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Medical Forum / Diseases and Disorders / Prostate Cancer / February 2006Reading between the lines of the pathology report
Here's the pathology report. Does anyone want to interpret between the lines? I know that the same result will produce different outcomes in different subjects. I see the doc on Friday and I'd like to have a few educated questions for him. Final Diagnosis: A) Right pelvic lymph nodes, excision: One lymph node negative for tumor (0/1) B) Left pelvic lymph nodes, excision: One lymph node, negative for tumor (0/1) C) Prostate, prostatectomy: Adenocarcinoma of the prostate, Gleason's grade 4+4 (combined score of 8) Left posterior margin involved by tumor. Bilateral seminal vesicles negative for tumor. See carcinoma worksheet below. Prostate Carcinoma Case Summary: Specimen type: Histologic type: Adenocarcinoma Histologic sub-type: Acinar Gleason grade: Primary: 4, Secondary: 4, Combined: 8 Tumor location: Left posterior Tumor volume: approximately 5-10% of gland involved Perineural invasion: yes Lymphatic (small vessel) invasion: No Venous (large vessel) invasion: No Extent of disease: Lobe(s) involved: Left Proportion of unilateral lobe involvement: less than 1/2 lobe Extra-prostatic extension: No Seminal vesicle invasion: No Invasion of adjacent organs: Not assessed Margins: Positive: Left posterior quadrant Regional lymph nodes: Right pelvic: 0 involved / 1 examined Left pelvic: 0 involved / 1 examined Distant metastasis: Not assessed Stage: 2 (pT2a, pNO, pMX) Some questions I have are: Do I external radiate that positive margin now or wait for the first PSA test in what 3 months? What does the pNO and the pMX in the stage mean? Is it common to only examine one lymph on each side? I was under the impression that a few on each side are taken out. Or do they look at them in order of proximity to the prostate and if the first is negative than forget about the others? That seems like enough for this thread. Thanks guys, WhiteSoxFan WSF..."O" means zero or none so NO means no cancer found in the lymph "N"odes. "X" means unknown, so MX means that distant "M"ets can't be assessed by examining a prostate specimen. The lower case "p" preceding these items indicates that the determinations were made by "p"athogical examination of a specimen (as opposed to clinical evaluations while the prostate is still in your body). The whole "pT2a, pNO, pMX" is standard jargon for describing the prostate pathology findings, everyone is PTsomething upon pathological examination (e.g. you can no longer be T1 at pathology). One question I'd have would be, what was the size of the tumor or conversely, what was the prostate size of which the tumor was 5-10%? Another question would be to describe the tumor at the margin; was it getting larger or smaller as it approached the margin from within the prostate? Was it substantial at the margin? As Walsh points out, even if a some cells were left on the other side (the side remaining in your body) of the margin, the surgical procedure could have well disrupted them and lead to their death. As to radiation now or later, that's another good question for your doc, but I think most would say later. Radiation and healing wounds do not mix well. All of the growth factors and cell replication that is occurring during healing can be adversely impacted by radiation. Heal up, get your PSA measured (use the ultrasensitive test) and see what it (or, if it is very low or undectable, see what the trend) tells you...Best wishes and good health, Ron the one part that looked good on the report was that they put you at pT2a. it is common after they get the prostate on the path table that you are staged from T1 or a T2. the "a" part means that you had less than 50% involvement in one lobe. as to radiation - they usually do a wait on it. some doctors do a one/two punch - some don't. you would burn the second chance for a cure right away and your body is going to take the hit from the radiation too. your psa reading should come back as 'undetectable' by the standards that they use. final thoughts - you have a confirmed gleason of 8 (4 + 4). if you were to have a rise in psa from here on, you would have to take action quicker than someone who has a gleason of 6. wishing you a lifetime of undetectables. ~ curtis knowledge is power - growing old is mandatory - growing wise is optional "Many more men die with prostate cancer than of it. Growing old is invariably fatal. Prostate cancer is only sometimes so." http://community.webtv.net/PALMER_ENT/doc > Here's the pathology report. Does anyone want to interpret between the > lines? I know that the same result will produce different outcomes in [quoted text clipped - 50 lines] > > WhiteSoxFan I have to echo what ron said. Don't worry about the "not assessed" business. It is impossible to determine by examining the prostate whther or not the cancer has spread to distant sits. The Gleason 4+4 and the positive margin are of some concern, but you should discuss with your doctor what to do as follow-up and when to do it. Don't assume that something is going to happen before it does. There is a quite reasonable chance the cancer has been entirely removed from your body. Good luck. > Here's the pathology report. Does anyone want to interpret between the > lines? ... I will add my completely inexpert and hence valueless endorsement to what everyone has already said. What Ron, Curtis and Leonard have all said seems logical to me. I'm guessing that the fact that the lymph node and seminal vesicle biopsies were negative means the chance of metastasis is very small. If the cancer metastasizes, lymph nodes and seminal vesicles are usually the first places that the cancer migrates to. Ron suggested that any cancer beyond the margin might die a natural death. _Maybe_ you can help that along by using dietary supplements like lycopene (e.g. in tomato products or watermelon) or pomegranate juice, or vitamins D & E, etc. I go back and forth on the value of supplements, and there is very little high quality data supporting their use. But it's a pretty sure thing that drinking a glass of tomato juice each day won't hurt you, so why not try it, while staying away from fats, cigarettes, and any other known carcinogens. Good luck. Alan Thanks for the input. When the biopsy came back positive I changed my diet to include these daily items. Lycopene in the form of tomato juice, I like it spicy. Pomegranate juice. I am adding selenium in the form of supplements and by eating raw Brazil nuts. Vitamin D by solar exposure of at least 10 minutes a day. I now have developed a fondness for my bowl of raisin bran with 8 oz of soy milk. Tofu, (I've read that the japanese version is better than any other.) I've all but eliminated animal fats. And the latest is to increase my turmeric intake. Luckily, I have a fondness for curries anyway so curried broccoli will become a regular item on our dinner table. Oh yes, the best part is the dark chocolate. Mmmmm good. WhiteSoxFan > Thanks for the input. When the biopsy came back positive I changed my > diet to include these daily items. Lycopene in the form of tomato > juice, I like it spicy. Pomegranate juice. I am adding selenium in the > form of supplements and by eating raw Brazil nuts. Exercise a bit of care with the selenium. It is possible to overdose. The usual regimen is 200 micrograms taken daily along with 400 units of Vitamin E. It is not known if this actually does any good, but there is now an ongoing trial to see if it has any effect in preventing prostate cancer. Some people believe that Vitamin E with at least some of the gamma form is more effective than the standard alpha form. > Vitamin D by solar > exposure of at least 10 minutes a day. I now have developed a fondness [quoted text clipped - 6 lines] > > WhiteSoxFan > Vitamin D by solar exposure of at least 10 minutes a day. This is sufficient only for those far closer to the equator than most White Sox fans, in the warmest months, with 40% exposure, for fair-skinned people, AND for more like 20 minutes a day. Otherwise, we need more D from food and/or supplementation. > I now have developed a fondness > for my bowl of raisin bran with 8 oz of soy milk. Tofu, (I've read that > the japanese version is better than any other.) I almost started that, but since each new soy trial rates soy as increasingly useless stuff other than as maybe a healthier protein source than lots of red meat, I didn't bother acquiring the taste. > the latest is to increase my turmeric intake. Luckily, > I have a fondness for curries anyway so curried broccoli will become a > regular item on our dinner table. Turmeric tastes great dumped on many/most chicken dishes, too, from casseroles to fajitas to grilled. I.P. > Adenocarcinoma of the prostate, Gleason's grade 4+4 (combined > score of 8) Good. Well, not good. But, it isn't any worse that originally graded. > Left posterior margin involved by tumor. Not good. That means that some of the cancer, possibly an extremely minute amount, was found at the cut. That means it probably wasn't all removed. > Bilateral seminal vesicles negative for tumor. Very good. > Lymphatic (small vessel) invasion: No Very good. > Stage: 2 (pT2a, pNO, pMX) Better than your initial diagnosis. > Some questions I have are: Do I external radiate that positive margin > now or wait for the first PSA test in what 3 months? Wait. At least until you are healed up. Some would say wait until your PSA starts to rise (three straight times). |
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