Reading between the lines of the pathology report
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From: WhiteSoxFan on 1 Feb 2006 21:40 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
From: ron on 1 Feb 2006 22:07 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
From: c palmer on 2 Feb 2006 01:24 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
From: Leonard Evens on 2 Feb 2006 10:22 WhiteSoxFan wrote: > 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 > 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.
From: Alan Meyer on 2 Feb 2006 15:02
WhiteSoxFan wrote: > 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 |