Is this a good pathology report?

I had my da Vinci robotic-assisted prostate surgery performed at MD Anderson, TX about 2 weeks ago. The MDA surgeon was able to perform retzius sparing prostatectomy and spare the lymph nodes.

The following is the pathology report got posted today in online portal. Follow-up appointment is still out for another 2 weeks. The following is copy and paste from the portal. The last two lines makes me feel concerned. Any comments? or questions that I should prepare for the follow-up?

Diagnosis
A: Prostate gland and seminal vesicles:
PROSTATIC ADENOCARCINOMA, GLEASON SCORE 7 (4+3). (SEE COMMENT)
TUMOR CONFINED TO THE PROSTATE.
Right and left seminal vesicles, no tumor present.
Segments of right and left vasa deferentia, no tumor present.
Margins of resection free of tumor.
LYMPHOVASCULAR INVASION PRESENT.
PERINEURAL INVASION PRESENT.

Post Edited (Ray57) : 9/1/2022 3:35:18 PM (GMT-7)

Nothing to add, but your How is tumor confined to the prostate followed by
4/3
LYMPHOVASCULAR INVASION PRESENT.
PERINEURAL INVASION PRESENT.

The following additional information is under Synoptic Checklist. I surely ask the folks @ MDA on my appointment day.

TUMOR

Histologic Type: Acinar adenocarcinoma

Histologic Grade:

Grade: Grade group 3 (Gleason Score 4 + 3 = 7)

Minor Tertiary Pattern 5 (less than 5%): Not applicable

Percentage of Pattern 4: 61 - 70%

Intraductal Carcinoma (IDC): Not identified

Cribriform Glands: Present

Treatment Effect: No known presurgical therapy

TUMOR QUANTITATION:

Greatest Dimension of Dominant Nodule (Millimeters): 13 mm

Additional Dimension of Dominant Nodule (Millimeters): 12 mm

location of Dominant Nodule: right lateral, right posterolateral and right posterior peripheral zone

Extraprostatic Extension (EPE): Not identified

Urinary Bladder Neck Invasion: Not identified

Seminal Vesicle Invasion: Not identified

Lymphovascular Invasion: Present



MARGINS

Margin Status: All margins negative for invasive carcinoma



REGIONAL LYMPH NODES

Regional Lymph Node Status: Not applicable (no regional lymph nodes submitted or found)



PATHOLOGIC STAGE CLASSIFICATION (pTNM, AJCC 8th Edition)

Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the time the report is issued. As per the AJCC (Chapter 1, 8th Ed.) it is the managing physician’s responsibility to establish the final pathologic stage based upon all pertinent information, including but potentially not limited to this pathology report.

TNM Descriptors: m (multiple)

Primary Tumor (pT): pT2

pN Category: pN not assigned (no nodes submitted or found)

The finding of cribriform morphology is another risk factor. As with others, it does not mean that the cancer has spread, but increases the risk.

Expect that radiation, and possibly ADT, may be proposed to best assure your treatment success.

4+3 should be treated as GS 8
I was Stage 3 GS7 (3+4)
My pathology report was a little worse than yours if you read my signature.
Surgery in 2007 Salvage radiation in 2015
PSA before radiation was .06
Radiation seems to have worked.
<.006 for 7 years
Pay attention - stay with great doctors

DjinTonic said...
I echo what ASA said about the cribriform morphology.

I don't understand why the surgeon removes no lymph nodes for examination. Your biopsy was also 7 (4+3), so this is perplexing (some surgeons take no nodes after a G6 biopsy, but your biopsy was Intermediate Unfavorable).

Djin

Really dumb.

Djin,
Thanks for the correction, I read it wrong.

Also, my Uro almost didn't take any LNs even though I was G8 at the time of biopsy. He wisely took one, and low and behold it was positive.

Thank you all for your responses and thoughts. I did ask them my concern on those 3 items thru the portal system.

Ray, please remember that we are not doctors. That may be the case, although I would think that if local lymph-node metastasis has just begun, it may be too small to cause an increase in PSMA and light up on this scan. As noted in your report, lymphovascular invasion within the prostate was, in fact, identified. Enlarged nodes on any scan--even a conventional one--of course, are suspicious for mets, but are not proof.

Opinions on PNI (perineural invasion) found at surgery differ. As I mentioned, the majority of men have it somewhere in the prostate when the whole prostate is examined, which includes many men who never have recurrence. PNI when seen at biopsy is taken as increased risk of adverse findings being found at the time of surgery, probably because if PNI is seen in the tiny amount of tissue removed at biopsy, it could mean that the cancer has been around longer and therefore is more likely to have spread locally (increased risk of EPE or seminal vesicle invasion).

Please let us know what you find out--we learn all the time, too!

Djin

My surgeon was one of the best around. He helped perfect the DiVinci method for Pca and taught many Euros how to use it. I believe he's performed 3,000 or thereabouts RALPS.
I biopsied a 3+4 - with PNI. No MRI beforehand. Ended up with pT3a and the malignancy 'abutting' (but not invading) the margin.The surgeon took only one node that was described as "reactive" but showed no signs of cancer in the pathology evaluation. I never asked him why he only took one. I just figured the man knew what he was doing. After 3,000 he could almost do it with his eyes shut. But I guess it worked out. 6 years out, at this point I'm still undetectable. Good at least until the next blood draw. It's pretty amazing how all these surgeons have their own methods and practices. It would seem to be standardized with all the data. Just goes to show how hunches and guesses play a BIG ROLE in health care. An attending anesthesiologist who was running the ICU where I recovered told me that exact same thing - that much of medicine is a guessing game. I appreciated his honesty. Most won't be that blunt.

Thank you again to all of your for thoughts and comments. Here is the response I got regarding PNI, LVI and cribriform:

"The stage and margins are the important parts. The others along with the Grade support the decision to treat this tumor vs observation."