Got post op pathology

To all my dear friends at HW,
I just returned from seeing my urologist/surgeon and received the pathology on my RRP (September 15).

Here goes:

Staging: pT2c pN0 MX
Gleason: 3+4=7 (biopsy indicated 3+3=6)
No discrete tumor mass
Bilateral involvement
No capsular penetration (carcinoma extends into but not through capsule bilaterally)
Perinueral tumor invasion: present
Perinuera margin: Free of carcinoma
Bladder neck: Free of carcinoma
Distal (urethral) Margin: Carcinoma present
Seminal Vesical: None present
Lymph Nodes: 18 nodes free of metastatic carcinoma

I am pleased with the results. Staging went down from Stage 3 to Stage 2, but Gleason went up from 6 to 7.

Only area of concern seems to be Distal Margin. My surgeon says he thinks he got it all. Pathologist is not so sure. I will see my oncologist Monday to get his take on the path report. Plan now is to see what PSA shows. May follow up with radiation, if indicated. Cath came out September 30 (15 days). I returned to work (restricted schedule) on Monday (three weeks to the day after surgery). I feel great, and am 90% continent. Little dribbles when I take "Little Elvis" out, and sometimes he is not done when I am. But I am learning to manage the new plumbing. Some white blood cells in urine, so I am on a week of CIPRO. Not uncommon with cath post op.

Thank you all for your wonderful support. I welcome your take on the path report...any concerns I may be overlooking.

Now that's a pretty good looking pathology. I'll be pulling for you when PSA time rolls around.
Bill

I would encourage you.  It looks like a promising pathology.  Isn't it great to have the surgery behind you, and also no more biopsy's.  I too had a Lupron shot, and it took a while for that to wear itself off.  Because of my biopsy the doc cut a little wider and my pathology is similar to yours.  The things associated with incontenence will continue to gradually improve and become less intrusive.

We will continue to follow your progress.  Blessings.

RB

Age 61
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA <.04

Hello, BillSD

Noticed your latest update regarding planned IMRT.  With extension to margins and having had the presence of PIN, IMRT is a reasonable safety measure to hit the prostatic periphery.  Did your physician also discuss continuing the Lupron through the radiation series?  Personally, with any ADT I support triple hormonal/androgen blockade as an all out attack and because antiandrogens and 5AR inhibitors play an important role in ADT.  I notice how often the word "capsule" is mentioned when, in fact, the prostate gland is just that, a mass of glandular tissue, though it does have visible "margins."  It is not an encapsulated organ that looks anything like the drawings indicating a gland within an acorn-like structure/capsule.  Good signs were clean lymph nodes and seminal vesicles.  PSA values won't mean much while on Lupron and during radiation.  More likely six months out from the completion of radiation and ceasing of Lupron will give a more accurate result, and at that time I would ask for an ultrasensitive/3rd generation PSA reading that can be performed by LabCorps or Quest Labs and should come back <0.01ng/ml since there is no longer a gland present.  Since radiation can play tricks with PSAs for quite some time, it may take more than six months to drop to its lowest nadir.  I'm glad to note that you intend to be ever vigilant, since our insidious men's disease requires continued monitoring so that in the event of recurrence, we nip that return in the bud before it becomes cumbersome to control. 

Chuck

UPDATE: Just got a call from my Oncologist. He did blood work yesterday, but I was not expecting my first Post Op PSA results. To my surprise, he did the PSA test, and the results (drum roll) 0.1.

BillSD

Good Post-op path Bill, now just get on with enjoying life, you deserve it.

Randy