Please help me read my Pathology Report

at 35%, that was a lot of cancer found, your tumor load

you have positive margins, which may prove to be a problem for you later down the road, I had (1), and it didn't take long for recurrence to occur, however, there are other men with positive margin(s) that do well and never have reccurance.

your report was very similar to mine, right down to the prostate size and your staging.

keep a close eye on your next 3-4 psa readings, and that will pretty well show you how well you are doing in the future

good luck

david

Insist on having your medical team interpretiy for you. You could even by pass them, call the pathology lab where the work was done and ask them to interpret it over the phone. I had questions on mine in hawaii months after and called seattle and had a chat with some one from the lab , who answered all my questions. Don;t call during lunch time, you want ti time it for hopefully a slack time. they may saw to ask your doctor and that may just answer you.

Hi,

Yes, you do have those positive margins. But, as others have noted, this does not always mean that there will be a recurrence. I had 1 small positive margin (the apex is a common area for PMs) but my doctor said it is unlikely that I will ever have a recurrence. No follow-up treatment was required so I was very lucky.

I hope you will be also! :)

tatt2man had a good point in noting that your Gleason score of 7 was a 3+4 and not a 4+3. In many cases, it is practically like a Gleason 6 (3+3). The stats apparently show that a Gleason 6 rarely ever spreads. So you should actually be in pretty good shape.

The doctor will probably discuss this with you & whether any salvage radiation might be called for. Or, perhaps the doctor might just want to keep a close watch on your PSA. Your first post-op PSA test should be taken about 3 months after surgery, so that will be a big thing to watch for.

Take care,
Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1.
Semi-erections now happening 14 months post-op & slowly getting a bit stronger.

My surgeon went over my biopsy report with my wife and me, line by line, taking time to explain each entry. I'll bet yours will do that, too, at your next appointment. It was very helpful to have someone with me so that we could compare notes and impressions afterwards. It was especially helpful that my wife went with me. She's a Registered Nurse, which has been a blessing to me, but just having someone along is a good idea, I think.

As for the note about Perineural Invasion being present, try not to sweat about that. Most of us have that in our reports, and there's not really anything that can be done about it. I take it to mean that the nerves within the prostate have been reached by the tumor. Whether or not any cancer cells have escaped by that route is impossible to tell, and nothing can be done about it anywy.

Others have already done a very good job of putting your results into context. Best of luck to you.

i agree with what others have said. It's a pretty good report overall. One thing that wasn't mentioned is the word "focal" in this context means "small". A "focal" positive margin means that a small spot of cancer was present in the surgeon's cut-line, like around a millimeter in diameter, a 25th of an inch. Even though you might think that it's essential to get every last cell, in cases of Gleason 3+4 often the remaining cells are mutated enough to be able to survive on their own, outside the prostate, so they just wither away. What you don't want in a path report are "extensive" positive margins.