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Thread: Up-Dated Path Stage

  1. #1
    Experienced User
    Join Date
    Aug 2017
    Posts
    74

    Smile Up-Dated Path Stage

    Well, I am not sure what the heck happened but I was just going through my thick file on my Prostate Cancer relishing my latest PSA results when I got to my post-surgery Path Report it was a PT3a, not a PT2 as I had put on my signature. So, for a moment I had a bit of a sinking feeling but bounced right back and decided it was better to continue relishing my 21 month PSA results. Wiped off the dusty file folder and put it back where it belongs (out of sight!)
    Next test dementia!
    Biopsy Date 7-14-2017
    DIAGNOSIS: Adenocarcinoma
    PSA-6.3-T2A
    2/12 cores: 10 Cores Benign
    #1: 5% Gleason 3+3 Left Apex
    Number Of Cores Involved 1 Of 2
    Tumor Length 1.5mm
    Perineural Invasion Not Identified.
    #2: 25% Gleason 4+3) Right Base
    Number Of Cores Involved 2 Of 2
    Tumor Length 4mm (Aggregate)
    Perineural Invasion Not Identified
    Size Of Prostate: 50.6
    Bone Scan Negative, Prostate MRI Negative
    9/27/2017 Robotic Surgery Da-Vinci
    10/5/2017 Pathology Report
    11 Lymph Nodes Negative For Malignacy
    Prostate Weight 48.6 grams
    Urinary Bladder Neck Invasion-Not Identified
    Seminal Vesicle Invasion-Not Identified
    Margins: Involved By Invasive Carcinoma
    Margin Limitations: Less Than 3MM Rt Posterior
    EPE Present Focal: Site Rt Posterior
    Path Stage pT3A
    PSA Test 11/27/2017 <0.02
    PSA Test 12-5-2017 <0.02
    PSA Test 1-25-2018 <0.02
    PSA Test 3-28-2018 <0.02
    PSA Test 6-28-2018 <0.02
    PSA Test 10-04-2018 <0.02
    PSA Test 1-20-2019 <0.02
    PSA Test 7-29-2019 <0.02

  2. #2
    Hey, BigAl. As long as your PSA cooperates and you watch when you cross the street, you'll be fine

    But for our continuing education, usually a positive surgical margin(s), when it is the only adverse finding, still earns a pT2 assessment. One thing to check in your path report: You had no lymph node Invasion and no seminal vesicle invasion. That leaves extraprostatic (or extracapsular) extension (EPE or ECE), which you don't mention in your signature. Do you see it mentioned either as identified or not identified in your path report? If found, it would explain the pT3a assessment--the "a" usually means the cancer penetrated into or through the prostate capsule. If present, there may be a description of the location or extent.

    (Note that EPE is a separate evaluation from the Surgical Margins.)

    Djin
    Last edited by DjinTonic; 08-10-2019 at 01:59 AM.

  3. #3
    EPE/ECE earns a "3" on The Path Report.

    Al: Keep in mind that: pT3a with all "<0.02" is far, far more preferable than pT2 with a rising PSA!

    MF
    PSA: Oct '09 = 1.91, Oct '11 = 2.79, Dec '11 = 2.98 (PSA, Free = 0.39ng/ml, % PSA Free = 13%)
    Referred to URO MD
    Jan '12: DRE = Positive: "Left induration"
    Jan '12: Biopsy = 6 of 12 Cores were Positive: 1 = G7 (3+4) and 5 = Gleason 6
    Referred to URO Surgeon
    March '12: Robotic RP: Left: PM + EPE. MD waited in surgery for preliminary Path Report then excised substantial left adjacent tissue(s) down to negative margins and placed 2 Ti clips for SR guidance, if needed in future.
    Pathology: Gleason (3+4) pT3a pNO pMX pRO c tertiary pattern 5 / Prostate Size = 32 grams / Tumor = Bilateral: 20% / PNI: present
    3 month Post Op standard PSA = <0.1 ng/ml
    1st uPSA at 7 months Post Op = 0.018 ng/ml
    uPSA remains "stable" at 84 Months Post Op: Mean = 0.021 (20x uPSAs: Range 0.017 - 0.026) LabCorp: Ultrasensitive PSA: Roche ECLIA
    Continence = Very Good (≥ 99%)
    ED = present

  4. #4
    Top User garyi's Avatar
    Join Date
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    1,346
    Quote Originally Posted by Michael F View Post
    EPE/ECE earns a "3" on The Path Report.

    Al: Keep in mind that: pT3a with all "<0.02" is far, far more preferable than pT2 with a rising PSA!

    MF
    Amen to that
    72...LUTS for the past 7 years
    TURP 2/16,
    G3+4 discovered
    3T MRI 5/16
    MRI fusion guided biopsy 6/16
    14 cores; four G 3+3, one G3+4,
    CIPRO antibiotic = C. Diff infection 7/16
    Cured with Vanco for 14 days
    Second 3T MRI 1/17
    Worsened bulging of posterior capsule
    Oncotype DX GPS 3/17, LFP risk 63%, Likelihood of Low
    Grade Disease 81%, Likelihood of Organ Confined 80%
    RALP 7/13/17 Dr. Gonzaglo @ Univ of Miami
    G3+4 Confirmed, Organ confined
    pT2 pNO pMn/a Grade Group 2
    PSA 0.32 to .54 over 3 months
    DCFPyl PET & ercMRI Scans - 11/17
    A one inch tumor still in prostate bed = failed surgery
    All met scans clear
    SRT, 2ADT, IMGT 70.2 Gys @1.8 per, completed 5/18
    Radiation Procitis, and Ulcerative Colitis flaired after 20 years
    PSA <.006 9/18, .054 11/18, .070 12/18, .067 2/19, .078 5/19, .074 7/19, .081 9/19
    We'll see....what is not known dwarfs what is thought to be fact

  5. #5
    Experienced User
    Join Date
    Aug 2017
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    EPE Present Focal: Site Rt Posterior. Not sure what that means. I do know that after discussing with Uro after he got the Path Report I was sent over to my Radiologist that said no point in doing anything at this time as if nothing is showing PSA wise we wouldn't know if Salvage Radiation had worked as we were radiating something that we don't think is there. So it would be impossible to determine the success of getting rid of something that wasn't there. His advice keep an eye on my PSA
    Nothing else was mentioned of concern on my Path Report. Unfortunately, with me taking the Alfred E Neuman Road (What Me Worry?) I may have not been listening as closely as I should have.
    Maybe my wife is on to something.
    Biopsy Date 7-14-2017
    DIAGNOSIS: Adenocarcinoma
    PSA-6.3-T2A
    2/12 cores: 10 Cores Benign
    #1: 5% Gleason 3+3 Left Apex
    Number Of Cores Involved 1 Of 2
    Tumor Length 1.5mm
    Perineural Invasion Not Identified.
    #2: 25% Gleason 4+3) Right Base
    Number Of Cores Involved 2 Of 2
    Tumor Length 4mm (Aggregate)
    Perineural Invasion Not Identified
    Size Of Prostate: 50.6
    Bone Scan Negative, Prostate MRI Negative
    9/27/2017 Robotic Surgery Da-Vinci
    10/5/2017 Pathology Report
    11 Lymph Nodes Negative For Malignacy
    Prostate Weight 48.6 grams
    Urinary Bladder Neck Invasion-Not Identified
    Seminal Vesicle Invasion-Not Identified
    Margins: Involved By Invasive Carcinoma
    Margin Limitations: Less Than 3MM Rt Posterior
    EPE Present Focal: Site Rt Posterior
    Path Stage pT3A
    PSA Test 11/27/2017 <0.02
    PSA Test 12-5-2017 <0.02
    PSA Test 1-25-2018 <0.02
    PSA Test 3-28-2018 <0.02
    PSA Test 6-28-2018 <0.02
    PSA Test 10-04-2018 <0.02
    PSA Test 1-20-2019 <0.02
    PSA Test 7-29-2019 <0.02

  6. #6
    Quote Originally Posted by bigalcalbisque View Post
    EPE Present Focal: Site Rt Posterior. Not sure what that means. I do know that after discussing with Uro after he got the Path Report I was sent over to my Radiologist that said no point in doing anything at this time as if nothing is showing PSA wise we wouldn't know if Salvage Radiation had worked as we were radiating something that we don't think is there. So it would be impossible to determine the success of getting rid of something that wasn't there. His advice keep an eye on my PSA
    Nothing else was mentioned of concern on my Path Report. Unfortunately, with me taking the Alfred E Neuman Road (What Me Worry?) I may have not been listening as closely as I should have.
    Maybe my wife is on to something.
    You can add:

    EPE present, focal, right posterior

    to your signature and add a uniforrm medal for your PCa campaign.

    The cancer poked through the thin capsule that surrounds the prostate. However, when that happens, focal is best, meaning it was at just one small spot, not several, and not extensive. Your good PSA told your docs that you should presume all the PCa was removed and, as you said, there was nothing known to be left to zap. However, the EPE+ is what earned you the pT3a pathology assessment

    I see you've been changed from 3-month to 6-month PSA testing (?) That's good!

    Djin
    Last edited by DjinTonic; 08-10-2019 at 11:00 AM.

  7. #7
    Experienced User
    Join Date
    Aug 2017
    Posts
    74
    Thanks, Djin and others for your comments and encouragement! I will post again after my late September 2 year follow-up with my URO and 2 years PSA test.

    Al
    Biopsy Date 7-14-2017
    DIAGNOSIS: Adenocarcinoma
    PSA-6.3-T2A
    2/12 cores: 10 Cores Benign
    #1: 5% Gleason 3+3 Left Apex
    Number Of Cores Involved 1 Of 2
    Tumor Length 1.5mm
    Perineural Invasion Not Identified.
    #2: 25% Gleason 4+3) Right Base
    Number Of Cores Involved 2 Of 2
    Tumor Length 4mm (Aggregate)
    Perineural Invasion Not Identified
    Size Of Prostate: 50.6
    Bone Scan Negative, Prostate MRI Negative
    9/27/2017 Robotic Surgery Da-Vinci
    10/5/2017 Pathology Report
    11 Lymph Nodes Negative For Malignacy
    Prostate Weight 48.6 grams
    Urinary Bladder Neck Invasion-Not Identified
    Seminal Vesicle Invasion-Not Identified
    Margins: Involved By Invasive Carcinoma
    Margin Limitations: Less Than 3MM Rt Posterior
    EPE Present Focal: Site Rt Posterior
    Path Stage pT3A
    PSA Test 11/27/2017 <0.02
    PSA Test 12-5-2017 <0.02
    PSA Test 1-25-2018 <0.02
    PSA Test 3-28-2018 <0.02
    PSA Test 6-28-2018 <0.02
    PSA Test 10-04-2018 <0.02
    PSA Test 1-20-2019 <0.02
    PSA Test 7-29-2019 <0.02

 

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