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Interpreting the dreaded histopathology report.

User
Posted 26 Jul 2021 at 16:21

Can anyone offer any input here? I recognise my case isn't as advanced or aggressive as it might be, and that I am in a better boat than many others - so I really appreciate anyone’s time spent reading or responding.

53 yrs. PSA 5.66 (Jan). MRI (Feb) PI-RADs 5, left side, T2a N0 M0. Biopsy (March), 9/10 cores G7(3+4), Grade 2. More in my profile.

Seven weeks after robotic RP (1st June), feeling good, recovered well. Had brief phonecall with Consultant after chasing them up for an appointment - histology has upgraded to 7(4+3), have a “touching margin” at nerve sparing area but “might be a tear”. “Get a first PSA, will monitor 3 monthly”, “Will speak in 6wks”, “Oh and I’ll send a letter to your GP and prescribe sildenafil”. He’s reasonably happy, nothing to be overly concerned about. Great.

Have now received my report and need some help interpreting. Main points below (with my thoughts bracketed)…

Surgical incisions: Absent (Good?)

Site: Right lobe, left lobe, multifocal. (Worse than previously understood?)

Dominant on left 19mm, 20% (No news)

Gleason: 4 + 3 = 7 with tertiary 5 (Gulp!)

High grade PIN: Yes (past that point?)

Confined to prostate: Yes (Good!)

Extraprostatic extension: No (Good!)

Invasion of seminal ves: No (Good!)

Involvement bladder neck detrusor: No (Good!)

Circumferential margin involved: Yes, left lobe posteriorly and laterally, Intraprostatic, <3mm (assume NOT good ??? Why is this one specifically called out as Intra, and next one not?)

Apical margin involved: Yes, <3mm (assume also NOT good ???)

Base margin involved: No (Must be good, got enough to worry about!)

Vascular invasion: Not identified (So…??)

Nodal status: No nodes sent (OK)

Additional info: extends into prostatic urethra (good that it’s out then, but does that hint at a potential for later bladder-based recurrence??)

Diagnosis: pT2c.

So glad to have got it out, given the new grading and staging. Little to celebrate though as we move to the next step. I’ve been doing some research and am interpreting this report as…

a) mentioned margins are ‘positive margins’

b) because there’s 2, that’s ‘multiple’

c) based on several studies, presence of tertiary Grade 5 is significant to likelihood of recurrence

d) with multiple margins and a sprinkle of 5, my 15 year survival % and recurrence-free survival % just dropped significantly

e) Gleason 4+3 with 5, coupled with T2c should surely be considered more like Gleason 8 and/or T3, to be sure ?

If I’m over (or under!) thinking this please shout. Am back to the usual un-nerved anxiety that comes between receiving daunting information and either getting clarification or making an active decision.
Obviously first PSA is key (bloods this coming Wednesday) and there’s nothing to be doing until I get that. At this point am praying that it will be undetectable, obviously.

User
Posted 26 Jul 2021 at 23:59
The difference between your positive margins (I think you might have 3 not 2) is that a positive margin at the apex is quite common because it isn't as clearly defined as the rest of the prostate while the 2 positive margins at left posterior & lateral (the intra-prostatic margins) are where the surgeon has left part of your prostate behind by mistake.

The positive cells in the urethra don't necessarily indicate possible bladder invasion in the future but if there is a biochemical recurrence, the urethra may be a good target for adjuvant / salvage RT just in case there are cancer cells in the remaining urethra.

Tertiary 5 does increase the risk of recurrence later but only if some of it has been left behind - hopefully, all of the cells are now in a dish in a lab so can't cause you any harm. Having a 4+3 with tertiary 5 doesn't make you an 8. The tertiary 5 must be only a small percentage of the cells seen otherwise they would have upgraded you to 4+5.

I can't see anything in your report that would move you from T2c to T3 and it wouldn't make any difference to next steps anyway - a T3 post-op is no different to a T2 post-op ... you wait for the PSA and hope it is undetectable. Although you have a couple of positive margins, there is no certainty at the moment that the bits left behind happen to have cancer cells in them.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 27 Jul 2021 at 02:45
I think you are over-reacting and over-researching your former cancerous condition - you did ask me to ‘shout’!

I suggest you regard yourself as ‘cured’, and forget about PCa, pending the results of quarterly PSA tests in the first instance, stretching to longer intervals as time goes by.

That’s what I did, three years ago. Just get on with the rest of your life!

Best of luck for the future.

Cheers, John.

User
Posted 27 Jul 2021 at 09:41

Hello Chippers, I think you're over-analysing the report, which is natural. We have similar starting stats. Have a read through my biog. Geason 4+3 with a tertiary 5 and now nearly 8 years in remission. Hope that allays some of your worries.

Flexi

User
Posted 27 Jul 2021 at 10:38

Lyn: Thanks for that. Reassuring to get another set of eyes on it. Plenty of follow up Q’s for consultant.

 

Edited by member 27 Jul 2021 at 10:40  | Reason: Not specified

User
Posted 27 Jul 2021 at 10:41

Flexi: 

Thx. Good biog.

 

I seem to have been really lucky (?) with recovery after RO. TWOC took some ’negotiation’ for release with 300ml retention. Consultants not particularly worried on a 2l bladder. Dry straight away (biggest fear), erectile function back after four or so weeks. Not long lasting but it’s there. You've alerted me to keeping an eye out for stricture and retention. I occasionally do a volume in vs volume out over 36 hours with focused emptying.

 

Curious about your dietary steps. Will read up. Love red meat and dairy and can’t see me having a good QOL without those! Its all a balance… 

User
Posted 27 Jul 2021 at 10:54

Chippers, I had a less than favourable histology and my journey has not been simple.  I don't worry about my situation but I am vigilant when it comes to tests and results. Never accept " your PSA is normal"  from GPs and receptionists, ideally get a hard copy of PSA tests and make sure you are being tested as appropriate to your situation.

Also a member of the stricture club.

Thanks Chris

User
Posted 28 Jul 2021 at 18:06

Hi,

That's an interesting post and set of replies.  I've never seen such a report.  

Quite a few people get their Gleason upgraded.  Mine went from 4+3 to 4+4 which didn't cheer me.  Although margins were clear.   From what you said about measuring your liquid in and out you seem to have a similar worry profile to me.   Although I only measured amount out per visit.

There are a couple of snippets of information in your report that could be of interest such as, if as Lyn says there could be some prostate left behind.   It will give you a heads up to ask about it if further treatment is ever required although you'd hope the doctors will know that.  Let's hope that isn't needed.

I know you've now done it but would you recommend others to get their report?   My own feeling is it's better not to.   It's a mixture of cowardliness and will it do any good.   I'm not sure if your experience supports it or not.  It has raised some questions, perhaps one's you didn't need to know.

I hope your psa is undetectable with a < less than sign at the front.  As Chris says above ask for the actual number, I've found they say it's undetectable although that can mean it's anything from <0.02 to <0.1 depending on hospital.  That level is often the subject of discussion on here.

All the best, Peter

User
Posted 28 Jul 2021 at 22:08
"I know you've now done it but would you recommend others to get their report? My own feeling is it's better not to."

Peter, every man should get this report, it is almist identical to the layout John got all those years ago and looks like a standard pathology report from urology to the GP.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 29 Jul 2021 at 17:39

Originally Posted by: Online Community Member

I know you've now done it but would you recommend others to get their report?   My own feeling is it's better not to.   It's a mixture of cowardliness and will it do any good.   I'm not sure if your experience supports it or not.  It has raised some questions, perhaps one's you didn't need to know.

They aren't given out by default at Oxford, but I asked the surgeon if I could have a copy of my pathology report at the followup out of interest. I'm the kind of person who wants to know all the facts.

I think not everyone wants all the gory details. But I like to know what I'm dealing with.

(I'll see your 'measuring output' and raise you a home-built uroflowmeter - but I'm an electronics geek, so it was a good rehab project while I couldn't cycle after surgery. My surgeon was well impressed with it too. I built it to confirm numerically that I could indeed 'piss like a race-horse' after surgery 😂).

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

User
Posted 29 Jul 2021 at 18:46
Patent it and whack it into production.
 
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