Report is in, not what I expected.

I got my pathology report and SP cath was removed one week out. The Dr. asked if he could do an ultra sound using a special scope they just got in. It was to check the blood flow thru the nerves that were spared and they both were working fine which is great news. The report was overall good but it turns out that I had a positive margin that my biopsy didnt show at the time. In 3 months time, the cells were about to leave the prostrate. I am praying that this thing was caught in time. There was an extraprostatic extention in the bladder neck region on the left side. The Dr. assured me that he removed everything seen but there may be a small chance that a cell or cells went to the bladder. I get my PSA checked in one month. The plan is to just go from that first reading. He said it could be nothing at all. If it's good, we just keep monitoring it but if it starts to rise, then we have to look at other options such as radiation treatment. I pray that this dosnt happen. I appreciate any input on my pathology report. Thank's.

*Dominant nodule location : Left anterior region/anterior midline
*Size of dominant nodule : 3.0 x 2.2 x 1.8 cm
* Gleason grade percentages ( dom nod ) : Gleason 3 = 98% : Gleason 4 = 2%
*Additional nodules : right anterior mid
*location and extent of extraprostatic extension ; bladder neck region ( left side ); established.
*location and extent of positive margin : bladder neck in the region of EPE; linear length = 8mm. Gleason score of tumor at margin is
6 ( 3 + 3 )
*Primary Gleason Grade : 3
*Secondary Gleason Grade : 3
*Tertiary Gleason Grade : 4
*Tumor Grade ; Moderately differentiated (Gleason score 5-6),G2
*Tumor Volume: Volume of tissue containing tumor : 14%
*Status of Inoperative/Biopsy margins for invasive carcinoma : bladder neck ( left )
*Invasion of seminal vesicle : Absent
*Angiolymphatic Invasion :Absent, LO
*Venous Invasion : Absent, VO
*Perineural Invasion : Present
*Primary Tumor: pT3a, tumor with extracapsular extension ( unilateral or bilateral )
*Regional Lymph Nodes ; pNO, Metastasis absent
*Distant metastasis : pMX, Cannot be assessed

Post Edited (DonaldJ) : 4/17/2013 9:13:13 AM (GMT-6)

 I think I've seen some argue that wit you numbers AS is a viable plan. I'm glad you got treatment.

many of those who "argue" for AS didn't do it themselves.  we've been seeing a lot of upgrades lately after surgery.  I don't even believe in telling someone that "you've got plenty of time to make a decision".  I mean, how the hell do you know how much time he has?

ed

 

Ed, I agree. My biopsy indicated that I had time as my urologist said no hurry. After a month or so I decided my treatment and then searched for the surgeon and took like a month to schedule my surgery. I could have had surgery sooner if I had choosen another hospital location but I wasnt really ready at the time and I was being stubborn. I will never know, but I hope that decision didnt cost me. In my opinion, dont wait any longer than you have to. Get it done !

Donald --  my doctor said I have plenty of time to make a decision.  when I asked how much he said "two weeks, not two months".

if you want to take your time and talk to five doctors and read six books and have three exotic scans that's your prerogative.  but you'll never hear me encourage it. what I will tell you is you have a better than average chance of having a more aggressive case of cancer than your biopsy shows.

ed

 

Davidg, I'm with you on this. When my husband was diagnosed, the urologist told us to take some time to think about it...but not too much. Since my husband already knew he wanted surgery, the time we had was moot but I spent it learning what I could about what to expect from the surgery and afterwards.

Again, in my husband's case, his initial stats weren't too bad: 2 out of 10 samples were positive, one a G6 and the other a G7 (3+4). PSA was 6.4, and nothing was felt during DRE and nothing seen on the sonogram or CT scan. After surgery, though, we found out that the cancer had broken through the prostate into the capsule and was poised to break through the capsule...that would have been a game changer. When the surgeon called us at home to give us the final pathology, his words were "looks like we got to it in the nick of time." Those were sobering words to hear because my husband was a candidate for AS (though this course of action was not encouraged due to the Gleason 7).

Not to scare any newbies who may be following this thread but it's worth repeating that because a biopsy has you at a low Gleason with a small amount of cancer, the surgical pathology often paints a more serious picture. This in and of itself is not a reason to have the surgery is certainly something that taken into consideration depending on the situation. We're hearing of too many guys who recently had surgery and received some serious news about their pathology.

Margins are not seen at biopsy so "spread" cannot be noted.  Margins are examined when the whole prostate is removed.  So you would never really have positive margins on biopsy.  Your extension is very minimal and you are really G6 - only 2% of G4 in you.  I think that you will do well - if the "spread" is G6 cells then even without surgery you would maybe have gone a long time with no issues.  I don't think that this pathology means your surgery was an emergency. Best of luck and live positive as the findings are overall good.  I don't think AS should be discouraged due positive margins - if they are minimal and with G6 pathology then patient may do fine for years and perhaps be a XRT candidate down the road.  I had surgery but it has its downsides as well.