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Posted 9/19/2017 6:44 PM (GMT 0)
I just got my post op pathology report and the Dr. seemed very happy and said I was "cancer free" but I just want to be sure I should be so excited. He said it had broke through, and it was good I did the procedure when I did, but with the negative margins at the area where it had broke through, it meant he got it all and I was good to go. So here is what it says:

A: Peri-prostatic fat, excision
Mature adipose tissue with no specific pathologic change
Negative for carcinoma

B: Prostate and bilateral seminal vbesicles, radical prostatectomy:
Invasively poorly differentiated adenocarcinoma. Gleason score 3+4 7 Gleason grade 4 component is
prominent
The carcinoma involves both the r ight and left lobes and has a greatest nodular diameter of 1.6 cm.
The carcinoma shows focal extracapsular extension in the left posterior baes of prostate
Bilateral seminal vesicles are free of carcinoma
All examined surgical resection margins are free of carcinoma
Pathological stage pT3aa NO Mx

C: Left iliac internal/external obturator lymph nodes, excision:
No evidence of carcinoma in nine lymph nodes examined

D: Right iliac internal/external obturator lymph nodes, excision:
No evidence of carcinoma in nine lymph nodes examined

The tumor was approximately 20% of the prostate with the greatest dimension 16mm

Extraprostatic Extension - Present, focal left posterior base

Seminal Vesicle Invasion: Not Identified

Margins: Margins uninvolved by invasive carcinoma

Treatment Effect on Carcinoma: Not Identified

Lymph-Vascular Invasion: Indeterminate, focus suspicious for angiolymphatic invasion noted

Perineural Invasion: Present

Lymph Nodes: Examined 18 Number Involved 0
Posted 9/19/2017 6:53 PM (GMT 0)
Looks like a good report. Now just hang in till your first PSA reading. Good luck.
Posted 9/19/2017 7:08 PM (GMT 0)
So far, so good. Of course, the EPE is a risk factor - hopefully cells have not gotten away. You'll know more in 3 months when you get your first uPSA. How are you faring?
Posted 9/19/2017 7:12 PM (GMT 0)
I feel far better then I was expecting. I am up and moving and have been able to get to my sons soccer games, spend time with friends and really have not skipped much of a beat. I had my procedure last Wednesday and have not needed any medicine since Friday. Pain is minimal and overall I am feeling very good.

Why would he proclaim "cancer free" when in fact, that may not be true? How much of a risk factor is EPE? The EPE would be when he said it had broke through correct? He followed that up by saying, don't worry, though, because where it broke through your margins are negative which means I got it all and you are cancer free.......

Post Edited (Mrbaseball220) : 9/19/2017 1:19:24 PM (GMT-6)

Posted 9/19/2017 7:53 PM (GMT 0)
If you enter your numbers in a nomogram /www.mskcc.org/nomograms/prostate/post-op and compare w/wo EPE you get the following:

PROBABILITY OF REMAINING RECURRENCE-FREE AFTER SURGERY

With EPE:.......2 YR 95%, 5 YR 88%, 7 YR 84%, 10 YR 78%
Without EPE:...2 YR 97%, 5 YR 92%, 7 YR 90%, 10 YR 86%

The of risk BCR is a bit higher.
I also had EPE and negative margins and are still recurrence-free at 3 years. Hopefully you will be too.
Posted 9/19/2017 8:03 PM (GMT 0)
I don't like when a doctor proclaims one is cancer free. How does he really know? He can't. Hopefully, you are cancer free and he won't have to apologize for his potential misstatement. It will take many years before you can determine whether all the cancer was removed. Time to relax and heal.
Posted 9/19/2017 8:25 PM (GMT 0)
Hey MrBaseball,

That sounds like great news. I see a lot of people upgraded after the post op so it could be much worse. Negative margins I think is a good deal, and the doc seems pretty confident in results. Celebrate! No sense in sweating that other stuff unless they give a real reason. Glad to see you're feeling good in recovery. Awesome!

Frosty
Posted 9/19/2017 8:43 PM (GMT 0)
Great report!

The post-op PSA will confirm the good news.

Andrew
Posted 9/19/2017 9:53 PM (GMT 0)
Good Report!
Posted 9/19/2017 10:12 PM (GMT 0)
Thanks for the responses guys! I am spinning a bit and am looking for some help. The doctor said it was "great news." I posted my report here and on another site and one gentleman said I should not be pumping pom poms because the nature of a t3 tumor was something that is not a green grass situation. He went on to say there was some good news and not all bad news etc. He has me thinking that with the EPE, I am in some serious trouble. I see the odds of BCR increase slightly with EPE, but I didn't get the sense I should not also be somewhat happen at this point. I know I still need the blood test to confirm, but all in all isn't this good news? Then I come here and people are saying good report, great report etc....confused and looking for help.
Posted 9/19/2017 10:26 PM (GMT 0)
but, what would you do about it right now?

nothing.

Even if, big if, more treatment is needed, it will be months before you even have to think about it.

Error on the side of good news, rest, heal, start living life.

The first PSA test will confirm/deny if there is a further problem. Then, you'd start planning the next step.

Don't search a sunny sky for clouds - well, except for ones that look like bunnies or doggies.

Andrew
Posted 9/19/2017 10:56 PM (GMT 0)
I'd take the hard numbers in Gemlin's post as your guide. Looks to me like your odds of a cure are definitely in your favor. I for one, would feel pretty darn good about those odds!
Posted 9/20/2017 12:07 AM (GMT 0)
MrB-

There is a difference in language that patients use and that doctors (should) use. I consider myself to be "cured" and "cancer free." My doctor would say that I am long-term "recurrence free" or "no evidence of disease." Doctors state objective facts, but as patients, we infer subjective meaning from those facts. As a fellow patient, I suggest you consider yourself to be cured and cancer free. It's a useful attitude to take because it reduces anxiety and enables you to get on with and enjoy your life fully. As far as you or anyone else knows, it is true at the present moment. It will continue to be true unless the objectives facts change, which they may never do. You gain nothing by worrying about it.
Posted 9/20/2017 1:45 AM (GMT 0)
Thank you for the responses and I guess you are both right. No reason to worry. Live and hope it doesn't come back. I suppose I would have been having the same yearly worries without EPE vs with.
Posted 9/20/2017 9:56 AM (GMT 0)
MrB,

I had RP a little over a month ago and have the same pathology as you (see my signature). Per the nomograms, the odds of recurrence for us are relatively low. A little higher with EPE but lower than they would be with positive margins or higher grade, so I feel fortunate overall. They had only ever found Gleason 6 in me over three biopsies so it wasn't clear whether I should treat or not, but now with my pathology results, I'm very happy I did.

We should be fine. Good luck with your recovery.
Posted 9/20/2017 10:32 AM (GMT 0)
Mr. B, that is an excellent pathology report. As others have said, even if something does show up in the future, that is the future. Now, your job is to recover and heal. The next steps are to (a) walk and run and climb stairs, and get your strength back. Your body has been through a major event. (b) get your doc to give you samples or scrips for viagra or cialis, and start taking it to get the blood flowing down there. You might be surprised at what happens. (c) Get your first post op PSA in a few weeks. Most docs do one at 6 weeks to see what the trend is. The definitive one will be at 3 months post op.

In the mean time, wake up every morning thankful that you've made it this far in good shape.
Posted 9/20/2017 1:24 PM (GMT 0)
As others have already said, it sounds like a good report. I think the docs wait about 90 days before they do a PSA test. That will tell you more and you will be able to discuss further treatment if necessary.
Posted 9/20/2017 5:16 PM (GMT 0)
Thanks for all the responses and support! The cath is out! I do truly feel like a new man. However, today I go to my local uro - who yes I've had issues with, but figured it was just to get the cath out. He sits down with me and starts talking to me about radiation? I said ummmm radiation...I'm cancer free according to the surgeon you recommended me to? He said don't worry about it now, but once you heal and are not dealing with the SE's (3-6 months) the surgeon will probably talk to you about doing radiation now vs. waiting. I said don't we wait for the PSA test and "if" it goes up we do that? He said well if you do the radiation within the first year, we can say that it is most often "local" However waiting longer then that means we may not know where it is and that it may not be "local" I said I still don't understand why we are talking about this because my surgeon told me that yes it had broke through, but "don't worry about that because the margins were negative where it had broke through, which means I got it all"

What a roller coaster of events. I got the call from the surgeon and literally was ontop of the world...now i'm not so sure I should be. I get not worrying, but these are some very big differences between two Drs.
Posted 9/20/2017 5:31 PM (GMT 0)
listen to your surgeon.
Posted 9/20/2017 11:33 PM (GMT 0)
And you trust this guy why?
Posted 9/21/2017 12:17 AM (GMT 0)
Halbert - are you saying trust my local uro? If so, no I don't. I was pissed when I left his office and called my surgeon who I have full confidence in. I only went to him today because he is local and I didn't want to drive the 2 1/2 hours just to have the cath. pulled out. Maybe a bad decision on my part, but once I talk to my surgeon, I'm sure he will have a different story.
Posted 9/21/2017 2:52 AM (GMT 0)
.....and if you talk to another Doctor you will get yet another opinion. There is no perfect path to success. The hardest part is waiting for the facts to play out and training yourself to move forward until the facts push you in a different direction.
Posted 12/20/2017 9:27 PM (GMT 0)

RickTrin said...
MrB,

I had RP a little over a month ago and have the same pathology as you (see my signature). Per the nomograms, the odds of recurrence for us are relatively low. A little higher with EPE but lower than they would be with positive margins or higher grade, so I feel fortunate overall. They had only ever found Gleason 6 in me over three biopsies so it wasn't clear whether I should treat or not, but now with my pathology results, I'm very happy I did.

We should be fine. Good luck with your recovery.

RickTrin,
Just curious how you are doing with progress on incontinence and ED. I ask because, I believe my pre surgery diagnosis is very similar to yours. Just had my 3rd 3TMRI yesterday over a 3 1/2 year period. One 14 mm lesion in transition zone. Would expect my URO to advocate biopsy after consultation next month. Up to this point I only have 1 G6 (1% of sample) that currently isn’t even visible on new MRI from a previous biopsy. The 14 mm lesion was HGPIN 3 1/2 years ago. My concern however is that the location of this 14 mm lesion is in an area prone to post op ED & incontinence. Really would like to know how you are progressing with the post op side effects. I would assume that if if I am advised to vacate AS and move the surgery I will be at high risk of ED & Incontinence.

Excuse me for being blunt. Is all your stuff working yet?

Thanks,
PC Legacy
Posted 12/21/2017 3:14 PM (GMT 0)
Congrats on what looks like a successful surgery and path report.
Now that you have gotten the hose pulled there really isn't any reason to ever go back to this URO is there? Got to be others...
Don't let someone/anyone play with your mind. Listen to the surgeon, get your PSA done on a regular basis, get yourself back into shape and enjoy life.
You are doing well.

Samster
Posted 12/21/2017 5:43 PM (GMT 0)
I was also a pT3a... going on 7 years ago! Best of luck!
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