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Posted 4/12/2013 2:16 PM (GMT 0)
I am hoping someone might help me with my stats. I understand some but not other. It says weight is 25 grams, interior shows a 2 x.1.5 cm yellow focus that is near a margin. prostatic adenocarcinoma, gleason grade 3+3(6), percent of prostate involved: 20%, tumor is bilateral, extra prostatic extension: no. lymph vascular invasion: absent, peri neural invasion: present, seminal vesicles involvement: yes, bilateral. cancer stage: pT3b. Tumor at surgical margin: right seminal is focally positive along a 0.08 mm inked margin, however additional right posterior lateral margin which consists of peri prostatic soft tissue and seminal vesicles have negative inked margins. Any help would be much appreciated.
Posted 4/12/2013 6:38 PM (GMT 0)
I would hope your urologist will go over this with you.

The good news is:
    • Gleason score within the tumor inside your prostate is 3+3
    • Only 20% involvement by cancer
    • No extraprostatic extension (tumor breaking through the prostate)
    • No spread to local lymph nodes that they looked at
    • No positive margins in the prostate itself - positive margins mean they left some cancer behind.


The bad news is:
    • perineural invasion - cancer in the area of the prostatic nerves
    • seminal vesicle invasion - cancer has spread to seminal vesicles on both sides (this is what the stage pT3b means), and furthermore, some cancer was left behind where the right seminal vesicle was removed.


At this point, you may want to discuss with a Radiation Oncologist having some follow-up radiation (after 3 months of healing) to the area around where your prostate was. At the very least, you'll want to monitor PSA closely.
Posted 4/12/2013 7:28 PM (GMT 0)
Hi there,

Good advice from Tall Allen. Your doctors will probably go over all of this with you.

The good news is that you have one of the less aggressive forms of PC in a Gleason 6. That is excellent. If any cancer cells were left behind (outside of the prostate), it is almost impossible for them to survive outside the environment of the prostate.

Also, Gleason 6 rarely metastasizes.

So your hopes for possible salvage radiation to complete the cure should be excellent.

Wishing you the best!
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-firm erections now happening 14 months post-op & slowly getting a bit stronger.
Posted 4/12/2013 9:30 PM (GMT 0)

Tall Allen said...
positive margins mean they left some cancer behind

Technically, positive margins mean they might have left some cancer behind.

Before they slice up the prostate and seminal vesicles for microscopic examination they cover the outside with ink. When they do the microscopic examination if they find any cancer that has ink on it they will usually note it as a "positive surgical margin" because it means that the surgeon cut into the cancer and some might have been left behind. But sometimes the tissue will get torn open so that even though all the cancer was removed with the prostate the ink can enter through the tear and color the cancer. This happens rather more with robotic surgery because the grasping tools are rather small and are somewhat more likely to tear tissue unintentionally when pulling the organ loose than are the surgeon's finger in an open operation.

If I read things correctly your positive margin was described as "focal" (which means small). I wouldn't be surprised if you are advised to wait and see what your PSA does rather than going straight to radiation. Gleason 6 cancer with focal positive margins will often behave.
Posted 4/13/2013 3:54 PM (GMT 0)
I would consider the path report to have indicated that there IS tumor "breaking through the prostate". It is in the seminal vesicle and there is positive margin and extraprostatice extension (EPE). Your stage is pT3 so these all indicate tumor outside of the gland.
The rest of the post by Allen is proper.
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