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Path report - not what the doctor said

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Posted 5/3/2009 6:13 PM (GMT 0)
An interesting development. As some of you guys may recall, I had my surgery (robotic) on 4/23. As a matter of fact, my cath comes out tomorrow, 5/4.

A few days after the procedure, my doc called with the post-op pathology results. He told me that it was contained, margins negative, lymph nodes clean. His tone was upbeat and said that he couldn't be happier at the way this all turned out. Time to celebrate, right? Maybe not. Just got the written report which says "Extraprostatic Extension - Present" and the staging is now pT3. How is that contained? How can I have clean margins and with extraprostatic extension? Isn't that in itself an oxymoron?

The report focuses a lot on the fact that my tumor was real close (0.6 mm) from the inked margin but "no extension to an inked margin is identified histologically". Then there is the sentence "Rare extra-prostatic extension is identified".

Obviously, this will be question #1 tomorrow but as today is a Sunday, the only place I trust that's open is HW. So, my new friends, any ideas?

Tony
Posted 5/4/2009 12:02 AM (GMT 0)
I could be interpreting this wrong, but can't you technically have an extra-prostatic extension, but the surgeon cut a wide enough margin that it is contained within his margin? In that case, the margins would still be clear? Hopefully, someone else will chime in. It sucks getting these types of reports over the weekend. If it is driving you crazy, I am sure they have an on call doctor that you could have paged. Otherwise, try to stay positive and to me, it sounds like he still got it all, but I am no expert.
Posted 5/4/2009 12:15 AM (GMT 0)
http://www.yananow.net/Mentors/TomR.htm

Check out the above Yana Mentor's website. His situation sounds pretty similar to yours and I think you will be very pleased with his status two years out. If the link does not work, his name is Tom Randall.
Posted 5/4/2009 1:26 AM (GMT 0)
The terms used are sometimes confusing to us lay folks. "Margin" is used when talking about the prostate but can be the margin of the prostate (the surrounding capsule containing all the gland) as well as the surgical margin. You can quite easily have an "extra-prostatic extension (EPE) but a negative surgical margin. All in all it sounds pretty good to me.
Bill
Posted 5/4/2009 2:10 AM (GMT 0)
Godfather,
My pathology report indicates extra prostatic extension yet I have clear margins. The way my doctor explained it is that he removed a wider margin beyond where the EPE was. As you can see my first PSA was zero and I hope to get many more. By the way my staging is also pT3a.
Posted 5/4/2009 2:32 AM (GMT 0)
Don't be discouraged, I am T3a- clear margins- at 15 months past surgery constant PSA .004 ( four readings at three month interval) - 4.5 before surgery GS3+4=7- Robotic surgery in 2007- going in two weeks for 21 month check up- expecting .004 again. My doctor said it's like real estate, location, location, location- that pesky cancer was just too close to the edge - not what we wanted but so far so good. You have a great doctor with good results.
Posted 5/4/2009 3:01 AM (GMT 0)
I also had EPE (actually in two places), but clear "surgical margins" with T3a. The surgeon told me he took a wider margin during the surgery. I've had FIVE post surgery PSA tests all coming back at 0. I think your report actually is good and you should accept what your doc is saying. Be well...
Posted 5/4/2009 10:50 AM (GMT 0)
Thanks all. I'm off to see the wizard...

Tony
Posted 5/4/2009 1:22 PM (GMT 0)
Godfather, hope your doctor visit gives you some peace and assurance. Your post-op situation is very similar to my husband's and many have already chimed in. After the biopsy, the surgeon knew that one of the cores was close to the edge of the prostate gland. When he went in to remove the prostate, he cut a wider margin than he thought necessary to give a better chance of clean surgical margins - which were achieved. Post-op report indicated a microscopic EPE but no evidence of disease outside the capsule. I think this defines "confined".

My husband's clinical stage was T1c but his surgical stage is T3a. He is 13 months post-op and has had PSA readings of 0.0. His doctor wants to continue the PSA testing every 3 months for the next year to ensure that we stay on top of this.

Godfather, you will be fine...good luck with your visit today!
Posted 5/4/2009 1:30 PM (GMT 0)
Sephie, glad to hear from you and that your husband is still doing well. :)

David in SC
Posted 5/4/2009 1:36 PM (GMT 0)
Back. What was said here was confirmed by my doc. He said that the tumor was out of the capsule but he cut a wider margin to assure he got it all - thus the negative margins and EPE. As is typical, what I was worried about eventually took a back seat during the meeting. His focus was the focal Gleason pattern 5, even though my Gleason stayed at 4+3=7. He said that was very aggressive and that some recommend post-op radiation treatments with this just in case.

No decision but we're leaning towards waiting for the 90 day PSA to see what's going on. Again, thanks to all who take the time to write.

Tony
Posted 5/4/2009 4:28 PM (GMT 0)
While you are awaiting the PSA, Tony, you may wish to do the research now on adjuvant radiation. I waited 3 months before starting mine. Things were working (I did not have ED nor incontinence) but the hormonal therapy I started put my sex life on hold. But I did my homework and know that Surgery/HT/Radiation is a great combination for the T3 and beyond. I am sorry that you appear to have some more work to do, but having been down the next steps, I can say that I am doing well and feel ok. HT has been the worst treatment to deal with for me, but still tolerable.

Feel free to write to my Email. I will be glad to chat with you.

PS: I will be in Miami Friday through Sunday morning. How's the weather?

Tony
Posted 5/4/2009 6:43 PM (GMT 0)
Godfather, glad you talked to your doctor. Sounds like he gave you some good advice and at least the start of the next phase of your treatment. The next PSA or two should tell a lot about what is going on or could be going on. I hope you do well.

David in SC
Posted 5/4/2009 9:06 PM (GMT 0)
Hey Tony, sounds like you are getting some good advice from this site, so stay positive and i wish you well, Jake
Posted 5/4/2009 9:45 PM (GMT 0)
TC

90's and humid - bring your trunks.

Tony
Posted 5/4/2009 9:53 PM (GMT 0)
Purgatory, thanks for the good wishes. I hope that you too are doing well. Some good news on the ED front ... hubbie had his first usable erection recently (with help from the little blue pill). It was his first orgasm since the surgery. I was so happy for him because he said it restored some of the confidence he had lost right after surgery and brought him closer to "feeling normal."

Life goes on...thank God!
Posted 5/5/2009 7:05 PM (GMT 0)

Hey Tony,

Good news on the negative margins!  Did they give you a percentage on the focus point of Gleason 5?  I had a similar focus point and the doc hasn't mentioned radiation at all.  It seems that these focal point Gleason scores aren't mentioned too often, it may be a more recent thing to include them in pathology reports, or maybe they're just uncommon.  I go in for my first post op PSA in 9 days.

Take Care!!

Mark

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