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Please help with Pathology report...after surgery.

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Posted 4/17/2015 8:07 AM (GMT 0)
Hello -

I have a question about a post prostate removal robotic surgery pathology report. with EPE and negative margins being Gleason 8 do they usually recommend some sort of hormone or radiation therapy?

How can there be EPE but no margins involved? Does EPE neurovascular bundle mean the surgeon was not able to remove that during surgery and the cancer remains...very concerned and all help appreciated.

Pathology Report shows

Gleason 8 PSA 3/25 2.1

Extraprostatic extension: Present, focal, right superior neurovascular bundle

Seminal vesicle invasion: Not identified

Margins: Uninvolved by invasive carcinoma

Treatment effect on carcinoma: Not identified

Lymph-vascular invasion: Not identified

Pathologic staging (pTNM)

Primary tumor (pT): pT3a

Regional lymph nodes (pN): pN0

Number of lymph nodes examined: 38

Number of lymph nodes involved: 0

Size (dominant nodule, if present)

Greatest dimension: 1.8 cm

Additional dimension: 1.5 cm

bone and cat scans clear

PROSTATE AND SEMINAL VESICLES:

PROSTATIC ADENOCARCINOMA, GLEASON SCORE 8 (4+4). (SEE COMMENT)

TUMOR EXTENDING FOCALLY INTO EXTRAPROSTATIC TISSUE.

Margins of resection free of tumor.

Right and left seminal vesicles, no tumor present.

Segments of right and left vasa deferentia, no tumor present.

PERINEURAL INVASION PRESENT.

No lymphovascular invasion identified.

The prostate gland contains three foci of prostatic adenocarcinoma, two in the peripheral zone and one in the transition zone.The prostate gland contains three foci of prostatic adenocarcinoma, two in the peripheral zone and one in the transition zone. The dominant tumor focus is located in the right lateral, right posterolateral and right posterior peripheral zone. This tumor focus measures 1.8 x 1.5 cm in the largest cross-sectional dimension and it is present in the four cross sections of the prostate, extensively in the apex and focally in the base. In the right superior neurovascular bundle region, this tumor focus extends focally (2.0 mm) into extraprostatic tissue.The margins of resection are free of tumor. The second tumor focus is located in the left posterolateral peripheral zone. This tumor focus measures 0.2 x 0.1 cm in the largest cross-sectional dimension and it is present in one cross section. The third tumor focus is located in the transition zone, exclusively in the anterior apex. This tumor focus measures 0.1 x less than 0.1 cm in the largest cross-sectional dimension and it is present in a single apical section. The nondominant tumor foci are of lower histologic grade and confined in the prostate. All margins of resection are free of tumor.










Post Edited (celia01) : 4/17/2015 2:41:09 AM (GMT-6)

Posted 4/17/2015 10:51 AM (GMT 0)
Hi,
I'm not sure I can give you a definitive answer but my situation was close to yours. I came out being a pT3a also with clear margins, vesicles and lymph. However I was a Gleason 7. In my case the Dr took about 15% of one bundle. Sounds like your EPE was close to one of your bundles so he probably took that bundle or some of it. I would think when you got your report that the Dr would have told you more. My Dr. didn't want to do any more treatments, radiation etc, because he felt with my low psa and negative margins I would be fine, and so far, going on 4 years, I'm still getting undetectable psa's. Again I was a Gleason 7. Sounds like with your clear margins, vesicles and lymph nodes, they probably got it all, I'm sure others will be chiming in. Best of luck!
Posted 4/17/2015 10:57 AM (GMT 0)
Celia, what I think this is saying is that the surgical margins were clear--a good thing, The surgeon cut wide enough to get it all. The tumor extended past the prostate capsule and into the nerve bundle on the upper right side. This does mean that he resected some or all of the right side nerve bundle. The lymph nodes were clear, as were the seminal vesicles and the vas deferens.

This is actually a really good pathology report. It appears it's saying that the left side nerve bundle was spared, and while the cancer got out of the prostate capsule, it didn't get far, and it's not in the lymph nodes. Not in lymph nodes means the chances of it having metastasized is low.
Posted 4/17/2015 11:41 AM (GMT 0)
Celia, so as I understand it, you had a small amount of tumor escape the capsule, but the surgeon cut out enough "extra" tissue past the prostate capsule to make sure he got negative margins, I.e. Got it all, as we like to say.

Not sure about additional treatments in this case, others will chime in
Posted 4/17/2015 2:14 PM (GMT 0)
Celia:
The surgeon removed the prostate but in doing so also removed a measure of tissue just outside the prostate itself. Some blood vessels, fat, and other tissue, and in your case, apparently, at the neurovascular bundle. There was a 2 mm bit of tumor that was beyond the prostate itself but not so far as the edge of the removed tissue. Thus your tumor was extra prostatic (beyond the prostate) but not at the edge of the removed tissue (the margin).
Sometimes doctors refer to this as "going wide" which means that if they suspect the tumor is outside the prostate itself they will take an extra amount of tissue to try to insure safe margins.
The EPE is an unfortunate finding and the Negative margins are positive. This is where psa enters the situation since your disease can be so closely tracked to determine if you have recurrence. Some men with your pathology opt for adjuvant radiation (as closely after surgery as possible after healing and regaining continence) and others opt to wait for salvage which is when psa returns and a doubling time can determine the risk.
Posted 4/17/2015 3:26 PM (GMT 0)
Every case is a bit different so it's hard to draw general conclusions. It's not a bad report. There is a chance the surgeon got it all. Next bit of data you need is the post op PSA test. In any case they aren't going to talk about more treatment until you've had a chance to make some post op recovery.

Before thinking too much about it, take some time to heal and get that first PSA test.

Then you'll want a long conversation with your doctor. There might be some benefit to a round of HT and/or radiation but it's also possible that surgery is all you'll. It's a bit early for those decisions.

Andrew
Posted 4/17/2015 4:13 PM (GMT 0)
Some Pathologists will at times use EPE and ECE wrongly in the way I might use words wrongly. With the context of the whole path report, in your case, nerve bundles being effected, they could have used either EPE or ECE and be absolutely correct with both terms, based on the nerve bundle being invaded. The real puzzle you were having ,I suspect, was explained by Prato and others.The wide cut of outer tissue beyond the prostate and its protective capsule that 'Nature" wisely provided, plus the extra tissue the wide cut provide, well it provided what is called a specimen with all the cancer "safely contained, hence negative margins. With 38 lymph nodes dissected all negative and no gl upgrade, thats about as perfect a path report you are gonna get. I highly doubt you will need any additional treatment in the future. But humans being human, you will create hobgoblins of the mind…possibly Your surgeon is to be commended for a very thorough job. I suspect the surgery was done at a major universitie's medical center and had lots of help.
Please celebrate the great news, especially with a gl8.
Posted 4/17/2015 6:09 PM (GMT 0)
Celia,

His doctors know more about prostate cancer and about your husband's particulars than any of us do. So bear that in mind.

That said, what I would expect is for his doctors to look very closely at his 3 month PSA. PSA has a moderately long half-life in the body so any PSA done before three months (or so) doesn't usually mean much since it could always be left over from the time of the surgery.

At that time they will determine what steps, if any, are needed for additional treatment.
Posted 4/18/2015 1:28 AM (GMT 0)
Thank you all so much for taking the time to respond. This is all very new to us. Logoslidat- we did go to a teaching hospital - MD Anderson in Houston. Dr. Brian Chapin did the surgery. It's a bit of a relief to think we did go to the right place and the surgeon did a good job. Thank you all again for reading the pathology report...we are grateful.
Posted 4/18/2015 5:41 AM (GMT 0)
You are welcome Celia. You might as an aside, ask your surgeon about the possibilities of Lymphoceles{ balls of lymph fluid, mine were 2 golfball sized} forming in pelvic area. Mine occurred about 2 months post surgery. Symptoms were a low-grade fever, malaise that lasted about 18 days and then self resolved. If they do not self resolve they are lanced in an office visit. A precursor to it is { but not always} more than " normal " period of having the Pratt Drain in the abdomen. Normal is 5-7 days. Mine was in for 5 weeks.
Posted 4/18/2015 1:54 PM (GMT 0)
Celia, your pathology report and Gleason score is identical to mine. I had EPE and negative margins with Gleason 8. The only difference being the removal of my nerve bundles. I have been cancer free for over 6 years and hope to remain that way. I wish you similar results.
Posted 4/18/2015 1:56 PM (GMT 0)

celia01 said...
Thank you all so much for taking the time to respond. This is all very new to us. Logoslidat- we did go to a teaching hospital - MD Anderson in Houston. Dr. Brian Chapin did the surgery. It's a bit of a relief to think we did go to the right place and the surgeon did a good job. Thank you all again for reading the pathology report...we are grateful.


You couldn't have picked a better place for the surgery! With just a quick read of his path report, it sounds very similar to mine except I was upgraded to a Gleason 4+3 from a 3+4 and I had cancer in one of 44 lymph nodes. Ask the Doc about genome testing (Decipher) to determine if his cancer is likely to metastasize (assuming some is left). At this point I'm in a waiting mode - waiting to get the results from the Decipher test and then with every future PSA test.
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