Questions about biopsy report terminology

Before surgery:
MRT: no evidence of tumor.
TRUS Biopsy:
3 out of 6 cores prostatic tissue showing Adenocarcinoma, Gleason score 7 (4+3) - middle and appex zone blocks N B and C. T2a grade group 3.
The tumor involves 10% of total specimen volume.
PSA 4.24

Biopsy of prostate after robotic radical prostatectomy:
Prostate 3x3x5 cm, 51 gr.
PSA=0.04 6 weeks after the surgery
Biopsy: Gleason 7 (4+3)
Apex right side: small multiple foci of tumor not reaching the linked surgical margin.
Apex left side: free of tumor.
Bladder left and right side: free of tumor.
Right lobe: multiple foci/areas of tumor, largest focus 1.2 cm in maximum dimension.
Left lobe: free of tumor.
Posterior capsule right side: the tumor focally infiltrates the capsule. There is no evidence of extraprostatic extension and the linked surgical margin is free of tumor.
Intraprostatic focal perineural invasion is identified.
Posterior capsule left side is free of tumor.
Additional findings: adenomatous hyperplasia.

Questions:
1. What is a meaning of: "Intraprostatic focal perineural invasion is identified"?
2. What is adenomatous hyperplasia?
3. Why after surgery biopsy report does not include stage (T2a grade group 3 - before surgery)?
4. What are my chances of recovery?

Gave your thread a subject line. -- PeterDisAbelard

Post Edited By Moderator (PeterDisAbelard.) : 10/20/2017 6:34:30 AM (GMT-6)

Thank you for prompt reply.

1. What is a meaning of: "Intraprostatic focal perineural invasion is identified"?

It is a very common finding on a path report, and doesn't add very much to the risk beyond other risk features. It just means that cancer was seen around the nerves that penetrate the prostate, and there is a small risk that the cancer could escape through there.

2. What is adenomatous hyperplasia?

That's BPH. It just means there was proliferation of healthy prostate cells.

3. Why after surgery biopsy report does not include stage (T2a grade group 3 - before surgery)?

You are probably still stage pT2a because there was cancer found only on one side of the prostate, with the 1.2 cm tumor and some smaller foci on the one side (possibly stage pT2b if it totalled to more than half of that side). Starting in January, they will only call it stage pT2 because the important fact is that it was fully contained within the prostate.

Your grade group is still 3, which means Gleason 4+3

4. What are my chances of recovery?

You can look at the statistical probability that you will not have a recurrence using the following nomogram:

/www.mskcc.org/nomograms/prostate/post_op

Your PSA of 0.04 (rather than <0.04) at 6 weeks is right at the point where you want to pay attention to it. I assume you will have a f/u at 13 weeks. BTW- "linked" should be "inked" which is the way they tell if there were any positive margins.

Thank you for clarification and calculator link.

BPH stands for; Benign Prostate Hyperplasia. Or more commonly identified as enlarged prostate.

6 weeks is too early for your first PSA. Get it retested in a month, chances are it will be undetectable.

Your path report is good.