Questions regarding husbands surgical pathology report

I’ll be first since I know the least but have been there trying to figure the reports out and every one is written differently. I have not seen the term before but I think that “non-limited” may pertain to the size of the margin where the margin is >3mm which seems to be a limiting value listed in reports many times. There is a statistical benefit to a margin being small and 3mm seems to be the cutoff. So in my simple mind, non-limited would probably apply to this value and that you husband’s margin was not limited to the 3mm criteria and thus non-limited. Just a guess and extrapolation on my part.

Definitely a good question and you could try to contact the pathologist who wrote the report and hopefully get it explained. They never talk to people so I think it might easier to contact them then doctors.

You are just in the beginning of a long process so take your time. After the first PSA is a good time to chat with urologist since you will have your first data point to go along with the post-op pathology. There are some concerns with the pathology that you presented that you will definitely want to go over with the doctor. Don’t be surprised if he just wants to monitor PSA at least to three months before making any recommendations other than monitoring.

Thanks for the responses. According to the reference document it does look like non-limited means equal to or greater than 3mm. Will ask about it at appointment.

Paige, if it were me I would ask the urologist straight out was any cancer left behind and if so, what's his recommendation for treatment plan.

Paige4 said...
Would like to be prepared to ask questions. Thanks.

Bladder neck margins have a high incidence of recurrence. Your discussion will be centered around this important point, and if/when to consider secondary radiation treatment.

Unfortunately, Paige, nothing is really cut and dried with PC. The positive margins at the bladder neck and urethra are concerning--but they are not a guarantee of surgical failure. Likely the Uro will refer you to a RO for adjunct radiation--but even then, they can't do anything until the 3 month post surgery date happens: healing has to happen first. Particularly at the bladder neck--that will be a double-whammy on the continence front.

Hang in there, the answers will come.

Agreed, Michael_T. Fairwind's comment "He failed to cure the cancer" was very poorly worded. First of all, the surgeon didn't fail anything. Second, while there is a high incidence of recurrence when BNI occurs, more of the case needs to be considered before that gets declared...although as halbert said (with a misspelling), this case has the potential for an adjuvant RT recommendation.

BTW, Paige4, this "size/extent 35 mm" is also significant. That's large.

Paige4,

Hopefully he is doing well recuperating from the surgery. While you are waiting on results, you may want to use one of the nomograms that can provide some direction, but not a specific prediction. I suggest you go to www.mskcc.org and find the Prostate Cancer nomograms. One will be for post surgery. Simply answer a few questions and it all provide some direction. This is at Memorial Sloan Kettering Cancer Center in New York. Another institution that has meaningful nomograms is Johns Hopkins.

Not the pathology report you would hope for but as others have said cure may still be possible. Surgeon did the best he could - he went as close to taking as much out as he could without damaging other organs.

I would go as aggressive as possible after recovering from surgery. You should start taking appointments with a world class prostrate cancer center now and plan next steps - could well be ADT followed by Radiation.

I would also ask the surgeon what was the Gleason score at the margin - he may or may not have that info but it’s information that could be useful.

Please do add your signature to your profile. What was his pre surgery PSA.

Most imp is the first 3 month PSA post surgery , so I hope you see a < sign.

Thank you all for the information and support. It's much appreciated. AZ Guy your recovery is inspiring. Leah77 hope your husband continues doing well. Did he have bni and perineural invasion? To answer some questions his psa before surgery was 7.7. The surgeon had told us he didn't plan to remove any lymph nodes as it didn't seem necessary and recovery would be easier. He had told us it should take about an hour and a half to two hours. It took three and a half hours and he said he had to do bladder neck reconstruction because the prostate was large and had been pushing against it. His regular uro spoke to us briefly when he had the cathether removed and gave us the pathology report. He said he now has locally advanced disease and we would discuss it at the follow-up appointment when he has psa results. His surgeon was another doctor in the practice that specializes in robotic surgery.

My surgery, if you count 'surgery time' as from anesthesia start to end was more like 4 hours--but the actual surgical time (first cut to last staple) was on the order of 2 to 2 1/2.

That's not particularly important..what IS important is the technical care the surgeon took. To take or not to take lymph nodes is an 'in place' call. Some do, some don't, some take a lot, some take very few. Debating whether the surgeon 'did right' or not is not particularly helpful to the OP.

The keys for this OP are, IMO,

1. Get an explanation of the language in the pathology report. Ask what the Gleason score of the margins is.
2. Take note of the PSA at 6 weeks. Then at 3 months. That will tell a significant part of the story for next steps.
3. Pay a visit to a RO soon. Ask his opinion about what is likely, based on what is known today.
4. Get him healthy, then get out there an live life!