path report upgrade = 4+3 plus tertiary 5 & INTRADUCTAL carcinoma (epe present)

hey all-

first off- we're spinning a little bit & looking for some feedback. my husband had surgery last week & we got the results last night.

he was upgraded to 4+3 with tertiary 5 (65% pattern 4) -- in addition there was EPE present in two locations on the left side & extensive PNI. also- under additional findings, intraductal carcinoma of the prostate was identified.

all margins were clear & no seminal vesicle invasion, thank God, but honestly with all these other findings it's hard not to worry.

has anyone else ever had these kind of results & been CURED by surgery?

i read briefly about intraductal carcinoma last night- is it true that this is a rare form of prostate cancer? does anyone know anything about it? is it resistant to certain treatments? picked up by PSA?

of course we are going to TRY to relax & wait for first PSA test (8 weeks), but we'd really like to wrap our minds around some of this first. and i'm wondering if we should be seeking 2nd opinions & the like.

THANKS FOR ANY/ALL FEEDBACK.

island time-

The reason why a second opinion is more important on a biopsy than a path report is because the biopsy is just a few cores cutting through at various angles through tumors. How they sample the tumor can affect the reading. Judgment based on experience is crucial. The path report, on the other hand, is based on close inspection of the entire prostate - they get to look at every tumor in its entirety. There are seldom judgment calls made on whole-mount slices.

thanks all- appreciate your responses & will look into another reading especially bc of how close we came on the left side (epe in 2 places).

tall allen- any thoughts on path report as a whole? the intraductal carcinoma etc?

P, I was wondering how things were going with your husband. We were pretty close in time to dx and RP. I wasn't sure if you had chosen Dr. Ahlering. We have been so happy with the care we got from the dr. and his team. Did your husband get to have his surgery at the MyVip surgery center? I am sorry to hear of the post op report for your husband. I feel like you are in really good hands.
We were a bit upset when he called to go over the path report with my husband and there was this a piece of weird tissue that he cut out by the urethra that seemed like it was necrotic. He said it looked like a dried up raisin. It ended up being positive for G8 cancer. The pathologist said he got clear margins.Dr. Ahlering is moving up the 1st post RP PSA test to 8 weeks. He feels like we don't need to run out and get RT asap. My husband really hopes to not go down that road if possible. Be sure to make your follow up appts early. We can of waited and we will be a few weeks past the 3 month mark.
As a side not, if one of our 4 kids were going to medical school I would recommend them to go into urology. I can't believe that in the populated So. Cal area it takes so long to get an appt. We called a dr. at St. Joes and told them my husband had G8 cancer and would like a consult and he still wouldn't be able to see for 6-8 weeks. What do the poor patients in rural America do? Does it mean that we need more urologists or there are just so many men with prostate cancer not to mention other prostate issues and women's urological treatment as well.
Good luck to you as you navigate the treatment. I hope your husband's recovery is going well.My husband is down to 1 pad a day. He hasn't been able to get past that. It has been 5 weeks.

thanks allen for your input - i haven't read anything about DNA repair mutations, so i'll look into that now.

up4thefight- thanks for checking in. glad to hear that your husband is doing well. my husband is recovering nicely overall- much to our surprise, he was continent right out of the gate! not a drop! we too love dr. ahlering & his staff (especially lydia)! we interviewed a TON of doctors beforehand, but TA was the best. we almost flew to new york to meet with tewari, but at the end of the day we're so glad we stayed local. as for docs in general, yes, it's crazy how long it takes to get in anywhere...the baby boomer movement is alive & well. please write again when you get your first PSA test.

logoslidat - i don't understand your comment. he will what?

thanks all!

Dear P and up4fight,
It is so good to hear that your husband's surgeries are behind them and that they are recovering well. I'm sorry that the elusive cure is not initially evident, but I hope that the outcome in the long run will be either that, or very well managed for many more years to come. Best wishes to you and your families. Please do keep us posted on how your DHs are doing and any future tx choices you make.
Beth

I'd also like to add my welcome. There are a couple of others in here who are dealing with intraductal, and not a lot is known about it, or it's treatment. The good news, in your case, appears to be the good margins. EPE may or not mean anything. Like it or not, you're in the waiting game now. SRT, if needed, has to wait a while after surgery to allow for healing.

Staying Tuned-

I think your understanding is mostly correct. EPE,positive margins, and seminal vesicle invasion are all significant risk factors. Positive margins are determined when they ink the removed prostate and they find cancer on the surface that was inked. Then there is probably cancer left behind where the cut was made. Risk goes up if the cut was made through larger amounts of higher grade cancer. EPE means that cancer has extended into surrounding tissues. It increases the likelihood of microscopic invasion into those tissues. It is possible to have both a positive margin and EPE where the surgeon cut through the extended part. It is possible that there is no positive margin there too - no evidence of cancer on the surface - but prostate cancer, being multifocal, does not always form contiguous tumors.

A positive margin is a higher risk factor because you know there is a high probability of cancer left behind, whereas with EPE and a negative margin there is less chance of that. You can play around with a nomogram to see the relative effect:

/www.mskcc.org/nomograms/prostate/post-op

PNI is a minor risk factor compared to those others.

My Intraductal was treated with surgery. My surgeon followed me closely with 6 month visits even into the third year post surgery. Now at 4 and 1/2 years we are on an annual follow-up schedule. My PSA is <.006.