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Medical Forum / Diseases and Disorders / Prostate Cancer / December 2003my pathology report
good morning everyone, as you know my laproscopic surgery was dec. 12th. right now i'm in the midst of recovery. age 51 good shape. gleason score 8 PSA 9.8 stage T2 before surgery so here's the report summarized: Gleason score: 8 (4+4) Tumor quantitation: 60%. (it was all in right side) Extraprostatic extension: present, right quad, unifocal. Linear extent: 0.06cm. Seminal vesicle invasion: absent. Margin involved by invasive carcinoa: unicfocal. Linear extent: 0.25cm.------------------------- (here's the part i don't get)------------------- > Perineural invasion: present. Lymphovascular invasion: present, multifocal.----------------------------------------- >Additional pathologic findings: high grade prostatic intraepithelial neoplasia, glandular and stromal hyperplasia. TNM STAGING: pt3a (extraprostatic extension) Regional lymph nodes: pn0. Distant metastastasis: pMX (cannot be assessed) -----------COMMENT---------------------------- The carcinoma is extensive and involves prdominantly the entire right lobe, both anteriorly and posteriorly, but with focal extentsion across the midline into the left anterior and posterior quadrants. Small foci of carcinoma have features of gleason 3 and 5 patterns, but these comprise less than 5% of the total tumor. (here's the part that scares and upsets me) Multifocal lymphovascular (some sort of blood viens) invasion is identified, including near the base of the right seminal vesicle at SOME DISTANCE from the primary tumor. Direct invasion through the prostatic capsule is present anteriorly on the right side, where tumor also reaches the cauterized, inked resection margin for a linear distance of 0.25cm. Immunohistochemical stains for cytokeratins are obtained to evaluate for possible micrometastases in the lymph nodes because of the presence of some crushed cells in the extracapsular lymphatics, but these stains are completely negative, and the cells are interpreted to be of lymphoid origin. .............................................................. The doctor said this was a good report. The blood vessel stuff was explained as: they are forien (my mis-spelling) and my immune system is fighting them, it takes a lot of these to create cancer growth, we'll see in 3 months the PSA score. it doesn't sound clear cut to me. yet i need to keep hope up. thanks everyone and if any of the non-doctors can offer any opinion then please do. the medical terms are spelled correctly. ~ greg Hello Greg, Thanks for your report and I can see your concern. I do think the idea of getting a PSA in 3 months is the best way of seeing your success. I had a report and took it to another Dr. who did not do the surgery and he was able to explain some of the terminology to me. It is hard to understand and hopefully your Dr.s remarks, "The doctor said this was a good report. " will help you relax and heal. so do heal, and hopefully your next PSA will launch you forward to many years of health. Keep us posted and maybe some of the other men on this group can understand some of the terminology and give us an explaination! Good wishes, John Loomis > good morning everyone, > as you know my laproscopic surgery was dec. 12th. right now i'm in the [quoted text clipped - 38 lines] > everyone and if any of the non-doctors can offer any opinion then please > do. the medical terms are spelled correctly. ~ greg I'm not sure exactly, Greg, but I'll take a stab at it. First, the reason the lymph glands cannot be assessed, I'm pretty sure, is because an LRP does not allow for that. That is one of the downside characteristics of LRP. Remember, I've always stated, 'once you've made your decision, don't look back.' Well you did. RRP has other problems and you chose LRP, so that is that. Seminal vesicles are removed during an RRP and I assume they are also removed during an LRP, so invasion of the seminal vesicles is not necessarily a problem. However, there are more chances of a problem when they are invaded. Mine were also invaded. Remember, my RP was exactly 3 years before yours and my PSA is < 0.1, so don't let it ruin your Holidays. In keeping with the 'seminal vesicles' are removed theme, he is reporting to you what he found in the seminal vesicles that are on his lab table. Those can no longer hurt you. In short, you have an iffy lab report and it is about as good and about as bad as can be expected with a Gleason of 8. On your next visit, your PSA will probably have been reduced to less than 1.0. Maybe even less than 0.1. In either case, I'd wager that by April, May, or June, you'll be discussing EBRT. Don't let that scare you either. EBRT is a minor irritation at best.  SignatureMERRY CHRISTMAS Prostate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 PSA .1 .1 .1 .3 .4 .8 EBRT 05-07/2002 @ 47 PSA .3 .2 .2 .2 .3 Erection 05/12/2003 @ 48 Begin Lupron 07/21/2003 @ 48 PSA .1 > good morning everyone, > as you know my laproscopic surgery was dec. 12th. right now i'm in the [quoted text clipped - 38 lines] > everyone and if any of the non-doctors can offer any opinion then please > do. the medical terms are spelled correctly. ~ greg > I'm not sure exactly, Greg, but I'll take a stab at it. > [quoted text clipped - 3 lines] > your decision, don't look back.' Well you did. RRP has other problems and > you chose LRP, so that is that.... Lymph node dissections are possible during a LRP. Most urologists look for the nodes with laparoscope and if they look normal they do not sample them. Pelvic lymph node dissection is not without morbidity. Look no further than this group and their resent discussions of scrotal swelling and ecchymosis. Dan Thanks for the correction, Dan. Support isn't worth spit if it isn't accurate information. SignatureMERRY CHRISTMAS Prostate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 PSA .1 .1 .1 .3 .4 .8 EBRT 05-07/2002 @ 47 PSA .3 .2 .2 .2 .3 Erection 05/12/2003 @ 48 Begin Lupron 07/21/2003 @ 48 PSA .1 > > > I'm not sure exactly, Greg, but I'll take a stab at it. [quoted text clipped - 12 lines] > > Dan Steve, One thing I don't understand in a case like this is why the doctors don't do EBRT right away. There is evidence that the cancer has escaped. It may still be in the tissue immediately near the prostate. Why do the docs want to wait for it to grow before going after it? You said yourself that "EBRT is a minor irritation at best." Doesn't it make sense to schedule it right now? The worst that can happen is that the radiation was unnecessary and the side effects, which admittedly can be severe in a minority of cases, hurt the patient. But on the other hand, wouldn't the chance of stopping a runaway cancer be greater if they don't wait until the PSA goes up - indicating that the cancer has grown since the last reading? Alan > I'm not sure exactly, Greg, but I'll take a stab at it. > [quoted text clipped - 75 lines] > > everyone and if any of the non-doctors can offer any opinion then please > > do. the medical terms are spelled correctly. ~ greg I can't find it now, but I've seen evidence (and my rad-onc confirmed) that there's no advantage in beginning RT immediately over waiting until PSA reaches a "cut point", and learning the PSA acceleration rate and/or doubling rate, which can give clues as to how best to treat the remaining PCa. Larry > Steve, > [quoted text clipped - 16 lines] > > Alan It takes a few months for everything to heal inside. Or that is the reason I was given. > Steve, > [quoted text clipped - 103 lines] > > > everyone and if any of the non-doctors can offer any opinion then please > > > do. the medical terms are spelled correctly. ~ greg just why does the report only say multifocal on the lymphovascular and not how much is there? it sounds as if another doctor reading this report to me might clear up some of this confusion. the hyperplasia in the dictionary.com isn't a very nice word. as my doctor said try to keep some perspective here and realize this is a very good report considering what it looked like. when it got to explaining the blood vessel things (lympovascular) he only said vague things like your immune system is fighting this thing as we speak (actually his assistant said that, the doc called me the next day) i don't like the idea of losing control of my life but none of us do i assume. yet this ''flying blind" is unsettling. a clearer answer would be better. greg Multifocal means that it started in more than one place in the prostate. Hyperplasia just means that the prostate was increasing in size due to the cancer. For prostate cancer terms, check out http://www.phoenix5.org/glossary/glossary.html. Unlike Dictionary.com, these terms are defined in relation to prostate and/or prostate cancer. SignatureMERRY CHRISTMAS Prostate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 PSA .1 .1 .1 .3 .4 .8 EBRT 05-07/2002 @ 47 PSA .3 .2 .2 .2 .3 Erection 05/12/2003 @ 48 Begin Lupron 07/21/2003 @ 48 PSA .1 > just why does the report only say multifocal on the lymphovascular and > not how much is there? it sounds as if another doctor reading this [quoted text clipped - 8 lines] > assume. yet this ''flying blind" is unsettling. a clearer answer would > be better. greg what does LYMPHOVASCULAR mean and how bad is this? does it mean the cancer is IN THE BLOOD stream??? it's not in the lymph glands. ~ greg I'm not sure what lymphovascular means. Sorry. But, prostate cancer, when it spreads, goes to the tissue closest to the prostate. Usually, it first goes to the pelvis, bladder, lymph nodes, or colon. So, like many of us, you are stuck with a biopsy that does not indicate that the cancer has spread and, like all of us, you won't know until your 1st PSA, then your second, then your third.... None of us really knows for years that it didn't. You'd have to go 15 years without a rise in PSA before you were sure. The only patients that know for sure are the ones whose PSA has risen. Then, we really don't know where it spread to until it matastecizes, but that's years later in most cases. SignatureMERRY CHRISTMAS Prostate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 PSA .1 .1 .1 .3 .4 .8 EBRT 05-07/2002 @ 47 PSA .3 .2 .2 .2 .3 Erection 05/12/2003 @ 48 Begin Lupron 07/21/2003 @ 48 PSA .1 > what does LYMPHOVASCULAR mean and how bad is this? does it mean the > cancer is IN THE BLOOD stream??? it's not in the lymph glands. ~ greg > I'm not sure what lymphovascular means. Sorry. But, prostate cancer, when > it spreads, goes to the tissue closest to the prostate. Usually, it first [quoted text clipped - 7 lines] > whose PSA has risen. Then, we really don't know where it spread to until it > matastecizes, but that's years later in most cases. I'm wondering just how reliable a bone scan would be in detecting any spread outside of the prostate. Although I'm a T1 which means it's probably still contained, my Rad Onc is going to do a bone scan in about 2 months tight before I start Rad Therapy. i've read that bone scans are reliable then where they aren't, so who knows. as for a MRI, it can see groups of cancer cells down to an ''o''. this small oh holds about 80,000 cancer cells. what would be interesting to know is how fast do they multiply or double. and with all the gleason scores showing a different rate of growth makes this difficult to pin? but and large prostate cancer grows slower compared to other cancers but how do you express this? and supposedly there is something (i can't remember what it is) that is produced in the prostate that slows cancer down, so does this mean that once it's gone the cancer cells that are left can grow without this prior restraint? the whole idea of knowing any of this is so we can judge for our selves who the cancer is doing within our bodies. this isn't idle sports talk. greg The most accurate test to determine whether it has spread after RRP is the PSA test. If you PSA begins to rise and a 'structured' rate, then you almost certainly have PCa in your body somewhere. But, at very low PSA, no test can tell where it is. The next most accurate test, when there might be sufficient numbers of cancer cells assembled is probably the ProstatScint scan. It shows prostate cancer wherever in the body it might be. Unfortunately, it also shows highlited areas wherever blood pools and in the colon. Blood pools most near the the femeral arteries, i.e., near the colon. PCa is most often found early near the colon. So, it can be very difficult distinguishing the PCa from where you would expect to find the isotopes. And it still has to be large enough to be seen to see it. Then, I guess, a bone scan is then next one up if the PCa has matured to tumors in the bones. However, a bone scan only shows it if it's big enough to see and sometimes will show hot spots that could be PCa or could be something totally different, like arhteritis. Somewhere in there is a PET scan, but I'm not sure where. Maybe our new friend, and nuclear med expert, can help with this one. SignatureMERRY CHRISTMAS Prostate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 PSA .1 .1 .1 .3 .4 .8 EBRT 05-07/2002 @ 47 PSA .3 .2 .2 .2 .3 Erection 05/12/2003 @ 48 Begin Lupron 07/21/2003 @ 48 PSA .1 > > > I'm not sure what lymphovascular means. Sorry. But, prostate [quoted text clipped - 21 lines] > probably still contained, my Rad Onc is going to do a bone scan in > about 2 months tight before I start Rad Therapy. Greg, Academic discussion: Just to answer your question on cancer cells in the blood - yes they are /were there - NOT part of the pathology report! I'm in a study that measures circulating cancer cells before/during/after RRP. They are trying to see if the numbers/types(?) of cancer cells can be of some predictive value. Best of luck and undectable's! DanR You can have a Prostascint Scan done.It will pinpoint exactly where the remaining cancer cells are.From there you can chose to wait or do radiation,with luck it will be in the prostate bed and easy to deal with.But if not you will know where it is. |
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