Path question

Please see post op path below. (Was read by JH)

“15% involvement”

“5% G4”.

So, 15% of my prostate was cancerous.

The 5% G4. Is that 5% of the 15%? Or, is that 5% of my total prostate?

I understand PSA is all that matters now but i’ve never asked before, so I thought I would.

Thanks

mattam said...
I would think 5% of the whole prostate.

That's what you'd think. 5% of 15% would be such a miniscule amount it doesn't seen as if they'd report it that way.

I remembered it not being all that clear to me on the report. I'm not gonna go through files looking for the answer to this though.

(But I was kind'a hopin'....lol)

None of the answers are definitive, only speculative. None of us are doctors, let alone pathologists. Ask the question of a pathologist. Email Epstein with the simple question. I have done so several times and he always answers within 24 hours. Just be brief and concise. This is an area where I wish people would have the good sense to say “I don’t know, ask your doc”.

do we have all the data from JH pathology report as it applies to cancer volume...you need to print what JH put on the pathology report...you may have dismissed some data you deemed irrevelant...but since...in your own view it is irrevelant...so be it...I actually think the more data the better...which does not mean that you do not... what would House say ???

Pratoman said...
as JNF said, we are not Drs or pathologists. With that said, it would seem that if 5% was Grade 4, then 95% was grade 3, and those cells together comprise the tumor which as is stated in the path report, is 15% of the entire prostate. So i think its 5% of the 15%.

Not even sure i know what i just said, so ask Epstein. But seriously, i think my logic makes sense.

This has always been the way I interpreted it. Now I’m interested. I’m looking at the report when I get home (in a couple of days). And i’ll Post it up.

I’ve always thought 3+4 could mean different things. My thinking is:

My path is actually 95% 3 + 5% 4. Seems that’s a far cry from 55% 3 + 45% 4. Just as...

55% 4 + 45% 3....seems as it would be more benign than 95% 4 + 5% 3.


Maybe I will look for it. Might email the pathologist if it’s unclear to me.

I've always read it as 5% of the examined prostate.

A note about pathologists. I tried to ask a simple question of the one who did my analysis at the university of Miami, only to be told several times, that "pathologists don't talk to patients".

We are so lucky to have access to Dr. Jonathan Epstein....he's the best!

Like everyone else here, I too am not a pathologist but it seems fairly obvious that the percentages in question refer to the various gleason types that make up the tumors. A Gleason score consists of a "primary" and "secondary" type that add up to the overall score. The primary is the most prevalent type. The secondary is the second most prevalent and the tertiary (if mentioned) is the third most prevalent. (The word tertiary means third.) Thus a Gleason 7(3+4) with tertiary 5 would describe a tumor that contained at least half Gleason pattern 3 cells with most of the rest being Gleason pattern 4. The tertiary 5 means that the pathologist saw enough pattern 5 cells to be worth mentioning since they are the most aggressive of the three types.
The count of positive cores and the percent involvement give some sense of how much cancer is present, the various Gleason type percentages tell what sort/how aggressive the cancer is.

My reading of your post-op path report is that your prostate was 15% cancerous tissue, and that of that 15%, 95% was Gleason pattern 3 (non-aggressive) with 5% Gleason pattern 4 mixed in. While the presence of any Gleason pattern 4 cells is somewhat worrisome that's a pretty good result. You also have a small positive margin (about the size of an apple seed) which allows for the possibility that some cancer was missed. But since your cancer was Gleason 6 at the margin (all Gleason pattern 3 cells) its unlikely that any missed cancer cells are particularly aggressive. Actually, since your PSA has been creeping up it's rather good that you had a positive margin since it indicates that the PSA is probably coming from a small lump of not-that-aggressive tissue that your surgeon missed that is slowly, slowly growing.