terms of biopsy pathology report

63 years old, PSA 10.7, heavy drinker, a bit overweight, but generally cheerful and appreciative of being alive.

7/13 samples are positive for prostatic adenocarcinoma (4+3) , all on the left. Right is clear. 62mm total.

That is clear to me. Well - I don't understand the significance of the 62mm . I suppose that's a measure of depth, but since I don't know the depth of the probe, it doesn't mean much.

The Synoptic Summary though I need help with understanding - on at least one point which I identify below. Please correct me where my understanding is incorrect or incomplete.


* Perineural Invasion = present.*
I understand this to mean that the samples include nerve fibres and that the cancer has invaded at least one of the samples. This raises the probability of post-RP recurrence.

* Seminal Vesical Invasion = Seminal vesicles are not present.*
I understand this to mean that none of the samples include pieces of seminal vesicles so the pathologist can say nothing about SVI. Cat could be alive. Could be dead.

*Lymphatic Invasion = Absent*
I understand this to mean that samples do contain lymph node tissue and no sample has cancer.

*High Grade Prostatic Intrapithelial Neoplasia = Absent*
This is confusing because I understand PIN to be a precursor of adenocarcinoma. If this understanding is correct, then this is a sample error. Given the finding of carcinoma, it is irrelevant.

*Atypical Acinar Proliferation = Absent*
Ditto.

* Periprostatic Adipose Tissue Invasion. PAT is present but invasion is not identified.*
NOW I'm confused. How is this judgement different from the "present" perineural invasion and the "absent" finding of the previous two issues?

I understand that this item of the report is saying that samples include some of the fat that wraps my prostate, but I don't understand why the pathologist would use "not identified" rather than "absent". This seems to me a very important distinction. Given the PNI, my post-RP prognosis is less than rosy. Fat invasion would make it even less rosy than that.

I apologize if this has already been beaten to death but my searches find nothing.

Thanks for this forum. It is a comfort.

I have a few thoughts, and I hope I'm correct on these points:

1.  I wouldn't say that PNI raises the "probability" of recurrence. I think it would be more correct to say it raises the "possibility" of recurrence.  Of course, recurrence is always a possibility, anyway.

2.  It sounds as if the surgeon felt confident that the seminal vesicles are clear.  Either they were left behind, or they were found to be cancer free.

3.  The lymph nodes may have looked fine, and the surgeon felt no need to remove any.  That was true in my case.

4.  You had adiposal tissue (fatty tissue in the area of the prostate), but there was no evidence of cancer there.

Don't lose sleep over the PNI result.  It's extremely common and not necessarily predictive of recurrence. 

If I'm wrong on these points, I'm sure more knowledgeable guys will correct my comments, but these are my thoughts.

All in all, there are some re-assuring comments in your report.  You should focus on that.  When was your surgery?