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Old 12-17-2008, 05:04 AM   #1
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My husband's pathology report..FINALLY!

OK here are the numbers.
Left Apex
GS 3+3=6
20% involvement

Left Lateral Apex
3+3=6
70% involvement

Left Mid
3+3=6
50% involvement

Left lateral mid
3+3=6
70% involvement

Left base
3+3=6
30% involvement

Left lateral base
3+4=7
90% with perineual invasion identified (not sure what this means yet)?

 
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Old 12-17-2008, 06:16 AM   #2
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Re: My husband's pathology report..FINALLY!

They did take their time informing you of all this. At least it's good to know
more than you did before, as it could play an important role in figuring out the range of alternative choices. (Did you also learn what the PSA is now vs. last year?- that's an important piece of information too.)

The spectroscopic MRI can help clarify how close the cancer is to the edge of the prostate capsule. It may or may not provide a definite answer, but it's a test I would want (and did get myself). I would not rely on the standard MRI. Perineural invasion means that the cancer is moving along the nerves and may be a higher indicator that the capsule has been pierced- or that the cancer is close to the edge. If that's true, it doesn't mean your husband won't be cured- if surgery is performed, there may be a wider section taken out at that side of the prostate. If radiation is performed, the field of attack can be extended to a little beyond the edge of the prostate. (If surgery is chosen, I'd ask whether a traditional "open" prostatectomy is better than the robotic procedure, since with the former, there can be on-the-spot biopsies to help learn if the edges are clear of cancer.)

If there's an indication that the capsule has been pierced, then there may be a need to add some form of hormonal treatment into the mix. But I think the spectroscopic MRI may tell a lot. If the capsule has been pierced and the prostate has been surgically removed, it might be more likely that some cancer cells are left behind and radiation of the prostate bed can be a subsequent treatment. That may be a good reason to start with the radiation, as they can radiate a wider coverage area from the outset. Again, I'm saying things that come to mind as a patient and one who has read a lot about the pros and cons-- not as a medical professional.

Hope you are pursuing your knowledge base in all of this. You mentioned you were getting the Marckini book, you can beat prostate cancer. I had also recommended the recent book by Patrick Walsh, and Jim (from this board) gave you some recommendations too.

Keep up with the posting as I know this is not always easy to comprehend. Have you had any more meetings/recommendations from doctors?

Last edited by daff; 12-17-2008 at 06:50 AM. Reason: corrected title of Marckini book

 
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Old 12-17-2008, 07:14 AM   #3
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Re: My husband's pathology report..FINALLY!

I realize that I launched into my previous response without mentioning anything about the meaning of Gleason scores of 3+3=6 and 3+4=7.

You've probably already read definitions of these, or heard a doctor explain what they mean-- basically a grading of cell patterns as to how fast cancer cells are growing, with Gleason scores of 4 and 5 defining the most aggressive cancer cells. The report shows two numbers, the first being the primary finding and the second, the next most prevalent. (So a 3+4=7 is more favorable than a 4+3=7. Your husband has the former, which is the same score I had.)

Generally the lower risk is implied with Gleason scores of 3+3=6. Those with 7 and 8 are in the intermediate risk classification. Those totaling 9 or 10 are in the high risk category.

Your urologist will also have determined the cancer "stage". This is meant to describe the extent of the cancer or how far it has spread. T1c is a common stage, referring to a cancer detected by biopsy. You will come across this when you're reading about prostate cancer, and would be another piece of information that your doctor should provide.

Sorry for responding twice, but I wanted to try to cover a little more ground.

 
Old 12-17-2008, 08:00 AM   #4
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Re: My husband's pathology report..FINALLY!

Thanks Daff! We actually got back from Florida last night. We had a great time and really needed some time away. Now we are back to reality The results were in the mailbox when we got home last night.

His PSA is 2.4ng/ml which as I understand is low. We don't have a former PSA level from him. I don't think one was ever drawn on him before. We meet with his urologist tomorrow. Hopefully, he will give us all the info we need. We don't have the cancer staging yet. Hopefully, I can find that out tomorrow.

 
Old 12-17-2008, 09:02 AM   #5
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Re: My husband's pathology report..FINALLY!

Quote:
Originally Posted by Trace212 View Post
...
His PSA is 2.4ng/ml which as I understand is low...
That's excellent news on the PSA reading! Hope you are comforted by that and will do some good preparation today in the form of reading and writing down questions for the doctor tomorrow. If you have a notebook with the questions written down, and space to jot down responses, that might make it a little easier in the future when you're trying to remember everything.

Hopefully your urologist will explain something about some of the advanced forms of external beam radiation in addition to surgery. While there are differences of opinion on which treatment is best, I was put off by my urologist not having much of anything to say when I mentioned proton beam radiation (as it is highly targeted with less damage to surrounding tissue than other radiation forms). (If you care to, you might ask about that to see how up-to-date he is with treatments other than surgery or seeds, both of which he would have some direct involvement and therefore, receive compensation.)

If he recommends surgery, which wouldn't be a surprise to me, I'd assume he'd first want the results of an MRI. If he's got a strong belief that the cancer is confined to the prostate, you might ask him about the pros and cons of open prostatectomy vs robotic assisted. And of considerable importance, how many he does each week and how many has he done in total. Good luck with your meeting.

 
Old 12-17-2008, 10:08 AM   #6
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Re: My husband's pathology report..FINALLY!



I read your post and would like to advise you to talk to an Oncologist also. With a PSA that low I would look into other paths to take. Your urologist is a surgeon so he probably will recommend surgery. I have been through all of this and I am staarting to beleave that there is a lot of un-necessary surgery being done. Rich

 
Old 12-17-2008, 01:24 PM   #7
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Re: My husband's pathology report..FINALLY!

What concerns me is the perineural invasion. My sister said that means it is invading the nerve. I have not read up on it yet as I have not had time today. I have been busy at work. I may look it up now though.

My husband said that his urinary symptoms are getting worse. It is harder for him to urinate. It takes a while to get going and it is a slow stream.

 
Old 12-17-2008, 01:58 PM   #8
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Re: My husband's pathology report..FINALLY!

Quote:
Originally Posted by Trace212 View Post
What concerns me is the perineural invasion. My sister said that means it is invading the nerve....
My husband said that his urinary symptoms are getting worse. It is harder for him to urinate....
I think that invading the nerve is ok if it's still within the prostate, since the cancer cells will be killed with radiation or removed with surgery. The more difficult question is whether or not it's gone beyond the prostate capsule-- so that's a question for the doctor to help you with and for the MRI (spectroscopic/endorectal) to help him... Just my opinion.

Urinary symptoms that you describe are quite common. A good thing to ask the doctor about would be prescribing something like Flomax.

 
Old 12-17-2008, 02:16 PM   #9
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Re: My husband's pathology report..FINALLY!

Quote:
Originally Posted by daff View Post
I think that invading the nerve is ok if it's still within the prostate, since the cancer cells will be killed with radiation or removed with surgery. The more difficult question is whether or not it's gone beyond the prostate capsule-- so that's a question for the doctor to help you with and for the MRI (spectroscopic/endorectal) to help him... Just my opinion.

Urinary symptoms that you describe are quite common. A good thing to ask the doctor about would be prescribing something like Flomax.

 
Old 12-17-2008, 02:17 PM   #10
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Re: My husband's pathology report..FINALLY!

Quote:
Originally Posted by daff View Post
I think that invading the nerve is ok if it's still within the prostate, since the cancer cells will be killed with radiation or removed with surgery. The more difficult question is whether or not it's gone beyond the prostate capsule-- so that's a question for the doctor to help you with and for the MRI (spectroscopic/endorectal) to help him... Just my opinion.

Urinary symptoms that you describe are quite common. A good thing to ask the doctor about would be prescribing something like Flomax.
He has been on Flomax but stopped taking it because he said it wasn't working. We will talk to the MD about that tomorrow as well. I sure hope this guy has a lot of time blocked off for us I will also find out what kind of MRI he wants my husband to get.

 
Old 12-21-2008, 09:45 PM   #11
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Re: My husband's pathology report..FINALLY!

Hi, Trace, You are getting good input from Daff & others. Daff's comments to me directly and to others have been helpful. I wanted to add a couple comments. It seems like you are hoping for more reassurance than seems available. Senator Boxer (Calif) put in some much needed legislation to fund more research for prostate cancer imaging. For now, I think your husband is wise to question what he hears or reads. Surgery must have some benefits. Some celebrities, who could have picked anything, selected surgery. Robert DiNero's father died of prostate cancer at age 71. He knows how serious it can be. He had surgery in 2003. John Kerry, whose wife is really up on health stuff, chose surgery. Bob Dole, Arnold Palmer, Norman Schwartzkof...it must be a good choice for some people. They may have picked what they felt was the best for survival prospects despite risks of the big "I" (impotence, incontinence) problems. A word of caution regarding proton therapy. Clinics in your area who do not provide it may not support considering it. Moreover, do not expect any serious consideration by Mass. General, even though they have it. They have tended to use the slots for other type cancers and think their other radiation is now "sophisticated" enough to be as good as proton. So he would need to check out Jacksonville, Bloomington, IN, Houston or Loma Linda to apply for proton. So...from what I have read...I would check out proton therapy at one of those sites. I would not bother with Boston. If I went to Boston, I would challenge them to convince me that their imaging can substantially reduce the damage to healthy tissue (as seems to be a benefit of proton which does little damage going in and no damage on the other side of the cancer). Another thing I would try to explore...if I wanted to stay close to home is the U. of Conn programs in Farmington. I guess Ray Neag benefitted from radiation and donated $10 million to try to enrich their services to cancer patients. Apparently they have the only TomoTherapy in the State. That radiation claims to have some of the advantages claimed by proton. ...but with it...like the other claims...can be questioned by your husband. I haven't found answers totally convincing, but after asking some hard questions...maybe your husband will be confident and satisfied. He may find what Jacksonville promises...treatment that is "hard" on cancer...and "easy" on him. Dale
Quote:
Originally Posted by Trace212 View Post
He has been on Flomax but stopped taking it because he said it wasn't working. We will talk to the MD about that tomorrow as well. I sure hope this guy has a lot of time blocked off for us I will also find out what kind of MRI he wants my husband to get.

 
Old 12-23-2008, 03:57 PM   #12
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Re: My husband's pathology report..FINALLY!

Quote:
Originally Posted by Trace212 View Post
OK here are the numbers.
Left Apex
GS 3+3=6
20% involvement

Left Lateral Apex
3+3=6
70% involvement

Left Mid
3+3=6
50% involvement

Left lateral mid
3+3=6
70% involvement

Left base
3+3=6
30% involvement

Left lateral base
3+4=7
90% with perineual invasion identified (not sure what this means yet)?
Trace,

There's a wealth of good information in those earlier responses on this thread.

Here are a couple of other points. Early on, before you posted these biopsy statistics, I had mentioned that "active surveillance" could be an option. I got the feeling that you and your husband were not seriously considering active surveillance, and it's just as well, with other approaches looking a lot more likely to be successful at this point. The biopsy report is favorable for the Gleason Grades, with just that one core with a secondary grade of 4 and all the others 3s. However, my recollection is that the major active surveillance programs are not comfortable with having a majority of a patient's cores positive, and they like to see the percentage in each core not exceeding 50%. The perineural invasion would also be a concern because that identifies a highway out of the prostate that the cancer often takes. All of this means that active surveillance would be a risky option, in my layman's understanding of what the experts in active surveillance are reporting.

Daff mentioned some of the imaging techniques that could help push the therapy choice in one or another direction, and the percent of positive cores and amounts of cancer in each suggest that an investment in imaging could be very productive. Endorectal MRI with spectroscopy might be enough to rule out surgery as a likely cure or, on the other hand, allow it for continued consideration. The new technique known as Sinerem or Combidex scanning of lymph nodes appears to be highly effective, but unfortunately the site regarded as reliable is in the Netherlands. There was an experimental site in the Boston area, and I suspect it is still operational. The leader of the Netherlands site has authored some reports that you could access, and I could give you the name of the leader of the experimental site. Please let me know if you are interested.

Here's a question you and your husband might want to ask the doctors: With all the cores positive, some with a high percentage of cancer, how does that reconcile with the low PSA of 2.4? (High Gleason Score cancer (basically 8 through 10) often produces relatively little PSA, but your husband's cancer is mostly Gleason Score 6, which should produce ample PSA. It just doesn't quite seem to add up to a consistent picture. It's conceivable that by chance the biopsy cores just happened to hit the few spots in the prostate with cancer and that most of the prostate was cancer free, leading to a result of a high percentage of cancer found at biopsy but a relatively low PSA.)

You might also want to ask the doctor how the odds of surgery success or radiation success, or a combination, were affected by the high percentage of cancer in several of the cores and the fact that 100% of the cores contained cancer.

By the way, there are a few of us with a lot of cancer in the prostate (not yet proven for your husband) but apparently little or none outside the capsule or at least not distantly spread. (So far, I seem to be one of those patients.)

I hope you both have a merry Christmas and holiday season! Prostate cancer is only one aspect of life, and it should take a back seat to enjoyment.

Take care,

Jim

 
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