Hubby's Final Pathology

Hello,

Just thought I would share hubby's final pathology following surgery.  It sounds good (I think), but I'm afraid to get too excited.  His surgeon said the PC was organ confined.  Not sure though about perineural invasion, it shows present.  What does that mean?  His surgeon called to give the news, but I wasn't around so I couldn't ask.  We will meet with his surgeon in the future, but just thought I'd share to get some insight. 

 Quick side note: we realize that Levitra is rehabilatative at this point, but we saw some very encouraging results from the first 1/2 dose he took last night.  Not firm enough for sex, but quite considerable. :)

Procedure:
Radical prostatectomy
Prostate Size:
Weight: 41 g
Lymph Node Sampling:
Pelvic lymph node dissection
Histologic Type:
Adenocarcinoma (acinar, not otherwise specified)
Histological Grade:
Primary Pattern: Grade 4
Secondary Pattern: Grade 3
Total Gleason Score: 7
Tumor Quantitation:
Proportion (percent) of prostatic tissue involved by tumor:
19%
Tumor size (dominant nodule): Greatest dimension: 16.0 mm
Tumor size (dominant nodule): Additional dimensions: 11.0mm
Extraprostatic Extension:
Not identified
Seminal Vesicle Invasion:
Not identified
Margins:
Margins uninvolved by invasive carcinoma
Treatment Effect on Carcinoma:
Not identified
Lymph-Vascular Invasion:
Not identified
Perineural Invasion:
Present
Pathologic Staging (pTNM):
Primary Tumor (pT):
pT2c: Bilateral disease
Regional Lymph Nodes (pN):
pN0: No regional lymph node metastasis
Number of regional lymph nodes examined: 3
Number of regional lymph nodes involved: 0
Distant Metastasis (pM):
Not applicable
Additional Pathologic Findings:
None identified

Perineural invasion is nothing to be concerned about in your case. He’s in great shape. Basically this means the cancer got out of the prostate near the edge of the prostate, but was still within the capsule. What’s most important is that the surgical margins are clear, which is in his pathology report where it says, “Margins uninvolved by invasive carcinoma”. Like your husband, I had perineural invasion with clear surgical margins, and have had 2 undetectable PSA tests since my surgery last June.

Also, if he’s already having a response to Levitra at 2.5 weeks, that’s really good.

Congratulations on both points!

Great looking path report! Looks like your a cinch for the "0" club.

Gotta ask you, how were you able to post so much data in your signature? I`ve tried to  add updates to mine and it won`t let me? What am I doing wrong?

snake

Faith, things look good!  Is hubby's PSA test in 6 weeks?

Aimzee

Generally sounds good, but despite the posting of a link to one study that makes PNI look like no big deal, it is a cause for some concern - my sense in reading up (I don't have it in my report) was that PNI was a tick in the bad box, and potentially a serious one. However, it does not really change what you do, which is watch, wait, hope and concentrate on things you can do something about.

Here's to seeing hubby in the zero club next month, and hopefully forevermore!

[In general, you can find a few studies that support almost any position you care to take with this disease, in my experience.] Here's a different take (based on other studies) on (and more explanation of) PNI. On the other hand, you seem to have gotten out of the "greater chance of extraprostatic extension" cleanly, so...

myprostatedoc.blogspot.com/2011/06/perineural-invasion-on-prostate-biopsy.html

Also, it feels like the studies out there are very confusing regarding PNI. Some say it is a significant, while others say it is not.

DesertRat,

I did notice that.  I have read about clinical pathology (needle), and then final pathology as it relates to PNI.  I understand it to mean (but who the heck am I) that it may be more significant if PNI was detected with the needle biopsy, and in hubby's case it was not.  It sounds like the studies have at one point put more value on PNI final pathology, and then backed away from it.  As with anything on the good old internet, we can find a lot of information and "studies".  I will follow up with his surgeon this week about it.  I appreciate you responding, by the way! 

Desertrat1,

Here's to a perfect PSA!

~walkbyfaith

I with you on that one. I should have my first 3 month PSA in early april.

The Water Guy,

"We are keeping an open seat for your husband in the zero club when he submits his application."

 

That is so sweet!  I showed this to hubby today and he really enjoyed reading it.  Thank you!

Hello Walkbyfaith, and Walkbyfaith husband too.

One of the hard things to do, now that you have chosen surgery, and it's over, and the pathology in, is to reset your PCa headspace.

Before treatment THE most critical thing is the biopsy pathology. That's what determines what treatment is an option and can, with careful sorting of the pathology tea leaves, help identify the most appropriate treatment. Having focused for so long on pathology it is difficult to make the post-surgical switch to realizing that it's now pretty much a Gone With The Wind situation --- frankly, it don't matter a darn. It may suggest certain possibilities, but ..... ???? Fact is, PSA is back as top dog. You can have the world's most rotten post surgical path report it don't matter a rat's pattootie. What matters is a zero PSA.

Your husband's report gives every indication that he's headed for a long string of zero PSA reports. Put the path report in a drawer and don't worry about it. If you have to worry about something, pick something more worth worrying about such as getting hit by a bus. Or, if you live in a city like I do, worry about getting hit by one of those crazy cyclists who weave in and out of traffic. Your husband has had a significant cancer. It's gone. Likely forever. You want to worry about a cancer? Worry about a skin cancer.

I don't mean to say the PCa isn't a threat. Of course it is. But it has now been reduced to a minor one. Skin cancer, heart disease, auto accidents, slipping on ice, falling in the shower, power saws, those are the things to worry about. I'm not promoting Pollyana, just perspective. Like someone who has been in an airplane crash and survived, it's difficult to accept that was yesterday's threat, and getting on a plane today is safer than the drive to the airport.

I've lots of friends who have still got their prostates. Those are the guys I worry about. My friends who, like myself, have donated their rotten organ to science .... we're all members of the lucky no-sperm club. Prostate is gone. We get followed up on every six months. Our risk, the way I see it, is nickle dime compared to the poor guys still walking around with prostates, many of them cancerous and growing, and they don't even know it!

Hope this helps, and I hope you'll keep posting and let us know how you are both doing.

Sheldon AKA Sleepless

Sheldon,

WOW! That's some good reading right there! I loved your post so much that I cut and paste it into an email for hubby and he loved it too! How true it is, and what I already know to be true, but question when really I shouldn't. I read somthing today that said, "don't put a question mark where there is a period." Thank you for taking to the time to write your post!

Aimzee,

Thank you!! We are slowly getting there, and what a great place to be. So happy for you and hubby!

Sleepless,

Now I see why you chose Sleepless. I agree with you so much. Many years ago I suffered from anxiety attacks, specifically related to my health. Mind you, I was healthy, but if I felt an ache or pain, I'd convince myself I was very sick. Often times I'd convince myself it was cancer. That sort of anxiety didn't serve me well, and so I stopped doing it. I developed some pretty awesome skills (spirutual) that taught me so much. The most amazing party is that I didn't have a single anxiety attack through out hubby's entire journey, and that is HUGE progress. There were, and still are days where I found myself going to that "panic" place, but when I do/did I use what I have learned and it always centers me. That's exactly why I enjoyed your reply...it was a nice reminder/validation of what I already know to be true.