Pathology results from Prostatectomy 09-26-2022

wife #1,
your husband is blessed to have such a supportive spouse. my wife was great in that regard too. yes, continue to remind your husband to “behave” and not over-do it during recovery. i didn’t heed that advice from my wife and surgeon and ended-up with a nasty hernia after my RP which required yet another surgery. it wasn’t until after that when i realized how major RALP surgery is, and how long recovery takes. good luck to you and your husband moving forward!

ha! hard-headed i was indeed: i moved 9 yards of woodchips with a pitch fork and a wheelbarrow three weeks after RALP.

Congratulations! Things are looking very good.

I just read your comments to my wife. I think she already has a coaches whistle around he neck and I haven’t left the hospital yet.😀😀🤦‍♂️

Mike had his follow-up with the surgeon. He was happy with the <0.04 PSA. The disappointing part was the John Hopkins 2nd opinion not back yet. The decipher not back yet either.
So, the Dr. mentioned at some point he would believe that he would need additional treatment. But right now, he is good.
He goes back in 3 months. I asked about the ultra-sensitive PSA test but right now the Dr. prefers the regular PSA. I am waiting for the other results to come in to change anything up, right now.
Mike asked me if he should get his golf pass for next year or wait. My advice was get the pass, you can't live on "what might happen or I might need". He is feeling so much better and is tackling 4 feet of snow with the son's help.
I guess right now, we just kind of wait.
Thank you for all your help and I will post when we get his results.

I logged in the John Hopkins sight after I saw that Medicare was billed. I think it is almost the same as our original pathology.
Same Gleason and same Grade. I see no mention of Cribriform cells as on original pathology. I think this is positive news. The Decipher is not back yet.

SURGICAL PATHOLOGY: CONSULT - Details
GU PATHOLOGY CONSULTATION SERVICE
Jonathan I. Epstein, M.D., Director
Andres Matoso, M.D.
Tamara Lotan, M.D.

1. Prostate (SP-22-0025523, 9/26/2022):

A. Periprostatic Fat (Excision): Benign fibroadipose tissue. Negative for tumor.
B. Lymph Node, Right Pelvic (Dissection): Two (2) lymph nodes and associated fibroadipose tissue, negative for tumor.
C. Lymph Node, Left Pelvic (Dissection): Five (5) lymph nodes and associated fibroadipose tissue, negative for tumor.
D. Prostate (Radical Prostatectomy): Metastatic carcinoma in one periprostatic lymph node (1/1).


HISTOLOGIC TYPE:
Adenocarcinoma (conventional, NOS)

GLEASON SCORE, DOMINANT NODULE:
3+4=7
Grade Group 2: 20% Pattern 4

location, DOMINANT NODULE:
Left, right, anterior, lateral, apex, mid

LOCAL EXTENT (8th Edition AJCC):
Extraprostatic extension
location and extent of extraprostatic extension:
Left (D7), anterior, apex, nonfocal
Right (D5-3), anterior, apex, nonfocal

MARGINS:
Positive
location and nature of positive margins (D7):
Left, anterior, apex
Positive in an area of extraprostatic extension (EPE)
Summed length of positive margin: <1 mm involved by adenocarcinoma, Gleason score 3+4=7 (Grade Group 2)

SEMINAL VESICLE INVASION:
None

LYMPHATIC (SMALL VESSEL) INVASION:
Present (D16)

PELVIC LYMPH NODES (including all parts):
Metastatic carcinoma in 1 of 8 lymph nodes
Extranodal extension is not identified

EXTENT OF INVASION (8th Edition AJCC)
PRIMARY TUMOR:
pT3a: Extraprostatic extension or microscopic bladder neck invasion

REGIONAL LYMPH NODES:
pN1: Metastasis in regional lymph node(s)

SUMMARY MARGIN:
Positive

NOTE: Extraprostatic extension (EPE) is identified in D5-3 and D7.







Resulted at JHH Pathology Lab, 401 N. Broadway, Baltimore MD 21231-2410, Phone: (410) 955-3580.

General Information
Ordered by John Rutkowski

Collected on 09/26/2022 9:00 AM from Prostate (Tissue)

Resulted on 10/24/2022 12:18 PM

Result Status: Final result

This result was released automatically. You may be seeing it before your provider has seen it.
MyChart® licensed from Epic Systems Corporation © 1999 - 2022

Wife1, if your husband can shovel snow he can certainly golf. However, playing in the snow could be more difficult than his recovery from the surgery, LOL. It looks like all the major treatments are over for your husband. Radiation may be in the future, but living life to the fullest is the main goal right now. I am so happy he has recovered his strength. Both of you have been through a lot lately, now is the time to listen to the docs. Most of them are smarter than we are. However, the wealth of information here is priceless. Have a wonderful Thanksgiving and I will pray that you and your husband have many more years together without any further worry. As always my best to all and for those of you that tee it up in the winter, no looking for a better lie with your foot. LOL
Jack

Hello, I have been following your posts and praying for your husband. My husband had a Laparoscopic Prostatectomy on 9/12 at Yale by Dr. Isaac Kim. Please read the signature for my husband’s stats. He was found to have had seminal vesicles invasion bilaterally which did no show on ant scans. He is pt 3b, and he tested at <0.04 last week. For now, it is watch and wait for three month PSA’s but this site has given me so much hope for what to do if/when the psa rises. Take care!

Hi Ann.

A PSA test with 2 decimal places is considered an ultrasensitive test and should be sufficient for monitoring your husband's PSA numbers and rate of rise. That, along with his Decipher results, will guide him and a RO in getting a radiation plan in place and determining the timing of therapy, which will be a balance between healing time vs. disease progress (as tracked by his PSA and, possibly, further imaging) and genetic aggressiveness (as determined by the Decipher results). It would probably be a higher dose to the prostate bed and a small one in a large pelvic zone surrounding it. I recommend the web seminar Rising PSA After Surgery that a Forum Brother linked in a recent thread. All these issues, as well as ADT, are discussed in the seminar.

Think of any further treatment needed after the RP as the second part of a two-stage primary treatment for his prostate cancer that wasn't prostate-confined, but which can still be knocked out.

(When you update your husband's signature, keep in mind that RP findings, post-op PSA numbers, and any future imaging, testing, and therapy are now the most important facts. His biopsy and pre-op imaging are important history, but are out of the spotlight now that you can benefit from the accurate staging afforded by the whole-prostate exam and post-op report. I would include his pre-op PSA value as well.)

All the best,

Djin

Djin, this advice has made a difference in my thinking. I feel better and this is what I told him and our kids. I would highlight above my post, but can't figure it out, so I copied.

Think of any further treatment needed after the RP as the second part of a two-stage primary treatment for his prostate cancer that wasn't prostate-confined, but which can still be knocked out.

Djin and Mumbo,
Thank you, my initial panic has calmed down. I did update my signature.

We saw the Dr on 02-17. I asked about the differences in the surgical pathology findings between our hospital and John Hopkins. Our Doctor was not real concerned as he considered the differences small. The big difference was EPE
Hospital, Left anterior apex focally with positive margin <3mm
John HH, Left anterior apex, nonfocal with positive margin <1mm, They also noted EPE in Right anterior apex nonfocal. Our Doctor did not seem concerned since prostate was removed.
The Decipher was 0.27, low risk, Doctor said he was surprised but pleased. I was surprised too and me being me was expecting a higher number. So feeling better and next PSA is in 3 months.
In case anyone is interested, MC was billed $5490.52, approved amount $4109.34
The MC deductible is covered by our BC/BS. We are so fortunate to have good coverage.
He is doing well with recovery, 5 months since surgery.