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Medical Forum / Diseases and Disorders / Prostate Cancer / August 2004Pathology Report is in!
It's a little hard to read though... All lymph nodes were negative Right prostate resection margin was negative For the prostate itself: 1) Adenocarcinoma (3+4=7) involving 10% of left lobe and 5% of right lobe. 2) Extension of tumor to left posterior resection margin. 3) Rare focus on perineural invasion present 4) No evidence of extension of tumor beyond prostate gland 5) Unremarkable seminal vesicles and vasa deferentia (sounds almost insulting, huh?) Two and three sound concerning - other than that it sounds pretty good. Any thoughts from the group? Oh, also Allen is finding the catheter to be pretty uncomfortable (I have no idea if it is silicon or not). He feels like the tube is "sliding" and it hurts a bit. We're cleaning it with hydrogen peroxide and then lubricating it with Neosporin (the anti-pain version). He is open to suggestions from those of you who have already been down this path. As always, thanks a ton! Debbie (wife of Allen, age 50, 8.4 PSA, 3+4 Gleason, Stage T2C, RRP on 8/18) > It's a little hard to read though... > All lymph nodes were negative [quoted text clipped - 21 lines] > Debbie (wife of Allen, age 50, 8.4 PSA, 3+4 Gleason, Stage T2C, RRP on > 8/18) It sounds very much like my pathology report. But I'm not sure what the resection margins are. Since it concludes there is no evidence of spread beyond the gland, it must be that the margins are clear. They take out more than just the prostate, so if the tumor extended right up to the margin, it would have to penetrate the capsule. You should get clarification about just what that means. "Oh, also Allen is finding the catheter to be pretty uncomfortable (I have no idea if it is silicon or not). He feels like the tube is "sliding" and it hurts a bit. We're cleaning it with hydrogen peroxide and then lubricating it with Neosporin (the anti-pain version). He is open to suggestions from those of you who have already been down this path." Although most people seem to recommend loose-fitting garments, I found that just the opposite was best. You do not want that thing (the catheter) dangling and shifting around. I wore boxer briefs that kept it pretty much in place and taped the connector securely to my thigh w/ surgical tape. Bill Denton RP 2/12/02 Memphis *It *Two and three sound concerning - other than that it sounds pretty good. *Any thoughts from the group? * *Oh, also Allen is finding the catheter to be pretty uncomfortable (I have *no idea if it is silicon or not). He feels like the tube is "sliding" and *it hurts a bit. *Debbie (wife of Allen, age 50, 8.4 PSA, 3+4 Gleason, Stage T2C, RRP on *8/18) Yeah, the Foley can be a bother. He has to be careful with it, that's about all. And the path reports sound very good! Al Please be quiet if replying via email, flames will be deleted promptly. I won't even read the whole message... I had the best luck with the elastic strap that came with the catheter. This strap secures the tube to your upper thigh without the sticky tape pain. I also wore boxers so there was not any binding. The recliner was my friend for that first week until the catheter came out. You are doing right in using the neosporin. Not only is an antiseptic, it also keeps the tube lubed so it doesn't stick and pull. That first week or two is a pain in the $%^(%^. Once you get past that, you got the worst behind you. I also had to be careful the way I sat. It almost felt like I was sitting on a baseball. A little tender down there. Sounds like you are doing normal recovery stuff. Just take it easy. MrBill age at diagnosis 48 PSA 1.4 Gleason 3+3=6 T2a robotic RRP 12/15/03 PSA 4/2/04, 7/8/04 = <.1 age 49 > *It > *Two and three sound concerning - other than that it sounds pretty [quoted text clipped - 18 lines] > flames will be deleted promptly. > I won't even read the whole message... Here's the question I would ask: If the tumor extended to the margin, and there was evidence of perineural invasion, does that mean that Al needs to go on to a course of radiation to make sure there are no cancer cells left? > It's a little hard to read though... > All lymph nodes were negative [quoted text clipped - 21 lines] > Debbie (wife of Allen, age 50, 8.4 PSA, 3+4 Gleason, Stage T2C, RRP on > 8/18) > Here's the question I would ask: If the tumor extended to the margin, > and there was evidence of perineural invasion, does that mean that Al > needs to go on to a course of radiation to make sure there are no > cancer cells left? I'm still confused about how far the tumor extended. As I noted previously, they take out more than just the prostate gland, so unless the tumor penetrates the capsule, it is hard to see how it could get right up to the margin. So the conclusion that it was confined to the gland would seem to preclude that. Perineural invasion is a fairly common finding in post-surgical pathology. From what my surgeon told me, I don't think it is significant. I also had a similar result, and there was never any suggestion that I might need followup radiation. I've been PSA free for nearly 4 years now. I think perineural invasion is more of a concern when discovered in the initial biopsy. The nerves internal to the prostate are considered a path for the cancer to migrate outside the gland, so some doctors think that if it is present, it is less likely that the cancer will be confined to the prostate. But after surgery, they get to look at all the tissue and if they don't see any extension beyond the prostate, perineural invasion loses its significance. >>It's a little hard to read though... >>All lymph nodes were negative [quoted text clipped - 21 lines] >>Debbie (wife of Allen, age 50, 8.4 PSA, 3+4 Gleason, Stage T2C, RRP on >>8/18) Leonard Evens <len@math.northwestern.edu> wrote...snip... > I'm still confused about how far the tumor extended. As I noted > previously, they take out more than just the prostate gland, so unless > the tumor penetrates the capsule, it is hard to see how it could get > right up to the margin. So the conclusion that it was confined to the > gland would seem to preclude that. Hi Leonard...As I understand it, there are two ways that a tumor can extend into areas adjacent to the prostate. First there is extracapsular or extraprostatic extension, where the tumor breaches the prostatic capsule. Given enough time, ECE can extend up the outside of the prostate and eventually grow into adjacent, non-prostatic tissue. A second pathway involves tumor contained within the prostate extending into (and beyond) the neighboring tissue that attaches the prostate to the local anatomy. You are correct that when the surgeon removes the prostate, some of this "connective" tissue is also removed, but it is still a bit of a crap shoot as the surgeon doesn't really know the location of the tumor as he or she is cutting. The "margin" refers only to where the surgeon cuts. Sometimes when the surgeon cuts through the connective tissue, the tumor is far enough away from the margin and a negative margin is obtained. Sometimes the tumor extends very close or right up to the margin. This is still a negative margin, but the nearness of the tumor to the margin is usually mentioned in the pathology report. Sometimes, the surgeon cuts through the tumor, leaving some tumor behind, and this is a positive margin. So when the pathologist examines the excised prostate, if he sees tumor at the edge of the specimen and it has been sectioned, his assumption would be that some tumor remains behind and you would have a positive margin. If he sees tumor extending beyong the capsule elsewhere than the surgical margin, you'd have ECE. You could have ECE and positive margins, one or the other, or neither...Best wishes and good health, Ron > Leonard Evens <len@math.northwestern.edu> wrote...snip... > [quoted text clipped - 32 lines] > ECE and positive margins, one or the other, or neither...Best wishes > and good health, Ron Without information from the doctors involved, we are just guessing. But one possibility is that the cancer appeared to be entirely within the gland but extended fairly close to the capsule, which at that point was pretty close to the edge of the specimen. In that case, the cancer could be contained in the gland but still close to the margin. If so, I doubt if any of this has any relevance for determining the chance of recurrence. I had a similar pathology report except there was no comment about how close the tumor was to the capsule. According to the Sloan Kettering nomogram, my chances of being PSA free at 7 years are about 95 percent. Of course, none of this is exact, other recurrence claculators may give lower values, and I still worry quite a lot whenever I have a PSA test. But the only rational course with the knowledge I now have is to make all decisions on the assumption I have been cured. At one point shortly after surgery, I asked my surgeon about that, since I had to make some pension decisions, which would have been made differently if my life expectancy was reduced. He told me that I should assume my life expectancy was no different than any other man my age and in my circumstances. Yes, I also understand that the surgical margins are outside the gland, so I read the extension to margin comment as meaning that there was some escape from the capsule (but maybe not from the surgery). My understanding is that they dye the outside of the surgically-removed tissue, and when the sections are done for pathology, they can see how far the cancerous tissue extends. It sounded to me like some cells reached the dye. However, only the doctor could say for sure. My comment was meant to say, if it was me, I'd be asking the urologist, "Is that it? Are we done, or is there sufficient concern about these other items that further treatment is necessary?" > I'm still confused about how far the tumor extended. As I noted > previously, they take out more than just the prostate gland, so unless [quoted text clipped - 13 lines] > they get to look at all the tissue and if they don't see any extension > beyond the prostate, perineural invasion loses its significance. I had about 25% of my prostate volume cancerous with a "very focal" 2 mm tumor that abutted the inked margin resulting in technically a positive margin although the pathologist also indicated no evidence of prostatic extension and graded me T2c. With no other evidence of spread (I also had perineural invasion which typically is of no consequence)I could see no reason for further treatment and none of my doctors indicated I should do anything unless the PSA tests indicated otherwise. So far at a little over a year all PSAs are <0.1 with no erections and still about a pad per day to catch the drips. My catheter tube also slid around and was pretty uncomfortable until I discovered a little speck of dried blood just inside the opening. Once I got that scraped off the sliding was not a problem. Dave Perry > It's a little hard to read though... > All lymph nodes were negative [quoted text clipped - 21 lines] > Debbie (wife of Allen, age 50, 8.4 PSA, 3+4 Gleason, Stage T2C, RRP on > 8/18) |
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