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Help Understanding Pathology Report
tony04williams posted:

I Have finaly got pathology report I dont understand it i wish
i had not read it im worried now someone pls explain it to me.

Clinical History
Prostatectomy . Left and Right apical tissue . Histopathology.
Macroscopic Description
Specimen container labelled ' prostate ' . Please note, tissue was
collected for tissue banking from the right mid zone and the left mid zone
on 04/15/2010by Dr Lightfoot. The 37 gram prostatectomy,40mm from
superior to inferior , 45mm from left to right , and35mm from anterior to
posterior , with attached seminal vesicles and vasa deferentia up to25mm
long. The seminal vesicles and vasa deferentia are amputated from their
insertion into the prostate is linked blue,and the posterior black. The
prostate is rendered into 7 slices through horizontal sectioning demonstating
heterogenous tan and pale tan solid and cystic nodular parenchyma
There is a suggestion of parenchymal firmness in the right apex.
Please note the radical prostatectomy microscopic diagram form has been
completed for the case. (1.1) left seminal vesile and vas deferens,(1.2).
Right seminal vesile and vas deferens. (1.3) to (1.5) apex longitudinal
(1.5) slice 2 (as per cut up form). (1.8) to (1.20) slices 3 (as per cut out form).
(1.21) to (1.23) slice 4 (as per cut out form). (1.24) to (1.26) slice 5
(as per cut out form). (1.27) to (1.29) slice 6 (as per cut out form).
Specimen container labelled left apical tissue. An irregular fragment of
Pale tan tissue, 9x6x5mm. (2.1) bisected specimen all submmited.
Specimen container labelled right apacal tissue. A single sausage shape
Tan tissue fragment, 8x4mm (3.1) all submitted.
Sections of the radical prostatetectomy specimen show infiltration
By prostetic acinar adenocarcinoma, Gleason score 4x3=7.
The tumour is transacted at the apex bilaterally and is so close to
Several other painted margins. Foci of perineural, invasion as seen
And there is some background high grade PIN. Please see synoptic
Report for further details.
The sections show benign prostetic glands and stroma only with no high
Grade PIN all malignancy.
The sections show prostetic tissue partially infiltrated by prostetic acinar
Adenocarcinoma, Gleason score is 4x 3=7. With focal perineural invasion.
Operative specimen — radical prostatectectomy including seminal vesicles.
Histologic type — acinar.
Gleason grade and score -4+3=7
Site and focality-
Multifocal tumor, predominatly involving the right to lower zone and
The left anterior lower zone with focal extension to the right upper zone.
Tumour involves approximately 20-25% of prostatic volume.
Capsular invasion —ABSENT
Extraprostatic spread =ABSENT
Perineural invasion-PRESENT
Lymphovascular invasion — ABSENT
Tumour is transacted at the apical margin bilaterally. Pleasr correlate
With specimens 2-3 below.
Tumour is <0.1mm from the anterior mid zone vmargins bilaterally.
Tumour is 2mm from the right anterolateral mid zone neurovascular margin.
Tumour is 1.3 from right posterolateral upper zone margin.
Seminal Vesicles — uninvolved.
Lymph nodes — not assessed.
Other pathological findings.
Focal high grade PIN in the left posterolateral mid zone and right zone.
Stage — UICC/AJCC stage 11 (pt2c,Nx,Mx)
Left apical tissue — benign prostatic tissue only
Right apical tissue-prostatic acinar adenocarcinoma , Gleason score
4+3=7 with focal perineural invasion.
Galileo1962 responded:
It doesn't sound all the frightening to this layperson. You may be
alarmed at "perineural invasion" but that does NOT mean the
cancer was found in the nerve bundles surrounding the prostate. It is something that sounds worse than it is.

4 3 isn't all that wonderful, but it's not the end of the world, either.
If you have Gleason 7, you'd rather have 3 4, but things are what they are. 4 3 tends to act more like Gleason 8, and 3 4 tends to act more like Gleason 6, but those are just generalities.

There is good news in your report: no seminal vesicle involvement and no capsular penetration. My reading of the margins indicates they were negative, and that's good, too.

A pathology report can be much, much worse than that. I would try to look at the bright side--there is every reason to hope that all the cancer was removed by the surgeon and that this bump in the road is now behind you.

I highly recommend "Dr. Patrick Walsh's Guide to Surviving Prostate Cancer" (2007 ed) which will further illuminate these matters for you, and you can reach out to expert layperson az4peaks (John) on this board who can explain the finer points of your path. report if you so desire.

Best wishes!
An_216445 responded:
Surgeon should have explained path report even if you were (like most of us) too stressed or upset at the time to phrase the questions. Still, there is some good news in it - tumor did not grow outside the prostate, no cancer found in the seminal vesicles and Gleason 7 (possible 2 to 10) is not the most aggressive. Although 4 3 (more of the grade 4 cells) is more serious than 3 4, the report did not mention any tertiary grade 5. Perineural invasion means that the cancer had spread (apparently just within the prostate) to space surrounding nerves - which may indicate increased chance of spread locally, as does the "less than 0.1mm" margin. The 20-25% tumor volume is associated with a slight increase in the chance of recurrence. Apparently the surgeon chose not to remove the nearby lymph nodes during the procedure. Adenocarcinoma is the most common type of cancer of the prostate. In general, it all means that it's important for you to have your PSA checked regularly and definitely ask your urologist/surgeon to explain the implications of the report. Good luck.
tony04williams replied to Galileo1962's response:
Thank you so much for taking the time to reply and explain.
tony04williams replied to An_216445's response:
Thanks so much its hard not to worry.

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