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Post Surgery Pathology Report Translation Needed

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Posted 4/22/2015 8:53 AM (GMT -5)
Hi Everyone!
I had my catheter removed yesterday (what a relief) and received the pathology report. My doctor didn't spend much time with me, other than to say "I don't want to consider radiation at this time, but would rather wait and see how the psa levels read in another month". I hope you guys can translate all of this information for me. I will try to list everything which seems relevant and maybe you can give me an idea of what to expect next.

Primary Gleason Pattern: Grade 4 Treatment Effect on Carcinoma: not identified
Secondary Gleason Pattern: Grade 3 Lymph-Vascular Invasion: indeterminate
Total Gleason Score: 7 Perineural Invasion: Present
Proportion of prostate involved by tumor: 10% TNM Descriptors:Not applicable
Extraprostatic extension: not identified Primary Tumor: pT2c: Bilateral disease
Seminal Vesical Invasion: not identified Regional Lymph Nodes: pN1 Metastisis in regional lymph
Margins: uninvolved by invasive carcinoma node
Total Lymph nodes examined: 27 involved:1

The doctor did tell us that the 1 lymph node involved was near the bladder neck. So how bad (or good) does all of this look to you guys and do you agree with the doctor that it is best to postpone any radiation treatment? Thank you all for knowledge you have already passed to me! David
Posted 4/22/2015 10:06 AM (GMT -5)
You have a post surgical G score of 7. This confirms the biopsy G score. (There was more G 4 than G 3 though this report does not identify the percentage of G 4 compared to G 3 found in the tissue which is an additional factor sometimes included in pathology reports.) You have negative margins, meaning tumor cells were not detected at the edge of the removed tissue. Your tumor volume of 10% was neither a minimal nor was it a large proportion of the prostate.
LVI or Lympho-vascular invasion is an examination of the lymph and blood system in and near the prostate removed to determine presence of any tumor cells. I do not know what "indeterminate" means in this situation. Perhaps some clarification from the doctor could clear this. I am more familiar with terms such as "positive", "negative", "not identified", "significant".

You had 27 lymph nodes removed for analysis which is a rather large number for a daVinci surgery. (This is perhaps as a result of your higher risk disease). One of the nodes removed was found to contain PCa tumor. The size of this node and amount of tumor within it was not noted on the report.

Bilateral disease means the tumor was in both sides of the prostate.
The use of the words "not identified" may mean the same as "negative (not found) but I am unsure if this is true in this case.

The factor that caused the surgeon's comment was likely the positive node meaning that tumor cells had traveled to this node close to the prostate without leaving a clear and unambiguous trail at the margins or in the tissue just around the prostate known as the EPE or extra-prostatic area or extraprostatic extension mentioned here. Tumor cells were found in the prostate and in this node but not in the intervening tissue (apparently).

This means the start of metastasis was detected, though perhaps not enough to support continued tumor growth. Some doctors prefer adjuvant (at nearly the same time) radiation for possible tumor spread in cases such as yours. In the prostate cancer world adjuvant commonly means 90 days past surgery or perhaps a bit more and regardless of an undectable psa. Salvage radiation means when the psa has risen to some pre-identified value of 0.05, 1.0 or some such figure.

In any case you need to to keep healing and doing your Kegel muscle exercises. Sleep as much as you can as healing takes place during sleep. Practice continence when possible and come back here when you wish.

I believe your surgery was an intervention just in time (without knowing any other pre-treatment issues than what you list here). Your surgeon appears to have done a good job.
Posted 4/22/2015 10:12 AM (GMT -5)
With your post-op pathology report confirming your Gleason 7(4+3) and with your single positive lymph node you appear to me to have two factors that elevate your risk a bit. Aside from that your report looks pretty good. I'm sure the smart guys will be along in a minute to correct me but I think that puts you in the group who can wait to see if their PSA goes undetectable but who need to be prepared to act quickly if it doesn't, or if it subsequently rises above 0.03 on an unltrasensitive PSA test.

This might be a good time to consult with a radiation oncologist so that a) you will have one in your rollodex is you need him, and b) you can get a second opinion on the triggers for follow-on treatment.
Posted 4/22/2015 10:22 AM (GMT -5)
Sounds like your Doc wants to proceed conservatively to determine if you will need additional treatment. Your gleason score and positive node are likely a factor in this decision.
Posted 4/22/2015 5:10 PM (GMT -5)
This is a good path report. With one positive node but otherwise negative extension you're in good shape. Your doc does sound like he's taking a conservative approach and waiting to see what the future holds. I would for sure ask for ultrasensitive PSA and watch for small changes.

The G4+3 is a bit on the riskier side compared to my 3+4. I can compare mine to yours and see that you're slightly higher up the scale from me, and I'm waiting for my 3 month PSA in about 3 weeks. From what I've seen and heard and read, a G7 surgical report is on the balance beam. G6 post surgery? Go on the 6 month PSA schedule and walk away. G8? You're on the path for radiation soon. G7? Judgement call.
Posted 4/22/2015 5:59 PM (GMT -5)
Hi David...
as mentioned by the other, plenty of rest & get your recovery on track
walking & drinking...kegal for pelvis muscle exercises if there is incontinence
A controllable bladder is required if RT is needed.
All the best to your route of recovery.
Posted 4/22/2015 9:05 PM (GMT -5)
Hope all is going well in the healing process by now. Please don't push yourself, the one bit of advice I can offer is you only have one chance to heal properly so take it easy and don't overdo things.

You already have great answers above. They speak the language well here! :)

All that sounds promising- seeing your core sample totals I would have assumed that there was more prostate involvement, I guess in my head I always correlated the two and apparently very mistaken.

Have you consulted with a Radiation Oncologist or general oncologist to get their take? Perhaps this will help the decision? You should have plenty of time.
Posted 4/23/2015 7:22 AM (GMT -5)
I've got to hand it to you all (tarhoosier, Peter,Almost a 10, halbert, yk,kukukajoo), you are the best!! I can't begin to thank you enough for helping me and giving me a little peace (in my unruly mind). I have support on the homefront, but hearing from those who are going through this life-changing disease really gives me hope I cannot get elsewhere. Thank you.
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