Deciphering my Pathology report - Advanced Prostate...

Advanced Prostate Cancer

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Deciphering my Pathology report

kpminn profile image
13 Replies

Good Morning! Had my 2 week post RP urology appointment yesterday and because I have some adverse results on my pathology report they have submitted samples for Decipher Genomic testing. There are 22 RNA markers that are good predictors of reoccurrence. These genomic markers or combination will determine that likelihood. If they come back positive then I will have some subsequent treatment, likely radiation. This is also contingent on my 90 day post op PSA test. This reduces the over treatment of the cancer because the pathology does not always mean reoccurance (which in my case would be 50% based on pathology alone). People are often given unnecessary treatments as a result. PC is one area where there has been so much over treatment that it has resulted in a large number of people being under treated (like me). So basicly good news despite what appeared to be bad news The Doc said I’ve over analyzed this and to just chill. I told him I was adrift in a sea of acronyms and been up too late trying to read Chinese medical journals.

Look at the post op video That explains this test

13 Replies
Tall_Allen profile image

What were the adverse results?

kpminn profile image
kpminn in reply to Tall_Allen

Tall, Here is my Pathology summary

TUMOR Acinar adenocarcinoma

Histologic Type

Gleason Pattern

% of Pattern 4 70%

% of Pattern 5 5%

Primary Gleason Pattern Pattern 4

Secondary Gleason Pattern Pattern 4

Tertiary Gleason Pattern Pattern 5

Total Gleason score 8

Intraductal Carcinoma (IDC) Present

Extraprostatic Extension (EPE) Present, nonfocal

Seminal Vesicle Invasion(SVI) Present, right

Perineural Invasion Present

Margins Uninvolved by invasive carcinoma

Lymph nodes Uninvolved by invasive carcinoma

Pathologic stage classification

Primary tumor pT3B

Regional lymph Nodes pN0

Addl Pathological Findings High-grade prostatic intraepithelial neoplasia (PIN)

Tall_Allen profile image
Tall_Allen in reply to kpminn

So, on the upside, there are no positive margins and the lymph nodes they sampled were clear. On the downside, there's IDC-P, tertiary 5, SVI, & EPE - you don't need Decipher to tell you it's aggressive. You might want to move up your ultrasensitive PSA to 6 weeks post-prostatectomy.

kpminn profile image
kpminn in reply to Tall_Allen

Allen, I do understand the implications of my negative pathology results. I only hope that the Decipher test will help determine the next course of treatment. I don’t feel very optimistic at this point and am expecting a negative prognosis.

Lyubov profile image
Lyubov in reply to kpminn

I wish you well, kpminn!

Tall_Allen profile image
Tall_Allen in reply to kpminn

The Decipher score will not determine the next course of treatment in your case, but the uPSA will.

kpminn profile image
kpminn in reply to Tall_Allen

I understand that the Decipher test will risk of metastases within 5 years and that for death due to PCa within 10 years. Won't this and post op PSA determine course of treatment?

Tall_Allen profile image
Tall_Allen in reply to kpminn

As I said, you already know it's aggressive. There's no such thing as a diagnosis of IDC-P, tertiary 5, SVI, & EPE that's not aggressive. So Decipher really only confirms what you already know. If you don't get confirmation, I would question the test. Either way, uPSA alone will determine if and when salvage radiation is needed.

kpminn profile image
kpminn in reply to Tall_Allen

So then are you saying that the uPSA is the only way to determine if and when RT is needed?

Tall_Allen profile image
Tall_Allen in reply to kpminn

In your case, yes, because of your aggressive pathology - any uPSA over 0.03 at 3 months or (over 0.04 at 2 months) warrants a discussion with a radiation oncologist.

j-o-h-n profile image
j-o-h-n in reply to kpminn

You're a very luck man you've got TallunderscoreAllen on your side.

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 01/05/2019 5:17 PM EST

cujoe profile image


I also had poor pathology on final biopsy and suggest you take a careful look at the document referenced in this press release . I found it by accident and used it as the basis for discussions with my surgeon and radiologist before quickly deciding to do adjuvant IMRT about 3 months after surgery. (Even tho my pre-surgery PSA of near 18 dropped to "undetectable" at 7 weeks post surgery)

Be Well & feel free to ask any questions - cujoe

kpminn profile image

I got my Decipher report back and I'm at .73. I will be considering adjuvant radiation and will have a consult in early March to decide best way to proceed.

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