Here's the comments from my Path report. My surgery was 19Dec at MD Andserson in Houston.
I have an appointment on 19Feb to see my surgeon. and get my 8 week PSA.
PATH report comments follow.
'The prostate gland contains two foci of prostatic adenocarcinoma, one in the peripheral zone and one in the transition zone. The dominant
tumor focus is located in the left anterior, mid anterior, right anterior, right anterolateral, right lateral, right posterolateral, right posterior, mid
posterior, and left posterior peripheral zone. This tumor focus measures 2.0 x 0.8 cm in the largest cross-sectional dimension and it is
present in the three cross sections of the prostate and extensively in the apex and base. On the right posterolateral surface of the
prostate this tumor focus extends focally (less than 1.0 mm) into extraprostatic tissue. At the site of extraprostatic extension, the margin
of resection is free of tumor. On the posterior apical region, focal extension of tumor to the inked margin in an area of surface disruption
cannot be unequivocally excluded. The potential area of marginal involvement measures less than 1.0 mm. The second tumor focus is
located in the left transition zone. This tumor focus measures 0.5 x 0.4 cm in the largest cross-sectional dimension and it is present in
three cross sections and focally in the apex. This tumor focus is confined to the prostate.
Because of the proximity of some areas of tumor in the peripheral and the transition zone, a stain for ERG was performed. The stain is
negative in both areas, therefore the stain is non contributory towards supporting different tumor foci.'
Sorry left the important stuff out. It isn't completely out of the woods news. But it's not terrible considering that my PSA was fairly high 13.4-16.6 over the three months leading up to this
(C) PROSTATE AND SEMINAL VESICLES:
PROSTATIC ADENOCARCINOMA, GLEASON SCORE 7 (3+4). (SEE COMMENT)
TUMOR EXTENDING FOCALLY INTO EXTRAPROSTATIC TISSUE.
FOCAL EXTENSION OF TUMOR TO THE MARGIN OF RESECTION CANNOT BE UNEQUIVOCALLY EXCLUDED.
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.
PROSTATIC INTRAEPITHELIAL NEOPLASIA (PIN), HIGH GRADE.
Looks like the pathologist had to equivocate about a positive margin. i am sure your docs have seen this before and they will know what the best plan is.
Who was your surgeon? How was your experience at MD Anderson?
I'm sorry to hear that you still have more to worry about, aside from recovering from the effects of the surgery, which I hope will be speedy and complete.
Unfortunately, even a 1 mm positive surgical margin doubles your risk for a recurrence, as you can read here:
Perineural invasion is also a risk factor, especially if the surgeon performed a nerve-sparing surgery:
On the other hand, the lack of invasion into the lymph nodes and seminal vesicles are a great sign that the cancer, if present, is still in the local area. It's also good that your Gleason score was only 3+4.
At this point, you face the "adjuvant" vs "salvage" radiation dilemma. Adjuvant radiation, meaning getting the radiation treatment now, has a better chance of curing you completely if there is any residual cancer. However, there may be additive effects on potency and continence. Salvage radiation, meaning you wait to see if your PSA begins to rise again before you get the radiation, has a lower chance of curing you completely if you do still have some cancer, but averts the side effects of unnecessary radiation treatment if you don't have any residual cancer.
There is some recent long-term data that demonstrates an advantage to adjuvant treatment:
However, recent analysis seems to show that if salvage treatment occurs early enough and with enough radiation (>70 Gy), outcomes can still be pretty good:
It's not an easy decision, especially because you do not have a lot of high risk factors.
I suggest you talk to a radiation oncologist next about all of this.