EPE in Second Opinion Path Report

I had RRP surgery about three weeks ago on 8/16 at Mass General in Boston. The pathology report was negative for SV, LN, margins and EPE. The final Gleason was 3+4=7 vs. my three prior biopsies (see signature below) which never showed anything other than Gleason 6. Given the upgrade, I wanted to know what percent was pattern 4. That was not provided in the Mass General report, so I had the slides sent to John Hopkins for a second reading and to get the percentage amount for pattern 4.

What came back from the JH reading was that the pattern 4 was 10%. The JH reading was the same as Mass General with negative margins, SV and LN, however, they did identify positive EPE whereas MG showed that as negative.

Given this I have a few questions - How subjective are these EPE opinions? How significant is positive EPE relative to negative margins? Is there anything I should do other than wait for first post surgery PSA test which is scheduled three months from surgery?

Thanks Gemlin

The EPE was the right base. The biopsies never found much of anything (2 out 47 cores <5% G6) other than the fusion biopsy which went 5 for 5 at the target 19mm lesion (from mpMRI) in my transition zone. I'm guessing this same nodule is the one in question with EPE.

My recovery has gone well. Never had much pain or even fatigue. My cath came out two weeks ago today and the incontinence is fading. Always dry at night and through most of the day until the afternoon. For some reason, I get some leaking from 3-6pm then it stops for rest of evening. For past few days, even 3-6pm leaking seems to be going away.

As for ED, for a week now, I've been taking 5 mg of Cialis every other day and then over the weekend took a full 20 mg dose which led to a little firmness (though not much) with stimulation. I'm supposed to keep taking the 5 mg every other day with a full dose once a week.

There's no question about it - at least not in my mind. Wait for the 3 month uPSA.

False negative rate of one prostate biopsy could be something like 30% and it will underestimate the Gleason scores in almost 50%!!
But you had three biopsies so the false negative rate in your case was only 2.7% (30% x 30% x 30% = 2.7%) and underestimated Gleason was 12.5 %.

This simple math is the reason why repeated biopsies is so important in AS programs.

BTW, your pathology report is great, better than mine was.

waiting is hard.

The three month PSA is what you really need.

Take some time off from PC and wait for the test.
Andrew