Final Pathology Report

We were able to pull up Jeff's final pathology report after his prostatectomy from his "My Chart." We don't talk to his surgeon until this Friday, but I thought I'd post the report now. Any feedback would be greatly appreciated. Thx!

myBeaumontChart - Test Details 11/15/21, 3:59 PM

DO SURGICAL PATHOLOGY TISSUE - Details

Reference values are the expected results for patients. Values outside the reference value do not necessarily indicate disease. More information is available in the Laboratory Test Directory and from your physician. To learn more about Beaumont Laboratory, click here.

If you have questions about this result, contact your provider.

Images
Scan on 11/9/2021 12:43 PM

Component Results

Component

CASE REPORT

Your Value

Your Value
Surgical Pathology Case: S01-21-41111
Authorizing Provider: Hafron, Jason M, MD Collected: 11/05/2021 10:23 AM
Ordering location: NORTH TOWER SURGERY RO Received: 11/05/2021 03:36 PM
Pathologist: Qu, Zhenhong, MD PHD
Specimen: Prostate Gland, PROSTATE

Your Value

--------------------------------alert-------------------- ------------

Your Value

Prostate, radical prostatectomy: Prostatic adenocarcinoma, (see Synoptic Report). Focal high-grade prostatic intraepithelial neoplasia (PIN). Focal acute and chronic inflammation.

ZQu

Standard Flag Range

<page1image63764160.png> <page1image63764736.png> <page1image63764928.png> <page1image63765120.png>
.

DIAGNOSIS:

<page1image63765312.png> <page1image63813120.png> <page1image63831040.png> <page1image63831424.png> <page1image63821248.png> <page1image63819328.png> <page1image63774592.png> <page1image63787520.png>
https://mybeaumontchart.com/mychart/inside.asp?mode=labdetail&eo...9GuLC01ImSR-2FP-2FYzNDDfuQ7VixYdDviBFdrr6uQvI-3D&printmode=true Page 1 of 5

myBeaumontChart - Test Details 11/15/21, 3:59 PM

COMMENT:

Your Value

A copy of this report will be faxed to the authorizing provider(s) specified above.

Your Value
PROSTATE GLAND: Radical Prostatectomy

PROSTATE GLAND: RADICAL PROSTATECTOMY - All Specimens 8th Edition

SPECIMEN
Procedure: Radical prostatectomy
Prostate Size:
Prostate Weight (g): 48 g
Prostate Greatest Dimension (Centimeters): 5.1 cm Additional Dimension (Centimeters): 4 cm Additional Dimension (Centimeters): 3.8 cm

TUMOR

Histologic Type: Acinar adenocarcinoma

Histologic Grade:

Grade Group and Gleason Score: Grade group 3 (Gleason Score 4 + 3 = 7)

Percentage of Pattern 4: 35 %

<page2image36207488.png> <page2image63870976.png> <page2image63871168.png>
SYNOPTIC REPORT:

https://mybeaumontchart.com/mychart/inside.asp?mode=labdetail&e...9GuLC01ImSR-2FP-2FYzNDDfuQ7VixYdDviBFdrr6uQvI-3D&printmode=true Page 2 of 5

myBeaumontChart - Test Details 11/15/21, 3:59 PM

Intraductal Carcinoma (IDC): Not identified

Tumor Quantitation: Greatest Dimenion of Dominant Nodule (Millimeters): 15 mm

Additional Dimension (Millimeters): 12 mm

location of Dominant Nodule: right lobe

Extraprostatic Extension (EPE): Present, focal

location of Extraprostatic Extension: Right posterolateral (neurovascular bundle)

Urinary Bladder Neck Invasion: Not identified Seminal Vesicle Invasion: Not identified Treatment Effect: No known presurgical therapy Lymphovascular Invasion: Not Identified Perineural Invasion: Present

MARGINS
Margins: Uninvolved by invasive carcinoma

LYMPH NODES
Regional Lymph Nodes: No lymph nodes submitted or found

PATHOLOGIC STAGE CLASSIFICATION (pTNM, AJCC 8th Edition)

https://mybeaumontchart.com/mychart/inside.asp?mode=labdetail&e...9GuLC01ImSR-2FP-2FYzNDDfuQ7VixYdDviBFdrr6uQvI-3D&printmode=true Page 3 of 5

myBeaumontChart - Test Details 11/15/21, 3:59 PM

<page4image63534592.png> <page4image63534784.png> <page4image63534976.png> <page4image63535168.png>
GROSS DEscriptION:

Primary Tumor (pT): pT3a Regional Lymph Nodes (pN): pNX

ADDITIONAL FINDINGS

Additional Findings: High-grade prostatic intraepithelial neoplasia (PIN)

Additional Findings: Inflammation (type): nonspecific

SPECIAL STUDIES

Ancillary Studies: Not performed

Your Value

A. Prostate Gland.
Received in formalin labeled "prostate" is a 48 g prostatectomy specimen measuring 5.1 cm (lateral to lateral), 3.8 cm (anterior to posterior), and 4 cm (apex to base). The attached right vas deferens (2.7 x 0.4 cm) and left vas deferens (2.8 x 0.4 cm) display a pinpoint lumen. The attached right seminal vesicle (3.4 x 1.5 x 0.6 cm) and left seminal vesicle (3.2 x 1.4 x 0.7 cm) display an unremarkable cut surface. The prostatic capsule appears intact.

Ink code:
Right half-black
Left half-blue
Apex and bladder base shave (not true margin)-green

The prostate is serially sectioned from apex to bladder base to reveal gritty, focally cystic cut surface is periurethral nodularity. A discrete mass is not identified grossly.

Representative sections are submitted as follows:
1 - right and left vas deferens margins shaved reverse en face
2 - base of right and left vas deferens and seminal vesicles
3-4 - apex, serially sectioned from right to left
5-7 - base, serially sectioned from right to left
8-24 - entire prostate gland in macro cassettes (15-16 - one complete section, 17- 18 - one complete section, 19-20 - one complete section, 21-22 - one incomplete section)
Multiple/24, + G. ed/

Your Value

<page4image63535360.png> <page4image63535552.png> <page4image63535744.png> <page4image63535936.png>
CLINICAL

https://mybeaumontchart.com/mychart/inside.asp?mode=labdetail&e...9GuLC01ImSR-2FP-2FYzNDDfuQ7VixYdDviBFdrr6uQvI-3D&printmode=true Page 4 of 5

myBeaumontChart - Test Details 11/15/21, 3:59 PM

INFORMATION: AUDIT:

Pre-op diagnosis:
Malignant Neoplasm of Prostate

Your Value

HKan

Your Value Flag - Attention A

<page5image63478912.png> <page5image63479104.png> <page5image63479296.png> <page5image63479488.png> <page5image63479680.png> <page5image63479872.png> <page5image63480064.png> <page5image63480256.png>
.

General Information

Ordered by Jason M Hafron, MD
Collected on 11/05/2021 10:23 AM from Prostate Gland (Tissue) Resulted on 11/09/2021 12:43 PM
Result Status: Final result

This test result has been released by an automatic process.

MyChart® licensed from Epic Systems Corporation © 1999 - 2021

https://mybeaumontchart.com/mychart/inside.asp?mode=labdetail&e...9GuLC01ImSR-2FP-2FYzNDDfuQ7VixYdDviBFdrr6uQvI-3D&printmode=true Page 5 of 5

Post Edited (Debralyn) : 11/15/2021 6:59:03 PM (GMT-7)

Thanks so much, halbert! "A good report" are the words I was hoping to hear. I really appreciate you taking the time to look at the report.

By the way, Jeff had his catheter out today. He has been able to urinate with a pretty normal stream. He can start and stop the stream without much problem. Minimal dribbling. Jeff says his body seems to be automatically containing the urine until he goes into the bathroom. We're taking this as a really good sign. Should we expect this to continue or are future hurdles possibly coming his way in the continence department?

Thanks!
Most warmly,
Debralyn

halbert said...
Your surgeon may suggest to plan for ART (adjuvant radiation) in a few months, just to be safe. It looks like it is fully contained, but the EPE is a concern, because errant cells can invade the nerves and move along.

I believe that studies in cases like this show no long term advantage to prophylactic ART vs waiting for BCR and doing SRT. Certainly worth more investigations and questions if it comes to that.

DjinTonic said...


Was the surgeon able to save both neurovascular bundles? I ask because the location of the EPE was at one of the bundles. (Erections can stlll be possible if only one bundle remains.)Djin

Thank you, Djin, for this thorough review with questions for the surgeon. Really gives me good direction for Friday when Jeff and I see the surgeon. It helps me make sense of the pathology report.

Yes, the bilateral nerve bundles were spared.

DjinTonic said...
Anything you learn about the above can help us as well: we learn too! Djin

You've given me really good questions to ask. I will report back after we meet with the surgeon.

Post Edited (Debralyn) : 11/16/2021 5:46:57 AM (GMT-7)

Hello, Debralyn ---

From the time I first joined this website, the presence of valued SUPPORT SISTERS like you have always been a supportive presence here.

You're in the trench --- alongside us fellows --- lending insight, asking valued questions, & sharing valued perspectives.

It means a lot to hear from our valued "SISTERS OF SUPPORT" here --- we all learn from each other --- and your devotion to Jeff shines through in every post.

Your posts will encourage others to post --- in the future. Your role as a caretaker is integral to Jeff's recovery --- and it's wonderful to see you and Jeff BOTH posting here!

That's powerful!

We have many readers, around the globe --- and your posts will encourage others! Together, you're a DYNAMIC DUO!

A good day ahead ~~~
CYCLONE --- # Iowa State University

@ShawsUnprostatedMan. I was not referring to necessarily removing a large number of lymph nodes, as in an extended pelvic lymph node dissection (ePLND), but rather at least a small number of nodes which would be likely to include the sentinel node--the one closest to the prostate and the node statistically most likely to be positive.

The advent of genomic testing has demonstrated that metastatic risk cuts across all Gleason scores as verified in a seminal 2016 study of Decipher test results. The percentage of men whose cancer's RNA showed a high risk for mets were as follows in the study:

Confirmed (post-op) Gleason score / percentage men with a high risk of mets (grouped by path staging)

pT2: G7 (3+4): 22% / G7(4+3): 37% / G8-10: 46%
pT3a: G7 (3+4): 31% / G7(4+3): 41% / G8-10: 57%
pT3b/pT4: G7 (3+4): 60% / G7(4+3): 66% / G8-10: 76%

These figures do not include intermediate-risk men, who are also at higher met risk than low-risk men.

No surgeon can predict your post-op Gleason score; nor can a surgeon predict your final path staging. But more to the point, the percentages of low-grade PCa with high met risk is IMO not to be ignored. Gleason score is not a good indicator of metastatic risk.

There is also benefit in the reverse case (mine, for example). I had a G10 (5+5) biopsy. My uro/surgeon removed 16 nodes, all negative. My Decipher test fortunately came back low-risk for mets; nonetheless, I was most relieved to have had the lymph-node report (and BTW had I no lymph drainage problems).

The lymph nodes closest to the prostate are sitting right there for the taking.

Djin

I am a bit surprised that ART is mentioned. In theory, it is recommended for the >T2 cases, but I cannot recall anybody here who had radiation with just T3a without waiting for the first three months psa test. This will give a clearer idea of where you stand. Hopefully, his next "treatment" will be just observation. In the meantime, it is a great thing to celebrate that urinary continence does not seem to be an issue.

Jeff's path report needs to be clarified as to where the error is: the 4+3 or the 35% pattern 4. The only definite adverse feature is the focal EPE (there were no cribriform or intraductal PCa findings). IMO the oversight of no nodes sampled adds to the desirability of a Decipher test. The latest findings from the three specifically designed studies may be pointing SOC toward early salvage over adjuvant therapy for intermediate risk men (assuming there is no persistent PSA, of course).

Djin

Hi Debralyn. Did you get any clarification or advice from Jeff's surgeon? When will Jeff have his first post-op PSA?

I hope Jeff continues to make good progress on his path to a great recovery!

Djin