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EPSTEINS FINAL PATH REPORT IS IN!

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Prostate Cancer
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Posted 9/5/2017 8:27 PM (GMT 0)
Hi Everyone

Last week i had hubbys slides sent to Epstein for a second opinion. I have to say the level of professionalism as i had read here truly is outstanding! Dr Epstein emailed himself from start to finish, and gave me a direct line for follow up questions!! Very very very impressive.


I thought i would share this because it is interesting to hear/see the differences and hear his opinion on treatment. He said that hubby is borderline on needing Radiation. He suggested an RO consult 6 months after surgery to allow further healing.

Here is his report, the original can be seen in my signature for comparison!

Gleason 3+4 - 5% pattern 4. - Grade group 2. - Dominant nodule

Secondary Nodule - 3+3. Grade Group 1

Tumor Extent: Moderate

location of dominant - Left, anterior, lateral, posterolateral

Secondary - Right, posterolateral, mid

Margins - POSITIVE - Left, posterolateral
Positive in an area of intraprostatic incision (II) - Length 3mm

Grade at margin: 6

Seminal vesicle not available, lymph - not available

Extent of invasion Primary - PT2X - organ confined throughout, unevaluable in are of positive margin.

Summary Margins - Positive (3) Verumontanum mocosal gland hyperplasia **can anyone tell me what that statement means

When on the phone Dr Epstein told me how the EPE couldnt be evaluated as during the surgery the surgeon made a mistake and cut through the prostate! This shocked me, he said is can happen! Its the first we've been told about this. But he said due to this fact and that the margins are positive although a 3+3 he said its borderline for radiation.
Posted 9/5/2017 9:26 PM (GMT 0)
Fortunately, it was only GS6 at the positive margin where he cut in and it was small. You just have to wait to see what your uPSA does.
Posted 9/5/2017 11:05 PM (GMT 0)
I would play it safe and get toasted.
Posted 9/6/2017 1:10 AM (GMT 0)
Doire,

Our husbands have somewhat similar cases. We'll have to keep an eye on each other smile. Are you going to switch from a PSA to uPSA?
Posted 9/6/2017 1:42 PM (GMT 0)
HI Diane

They are very similar indeed! I requested a uPsa but the surgeon's practice only does it to 0.00. Does anyone know if you can request a PSA yourself without a script from the doctor and if so what lab is best? I think we are going to go visit an RO towards the end of the year to hear his take on things. Meeting the surgeon for 6 mth check up in october and will also ask if because of the intraprostatic incision if an MRI would be advisable.
Posted 9/6/2017 1:53 PM (GMT 0)
Glad to hear that you got a good deep dive from Epstein on this. BTW, I'm no doctor, but with a G6 at the margins and a small margin at that, I'd be taking a wait-and-see approach. It also seems that he had a very tiny amount of pattern 4 in his entire prostate, so that would seem to me to be good news.
Posted 9/6/2017 2:48 PM (GMT 0)
Hi Michael

Thanks, yes the G6 at the margin is very appealing and the qty of 4 is very good also. He seemed more concerned with the intraprostatic incision ... i researched this last night and from my understanding when this happens it means that there is some of the prostate that didnt get removed and the PSM is called as a result of this. EPE couldnt be evaluated also because of this. Wait and see i think is the way to go, have an RO consult to be ready just in case and use uPSA going forward also! I also ready last night that an MRI at six months has been known to show what was left from the incision but i dont know if PSA has to be rising or not! All questions for the uro next month!
Posted 9/6/2017 5:03 PM (GMT 0)
There is really no point to seeing an RO until you have some uPSA data. There is no being "ready." You just take it as it comes. Incisions are not uncommon or surprising - even the best surgeons have them about 10% of the time. It's only worrisome if the margin was large or high grade - it is neither of those things. You don't throw radiation at it unless it seems to be progressing - you will have plenty of time even if it does. Your only concerns now should be penile rehab and continence recovery.
Posted 9/6/2017 5:26 PM (GMT 0)
Yes we had the same problem. So I do order his uPSA test online at walkinclinic.com. I just purchase the uPSA and print the lab order.
He then takes it to labcorp and then the results come directly to us it's fantastic!

The cost is about a $100 It was such a stress reliever when I found out I would be able to do this instead of trying to argue with doctors to give us the uPSA.

Post Edited (Jack & Diane) : 9/6/2017 11:32:14 AM (GMT-6)

Posted 9/6/2017 6:43 PM (GMT 0)
Thanks TA, i had no idea about these incisions until i researched last night. Apparently when removing nerves it happens quite often, as you said to even the best of them. The waiting and wondering and the what ifs have been on overdrive lately. Thanks for the solid advice

Diane, thanks for that info, ill sign up for that and start hubby on the uPSA's.

Hope everyone is well today!
Posted 9/6/2017 7:04 PM (GMT 0)
Hi Diane

Can you double check that website for me, it doesn't exist as walkinclinic.com

Thanks a million
Posted 9/6/2017 9:42 PM (GMT 0)
Oh gosh! I'm sorry, it's walkinlab.com
Posted 9/6/2017 9:49 PM (GMT 0)
The test number I use is 140731.
Posted 9/6/2017 11:15 PM (GMT 0)
The only way to know if the positive margins will lead to further problems is to wait until a few months pass and you get a uPSA reading or two or more. Besides, they can't start radiation for a few months after surgery anyway. It may be that he'll never need anything.
Posted 9/7/2017 8:09 PM (GMT 0)
So after all that, quest and labcorp are not permitted to test via walkinlab in NY! Just my luck! When we meet with URO next month we will ask for labcorp script with uPsa ... although he may not as his facility do their inhouse labwork!
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