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Medical Forum / Diseases and Disorders / Prostate Cancer / February 2004Post Surgery Pathology
I just received a copy of my post surgery pathology report which was about as good as could be expected under the circustances: Gleason 3+3=6 Seminal vesicle tissue free of tumor Apical region free of tumor Anenocarcinoma basal region Negative margins focal perineural invasion Here is what surprised me, both the right and left lobes were affected, with the majority of the ca in the left lobe. After my 3rd biopsy a very small amount of cancer was found in the right lobe, nothing in the left lobe. Now I am really glad to have had surgery to remove the entire prostate. My original urologist (not the one who did my surgery) was pushing me to do cryrotherapy in just the area of the tumor. He proposed to do an additional saturation biopsy to more precisely define where the cancer was located, but given the biopsy errors of the past I wonder if it would have been accurate. I could have gone through that procedure and still have had a bunch of cancer. I do recall one urologist that I spoke to saying it is a multi-focal disease and that over 70% of the time more cancer is discovered after surgery than was originally suspected. Guess he was right. Moral of the story listen to the comments on this board and do your research. John > I just received a copy of my post surgery pathology report which was > about as good as could be expected under the circustances: [quoted text clipped - 20 lines] > > John John, Congratulations on your excellent report. Mine was another case where the cancer was more extensive than the biopsy might have implied. jimhoney > > I just received a copy of my post surgery pathology report which was > > about as good as could be expected under the circustances: [quoted text clipped - 29 lines] > > jimhoney I'm pretty sure that Patrick Walsh says as much in his book... that the cancer is often more extensively spread throughout the prostate than shown by the needle biopsy. In any case, glad you got a good report, John!! MikeH >I just received a copy of my post surgery pathology report which was >about as good as could be expected under the circustances: [quoted text clipped - 4 lines] >Negative margins >focal perineural invasion -------------------------------cut------------------------- >John Hi John, Since I do not know the circumstances, I am wondering what is the plan of action re "focal perineural invasion"? Tee > Hi John, > Since I do not know the circumstances, I am wondering > what is the plan of action re "focal perineural invasion"? > > Tee Maybe there would be no plan. I was curious about it, so went looking and found this article about it: <http://www.conturo.com/be_core/content/journals/u/data/2001/0101/cmeperineur.html> Title: "What are the implications of perineural invasion on prostate biopsy?" The following statement is from the conclusions: "While the presence of PNI on pathologic analysis of radical prostatectomy specimens has no significance with respect to long-term cancer control, PNI extensive enough to be sampled on routine needle biopsy of the prostate likely confers an increased risk of extraprostatic extension of pros-tate cancer. Conflicting data on the significance of this finding exist..." PNI is perineural invasion. Note that phrase, "no significance with respect to long-term cancer control." JohnG > > Hi John, > > Since I do not know the circumstances, I am wondering [quoted text clipped - 24 lines] > > JohnG You are correct there is no plan, prostate is gone and so are the nerves within the prostate, not to be confused with the external nerves that are necessary for an erection. Those were spared and have nothing to do with the perineural issue. According to my surgeon/urologist focal perineural invasion means there was a small ie "focal" incidence of cancer in the microscopic nerves within the prostate. Which he indicated is very common. The fact that there were negative margins is the key. I think the above statement refers to a needle biopsy prior to surgery and if the PNI is significant enough to be sampled it may suggest extraprostatic extension ie not Pca not confined to the prostate. This would also probably not be "focal" perineural invasion due to the extent of the cancer. Of course I am not an MD or a pathologist, and my response is based on what I have read and been told. John > I think the above > statement refers to a needle biopsy prior to surgery and if the PNI is > significant enough to be sampled it may suggest extraprostatic > extension ie not Pca not confined to the prostate. The article referred to both the needle biopsy prior to survery and what is found post-surgery. You are basically correct, though. If there is PNI that is seen on the needle biopsy, it -might- make a difference for treatment, though exactly what difference it should make is a matter for debate. The statement about "no significance with respect to long-term cancer control" applies to your case - where there was a bit found in the post-surgery pathology. It all sounds like good news to me, and I'm sure it does to you, too! JohnG That's great John. Sounds like you're on your way to a longer life.  SignatureProstate 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 HTbegins 07/21/2003 @ 48 PSA .1 Lupron 7/03, 8/03, 12/03 > Gleason 3+3=6 > Seminal vesicle tissue free of tumor > Apical region free of tumor > Anenocarcinoma basal region > Negative margins > focal perineural invasion > That's great John. Sounds like you're on your way to a longer life. Yes, I am pleased with the results so far but as we all know this is a life changing event and the future is never a to be taken for granted. Personally, I am comitted to do what ever I can to maintain my health and try to help others do the same. Thanks for the positive responses. John > > Gleason 3+3=6 > > Seminal vesicle tissue free of tumor > > Apical region free of tumor > > Anenocarcinoma basal region > > Negative margins > > focal perineural invasion |
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