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  • Final Surgery Pathology

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    Old 03-22-2020, 10:36 AM   #1
    murphy496
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    Final Surgery Pathology

    We haven’t gotten to speak with the Doctor yet. Follow up with doctor isn’t till April.
    I saw the pathology report posted on my husband health app. We understand some if the findings but are confused on some. Below is the final results.

    Prostate size 41.5 g
    Histologic type : acinar adenocarcinoma
    Grade group 2- Gleason score ( 3+4, 4+3)
    Prostate involved by tumor : 5 %
    Extra prostatic extension: present left posterior
    Bladder neck invasion: not identified
    Seminal vesicles: not identified
    Margins: uninvolved by invasive carcinoma
    Perineurial Invasion: present
    Primary Tumor: PT3A - extra prostatic extension ( unilateral or bilateral) or microscopic invasion of the bladder neck
    Lymph nodes examined: 6
    Lymph nodes involved: 0
    Distant metastasis: not applicable
    Additional pathology: High grade prostate intraepithelial neoplasia

    Any feed back on this would appreciated.

    Thanks
    Murphy

     
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    Old 03-22-2020, 11:24 AM   #2
    DjinTonic
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    Re: Final Surgery Pathology

    Quote:
    Originally Posted by murphy496 View Post
    We havenít gotten to speak with the Doctor yet. Follow up with him isnít till April.
    I saw the pathology report posted on my husband health app. We understand some if the findings but are confused on some. Below is the final results.

    Prostate size 41.5 g
    Histologic type : acinar adenocarcinoma
    Grade group 2- Gleason score ( 3+4, 4+3)
    Prostate involved by tumor : 5 %
    Extra prostatic extension: present left posterior
    Bladder neck invasion: not identified
    Seminal vesicles: not identified
    Margins: uninvolved by invasive carcinoma
    Perineurial Invasion: present
    Primary Tumor: PT3A - extra prostatic extension ( unilateral or bilateral) or microscopic invasion of the bladder neck
    Lymph nodes examined: 6
    Lymph nodes involved: 0
    Distant metastasis: not applicable
    Additional pathology: High grade prostate intraepithelial neoplasia

    Any feed back on this would appreciated.

    Thanks
    Murphy
    Hi Murphy,

    I'm not clear on one thing --

    Grade Group 2 corresponds to Gleason 7 (3+4). There should be only ONE final Gleason score, so I don't know why both (3+4) and (4+3) are listed. (The predominate Gleason pattern (>50%) is always listed first.) G7 (4+3) is Grade Group 3, NOT 2. You can put this on your list of questions for your doc. You want to know with certainty what his final Gleason score is.

    The overall path grade pT3A is due to the (unilateral) extra prostatic extension (EPE), not bladder neck invasion, which was not present and is mentioned only to explain what qualifies as pT3A.

    Acinar adenocarcinoma is the most common type of PCa that the large majority of men have.

    The EPE was the only important adverse finding. It usually refers to some growth of the tumor coming through the thin prostate capsule. While it is a risk factor for BCR (biochemical recurrence -- a return of a rising PSA), it does NOT necessarily mean that all the cancer wasn't removed with the surgery. Most men have perineural invasion, PNI, identified somewhere when the entire prostate is examined and IMO is not of concern. High-Grade PIN is atypical tissue thought to be pre-cancerous, and of no concern once there is a diagnosis of PCa.

    That only a small percentage (5%) of the prostate was involved by the cancer is very good. There were no positive surgical margins, no seminal vesicle involvement, and no positive lymph nodes! All excellent.

    When will the first post-op PSA be done? Assuming it is undetectable, it will mark the end of your husband's primary treatment, and, very possibly, the end of his PCa, too! But, like all men after treatment, he'll need to monitor his PSA going forward.

    Congrats!

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    11-10-17 Decipher 0.37 Low Risk; 5-yr met risk 2.4%, 10-yr PCa mortality 3.3%
    LabCorp uPSA: 0.010 (3 mo.)Ö0.015 (1 yr. 6 mo.)Ö0.015 (2 yr. 4 mo.)

     
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    Old 03-22-2020, 12:58 PM   #3
    murphy496
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    Re: Final Surgery Pathology

    Djin,

    We go back April 22 and they’ll do the first PSA test then. You cleared up a lot of the confusion on the path report. I’ve noted questions for the doctor when we go. Thanks for your quick response and all of the valuable information.

    Murphy
    __________________
    Husband 57 DX Aug 2019
    PSA 2016 2.6, 2017 3.5, 2018 4.0, 2019 5.24
    K4 - 17
    Decipher score -23
    Biopsy Aug 2019 - 5/12 positive G6 3+3
    MRI - November 9 ,2019 - 3 lesions BI RADs 3
    Biopsy November 20,2019 - 10/18 positive - 9 G6 3+3 -1 G7 3+4
    Ralp - March 2020

     
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    Old 03-22-2020, 02:54 PM   #4
    Prostatefree
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    Re: Final Surgery Pathology

    You are at some risk for recurrence with the adverse condition.

    In conversations with your doctor, i recommend you use uPSA testing to follow up.

     
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    Old 03-22-2020, 03:49 PM   #5
    murphy496
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    Re: Final Surgery Pathology

    Quote:
    Originally Posted by Prostatefree View Post
    You are at some risk for recurrence with the adverse condition.

    In conversations with your doctor, i recommend you use uPSA testing to follow up.

    Prostatefree,

    We will definitely talk to my husbands doctor on this uPSA test.

    Thanks so much
    Murphy

     
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    Old 03-23-2020, 03:15 AM   #6
    Steve135
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    Re: Final Surgery Pathology

    Hi Murphy, I read your Path and thought I was reading mine from 2015. We are so close just a few terms. I was originally thought to be 4+4 but Path came out 4+3 you can see the rest. Keep that doctor on his toes and if you see anything that concerns you seak up early!

    good luck steve

    _________________
    Diag. 56 DOB 2/59 PSA Base 1.5 01/14 2.0 6/15 2.4
    Biopsy 6/15 5 Gleason Score 8
    RP 10/15 Path 54g 5x4.2x2.8cm 4+3=7 Tumor location quadrants Bilateral
    Extra-capsular extensions present,SV no invasion
    Vascular invasion none, PNI ,Multicentricity multifocal
    Margins No tPresent inked margins 5 neg pT3a,N0
    PSA 10/16 <0.1 02/7/17 1st BCR 0.4 02/15/17 0.5
    Pet Scan 2/17 Neg PSA 03/17 0.6 Axumin trial 17.4mm tumor rt. SVB Casodex + Trelstar
    04/17 SRT (42) to include location of tumor
    08/17 PSA 0.1 Last 6 uPSA 0.006 uPSA 2/19 0.030 2nd BCR 5/19 0.235 5/30 0.32 6/19 0.34
    7/19 0.06 8/19 0.08 9/19 0.05610/190 0.08 11/19 0.07 12/19 0.07
    7/19 Trelstar, Xtandi, Zoledronic Acid
    12/19 (3) SBRT Iliac bone liasion post SBRT 1/ 20 0.06 2/20 0.04 3/20 0.02

     
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    Old 03-23-2020, 09:18 AM   #7
    Michael F
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    Re: Final Surgery Pathology

    Hi murphy496!

    I agree with suggestions by Dj, Pf & Steve.

    On April 22 be sure to discuss with his URO Surgeon:

    - Is his Path Status: Grade Group 2 or Grade Group 3?

    - pT3a: Should he monitor via uPSA? IMO, he should!

    Be sure to:

    - Use The Same Lab Using The Same PSA Methodology Each Time! Otherwise, uPSA results can not be compared.

    - Ask how you can obtain a copy of The Original Lab Report Each Time! If using LabCorp or Quest, you can set up a patient portal and get all of the results and testing details each time.

    Beyond that, How is his recovery progressing?

    Good luck & keep us updated.

    MF
    __________________
    PSA: Oct '09 = 1.91, Oct '11 = 2.79, Dec '11 = 2.98 (PSA, Free =13%)
    Jan '12: Biopsy: 1/12 = G7 (3+4) & 5/12 = G6
    March '12: Robotic RP: Left: PM + EPE => MD excised additional adjacent tissues
    Pathology: Gleason (3+4) pT3a pNO pMX pRO c tertiary pattern 5 / Prostate Size = 32 grams / Tumor = Bilateral: 20% / PNI: present
    uPSA Range: 0.017 - 0.032 at 94 Months Post Op: Mean = 0.023 (n = 23)
    LabCorp: Ultrasensitive PSA: Roche ECLIA
    Continence = Very Good (≥ 99%) ED = present

     
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    Old 03-23-2020, 10:17 AM   #8
    Insanus
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    Re: Final Surgery Pathology

    Your husband has about an 80% chance of no recurrence before 7 years. Watch the PSA and if it hits 0.03 blast it.

     
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    Old 03-23-2020, 12:01 PM   #9
    Southsider170
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    Re: Final Surgery Pathology

    Nothing really that ominous in the pathology report. Low volume of cancer, only moderately aggressive, your pre-surgery PSA was elevated but not ballistic. "Acinar Adenocarcinoma" is what you want to see as the type definitely, as that is the garden variety of PCa.

    There is actually a very good chance that he is through with cancer treatment, although he should do the followup psa testing indefinitely, and probably with the specialist for at least a few years.

     
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    Old 03-23-2020, 05:48 PM   #10
    murphy496
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    Re: Final Surgery Pathology

    Steve,

    Thanks for your comments. We’ll definitely stay on top of the doctor.

    Murphy
    __________________
    Husband 57 DX Aug 2019
    PSA 2016 2.6, 2017 3.5, 2018 4.0, 2019 5.24
    K4 - 17
    Decipher score -23
    Biopsy Aug 2019 - 5/12 positive G6 3+3
    MRI - November 9 ,2019 - 3 lesions BI RADs 3
    Biopsy November 20,2019 - 10/18 positive - 9 G6 3+3 -1 G7 3+4
    Ralp - March 2020

     
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    Old 03-23-2020, 05:58 PM   #11
    murphy496
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    Re: Final Surgery Pathology

    Micheal,

    Thanks for you input. I’ll add the lab information to questions.My husband is doing pretty good. He’s having some leakage on standing but other wise doing very well. Pain has improved from the surgery, but he has an autoimmune disease that causes pain in his spine & rib cage that’s he dealing with now since he hasn't taken his humira since September of last year. He’s sleeping a little more but I think he needs the rest after surgery. He is walking daily and doing his Kegel exercises. I’m hopeful everything will turn out good. I appreciate all the well wishes and information.

    Murphy
    __________________
    Husband 57 DX Aug 2019
    PSA 2016 2.6, 2017 3.5, 2018 4.0, 2019 5.24
    K4 - 17
    Decipher score -23
    Biopsy Aug 2019 - 5/12 positive G6 3+3
    MRI - November 9 ,2019 - 3 lesions BI RADs 3
    Biopsy November 20,2019 - 10/18 positive - 9 G6 3+3 -1 G7 3+4
    Ralp - March 2020

     
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    Old 03-23-2020, 06:02 PM   #12
    murphy496
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    Re: Final Surgery Pathology

    Quote:
    Originally Posted by Insanus View Post
    Your husband has about an 80% chance of no recurrence before 7 years. Watch the PSA and if it hits 0.03 blast it.

    Insanus,

    Thanks for the percentage information. Weíll stay on top of it and definitely blast it it quickly if it reoccurs .

    Murphy
    __________________
    Husband 57 DX Aug 2019
    PSA 2016 2.6, 2017 3.5, 2018 4.0, 2019 5.24
    K4 - 17
    Decipher score -23
    Biopsy Aug 2019 - 5/12 positive G6 3+3
    MRI - November 9 ,2019 - 3 lesions BI RADs 3
    Biopsy November 20,2019 - 10/18 positive - 9 G6 3+3 -1 G7 3+4
    Ralp - March 2020

     
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    Old 03-23-2020, 06:06 PM   #13
    murphy496
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    Wink Re: Final Surgery Pathology

    [QUOTE=Southsider170;5502269]Nothing really that ominous in the pathology report. Low volume of cancer, only moderately aggressive, your pre-surgery PSA was elevated but not ballistic. "Acinar Adenocarcinoma" is what you want to see as the type definitely, as that is the garden variety of PCa.

    There is actually a very good chance that he is through with cancer treatment, although he should do the followup psa testing indefinitely, and probably with the specialist for at least a few years.[/QUOTE


    Southsider 170,

    Thanks for the information on the pathology and follow ups. I pray heís done with this cancer, but Iím so thankful to all of you who answer questions and give hope.

    Murphy
    __________________
    Husband 57 DX Aug 2019
    PSA 2016 2.6, 2017 3.5, 2018 4.0, 2019 5.24
    K4 - 17
    Decipher score -23
    Biopsy Aug 2019 - 5/12 positive G6 3+3
    MRI - November 9 ,2019 - 3 lesions BI RADs 3
    Biopsy November 20,2019 - 10/18 positive - 9 G6 3+3 -1 G7 3+4
    Ralp - March 2020

     
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