F8 asked for my stats

In a separate thread, F8 (Ed), who is approaching the 4th anniversary of his prostatectomy, asked what the largest percentage core was in my biopsy....because, like him, I am at the fourth anniversary of my surgery and just got an undetectable PSA reading.

Well, Ed, first let me thank you for asking, because your query finally caused me to look around and find my medical records related to the diagnosis and surgery.  I haven't seen that folder in the last 3 years, but tonight I found them.  Thanks!

But, I also want to mention them here because I still find them confusing, just as I'm sure a lot of newly-diagnosed guys find their biopsy and final pathology reports confusing.  So, here we go:

On the biopsy, back in June of 2010:

Right base, right mid, right apex, right base lateral, right mid lateral, and right apex lateral:  all benign prostatic tissue, no malignancy noted.

Left base, prostatic adenocarcinoma, Gleason 3 + 3, 20 % of total

Left Mid:  Prostatic adenocarcinoma, Gleason 3 + 4, 60 percent of total biopsy

Left Apex:  Prostatic adenocarcinoma, Gleason 3 + 3, 50 %

Left base lateral:  Prostatic adenocarcinoma, Gleason 3 + 3, 30 % of total.

Left mid lateral:  Prostatic adenocarcinoma, Gleason 3 + 3, 15% of total

Left Apex lateral:  Prostatic adenocarcinoma, Gleason 3 + 3, 60 percent of total.

So, just one core was 3 + 4.

However, after surgery, the final pathology report reads, "Prostatic adenocarcinoma, Gleason 3 + 4 =7, present in the left AND right lobes (left much greater than right) and involving less than 10 percent of the examined prostatic tissue.  Extensive perineural invasion; all surgical resection margins, negative for carcinoma; high grade intraepithelial neoplasia (HGPIN); Benign glandular and stromal hyperplasia; Bilateral seminal vesicles, negative for carcinoma.  Note:  Benign prostatic glands are focally present at the inked and cauterized apical resection margin.  (I have no clue what this sentence means).

Weight of specimen, 80g

So, Ed, there you have it, and as you can see there are significant differences between the biopsy results and the final pathology.  I especially notice that the biopsy only found cancer on the left, whereas the final pathology showed 3 + 4=7 in both the right and left lobes.

I don't know how those numbers compare with yours, but maybe they will help you, and others, come to some sort of conclusion about their personal situations.  Good luck to all.  Bill

 

clocknut,

I’d agree with davidg, your pathology looks great.

I’d disagree with the idea that there are “significantly differences” from the clinical result. An upgrade to 4+4 would have been a significant unfavorable, and unexpected, surprise; a downgrade to 3+3 would have been a favorable, but less unexpected, surprise. You had neither.

You were 3+4 before, and you were 3+4 after. You had 6/12 cores positive, and 10% involvement after. I don’t see where you mentioned DRE before, but you were –SM and –SVI after. Enter your data into the Sloan-Kettering nomogram and you have almost no chance of recurrence. I saw you wrote in your other thread that you were apprehensive about the outcome of your recent annual PSA test…in my opinion, you shouldn’t be.




You also posted a question/comment about not understanding the comment (the "Note") in your report about benign glands present at the apex surgical excision margin. I’m not a doctor, and not a pathologist, so don’t shoot me for any misconception that I am “playing” one, but I’ll give my explanation and let you ask your surgeon about it, if you wish to learn more...although after 4-years, maybe you don't (and maybe you shouldn't).

The apex, perhaps counterintuitively, is portion of the cone-shaped gland directed ‘downward’ in the anatomy (whereas the base is at the top, and mostly in contact with the bladder wall). The apex is where the uretha "exits" on it's way to the penis; it "enters" the prostate at the base. Counterintuitive? I think so.

The apex is also where the right and left sex nerves converge, as well as the muscles that control urination. AND, it is a hard-to-reach area because the apex of the prostate is often “buried” deep underneath the pubic bone, and/or a large vein in the area may interfere. (And, at 80g, your prostate was extra large, and perhaps extra difficult to see/reach the apex.) AND, the “capsule”(the fibrous muscle) is thin in the area of the apex. Add to this the fact that every man’s anatomy is slightly different, which is why—with all these challenges taken together—surgical experience really matters.

Because of all these challenges, the area of apical resection is also a common area of iatrongenic entry, or inadvertent incisions of the prostate. It appears to me that the surgical pathologist is subtly pointing this out on the report—that the prostate itself was cut, but the margin caused by this was all benign.

It doesn’t appear to be anything to worry about, and probably wasn’t even mentioned by your surgeon (in addition to the fact that he/she wouldn’t probably want to mention this incision to the patient as it might be viewed as a surgical “error”).


Good pathology outcome!

Post Edited (NKinney) : 7/9/2014 9:42:46 AM (GMT-6)

clock -- thanks. your pathology isn't too much different than my biopsy. I was 12-12 positive and had one core at 70%. who know what my pathology would have looked like.

im happy for you man!

ed