Path report question

[C-RI]

I have my first post RP meeting with MO next Thursday, marking 6 weeks. My PSA heading into surgery was 98.8, but bone scan and Axumin scan showed no mets. Pathology report post surgery has Gleason at 4+3 = 7, with some positive non-focal margins and tumor invasion into seminal vesicles - T3b NX. I think that makes me “higher-risk stage 3”. The surgeon indicated that the cancer he saw locally does not explain my high PSA heading in.

I may be thinking incorrectly on this, but next week I am expecting a low PSA and a recommendation of adjuvant radiation and ADT. Even then, I will wonder if there is pre-spread somewhere (micro-mets?) and the “localized” radiation treatment may not get it. If PSA is high, I assume systemic treatment will be on the table. This is all speculation; we need to see PSA score.

My question is, there is one part of path report I do not understand and that is the denotation of ESS or RSS for each of the slices. Does anyone know what they refer to?

Thanks

[Dachshundlove]

Hi C-RI

PSA is complicated at diagnosis. If you dig around the different posts here, one finds very quickly that PSA is extremely random at diagnosis.

Some people with extensive metastasis have low (less than 5) psa and some people with localized cancer have psa numbers like yours. There is a wide variety.

If the Auxiom scan showed no Mets— be grateful.

PSA is good for monitoring progression after diagnosis but questionable for monitoring development of PC. Is a test that efficacy shall continue to be the subject of debate—as it should be, in my opinion.

My husband has multiple lymph nodes involved, recently diagnosed stage 4 and his psa is 20.

🤔

[Fairwind]

Can't help you with the ESS / RSS notations...Your next PSA test will tell the story. If they got it all, it will be zero, undetectable..If they didn't get it all, you will have what is called "persistent PSA" which will require further treatment..Just know that G-7 is very treatable and curable..

[timotur]

RSS and ESS just refer to whether all or a portion of the biopsy sample is included in the the cassette for analysis:

- RSS: representative sample submitted

- ESS: entire sample submitted

[monte1111 in reply to timotur]

That's what I like about this site. Ask and you shall receive. Thanks for the info. Enjoy.

[tango65]

How many pelvic lymph nodes were taken during surgery? Was any of them positive for cancer?

[C-RI in reply to tango65]

Not sure how many. He ran into issues with hernia mesh. The few that were taken were clean.

[tango65 in reply to C-RI]

All the evidence points that there are not local or distant metastases. If your PSA remains elevated after surgery, you should consider to obtain a Ga 68 PSMA study to determine if there are local and/or distant metastases. This study could help to plan the radiotherapy treatment if there were local metastases (pelvic lymph nodes) and avoid the radiotherapy treatment if there were distant metastases.

[Tall_Allen]

Does your path report tell you the length of the non-focal (>3mm) margins and the Gleason score at the margin? If there is any pattern 4 at the margin, you are a candidate for SRT. But...

You are right that if your PSA is still high, it is a very good idea to have an Axumin PET /CT scan or experimental PSMA-based PET/CT to rule out that there are distant metastases. In that case, SRT may be futile and moving straight to ADT would be worth considering.

[Lupronzytiga]

Please see if you can get a GA-68 PSMA PET MR.

This scan is able to see soft tissue and bone mets any where in the body.

Resolution is down to .2mm.

AXIUM PET MRI resolution is up to .5mm but is most useful around the pelvis area.

The GA-68 PET MR scan is up for FDA approval this year.

I believe this scan could be the SOC 4 metastatic disease in the near future.