given when we first talked to the surgeon and asked about "what if". He said 6 months was a good healing time. That will give us time for some PSA numbers. Also, there has always been question of my husband's PSA numbers. All of the doctors we have talked to have repeatedly said his PSA number should be higher than it is. There was a great discussion about my husband being a non-secreter(or) which no one here has ever heard of before. It just means that the cancer cells don't secrete PSA like "normal" cancer cells do. I actually found a small mention of it in the big book of prostate (Walsh Surviving Prostate Cancer). He didn't call it the same thing but he said there are some cancers that don't secrete correctly. So I think the doctor will be hedging his bets on my husband's numbers not telling us the need to begin treatment. We have to depend on ct scans and bone scans to give us help too. Although, I don't find that very comforting considering they won't tell you if it has moved until a million or more cells have gathered there.

Not to scare you because I know you are coming up on it, but we had a comedy of errors happen to us. If it could go wrong, it did. The catheter had all kinds of blockages because of clots and the drain didn't even drain in the first two days. Instead it just bled out around where it came out of my husband's side. Then all of a sudden it started draining in copious amounts. That is when they think one of the sutures let go because creatinine was found in the output in the drain. Now my husband has two bags of catheter collection type on him to catch all of the output of the drain. Two weeks? Just a number because he wants to give it ample time to heal and for the drain to stop draining. We didn't really ask him why. We just went with it.

I am just so relieved to get the pathology report and know that the prostate is gone, that the seminal vesicles and lymph nodes were clean, and, as Halbert said, "as good as it gets". I'll take it.

Will be praying for you and a successful surgery, recovery and pathology report.

With the suspected positive margins you could have RT as a preventive measure or you could monitor the PSA levels and have RT only if the PSA begins to rise from undetectable. You probably need at least four month to heal before receiving RT.

The only thing I'd find concerning is the positive margin. You might want to ask the pathologist two further questions:
(1) What was the Gleason score at the positive margin?
(2) How many millimeters was the extent of the positive margin?

Those are correlated with recurrence prognosis.

You asked about the prostate size. It is small for the amount of PSA (PSA density=.11 vs .15 for the average man). So I can see why he'd want to use an ultrasensitive PSA test (starting at about 3 months) to monitor PSA progression, but I can't see why he'd ignore that entirely. This may be a particularly good case for using the Decipher test (you can ask for that now).

- Allen

cancer cells when dividing will follow the path of least resistance, hence they will go around the nerve tunnels{empty space peri[around] the nerves[neural]…so yes a grade3 will do this slower than a higher grade4, but in your case the 4 it didn't do it fast enough to get a definitive +margin. that is the total extent of the concern you should have with PNI in your case. Could it, the 4 , have gotten out, yeah,, is it likely no!!!
Your doctor is using words to bamboozle you into radiation.. Wait until you get a definitive rise in psa…my definition is at the lest .2 with 3 consecutive rises. Good Luck..

lapilot said...
Statistics have shown that there is little benefit to gain to have salvage radiation before the 0.2 value.

I would very much like to see the source of the statistics you quote, since everything I've seen says exactly the opposite. 0.2 is a relic of the past when that was the lowest PSA they could reliably measure. While the outcomes of adjuvant radiation exceed a wait-and-see approach, most studies now are showing that in the presence of adverse pathology (positive margins, T3) early salvage when PSA hits 0.03 may be as good as adjuvant.

Et tu, Praté? Unbelievable to me as well. I thought you stood for evidence-based medicine.

Sending my post op slides to JH gave me more information about my positive margin. 5% of my cancer was grade 4. There were no grade 4 cells along the margin. They may also be able to shed a little more light on this....

AnnieW56 said...

...a margin at left posterior aspect. The doctor said he wasn't certain that the margin was a true positive because he said sometimes when they pull it away, they can expose it themselves when it really isn't.

If it were me I'd want more than this. But that's me.


It's good they dye tested before they pulled the drain. It means that everything that could have gone wrong did not. (Don't ask me how I know)


Radiation is "standard protocol" for positive margins. ..at least in these parts it is. And it may be with 4+3's as well...i don't know. What I do know is that more and more men are beginning to hold off on radiation for positive margins. This devolves into a debate where even the best minds seem to diverge.

Right now...just keep getting better. And send those slides off.