Surgeon says I'm intermediate risk, but I think I'm high risk based on the pathology report below

[twostrats]

I had an RP in March of this year. The 3 psa tests I've had since then have been <0.1 my question my surgeon calls me intermediate risk, but according to my pathology report with T3a I think I'm high risk.

Final Diagnosis:

1. Periprostatic fat, excision:

- Adipose tissue with no tumor seen.

2. Right peri vesicle bundle margin, excision:

- Fibroconnective tissue and nerves only; no tumor seen.

- Prostatic epithelium is not identified.

3. Prostate and seminal vesicles, prostatectomy:

- Prostatic adenocarcinoma, Gleason's score 7 (4+3) [Grade Group 3].

- The adenocarcinoma invades into thick intersecting smooth muscle bundles

at the right base, consistent with bladder neck

invasion.

- Lymphovascular invasion is not identified.

- Seminal vesicles with no tumor seen.

- Resection margins are negative for carcinoma; adenocarcinoma is less

than 0.001 cm to the right base margin (see part #2).

4. Right pelvic lymph nodes, excision:

- No tumor seen in three lymph nodes (0/3).

5. Left pelvic lymph nodes, excision:

- No tumor seen in six lymph nodes (0/6).

MH/al/mm

Report Name: Prostate - Radical Prostatectomy

Status: Submitted

Part(s) Involved:

3: Prostate and seminal vesicles

Synoptic Report:

Specimen

Procedure: Radical prostatectomy

Tumor

Histologic Type: Acinar adenocarcinoma

Histologic Grade

Grade Group and Gleason Score: Grade group 3 (Gleason Score 4 + 3 =

7)

Percentage of Pattern 4: 65%

Extraprostatic Extension (EPE): Not identified

Urinary Bladder Neck Invasion: Present

Seminal Vesicle Invasion: Not identified

Treatment Effect: No known presurgical therapy

Ma

rgins

Margins: Uninvolved by invasive carcinoma

Lymph Nodes

Number of Lymph Nodes Involved: 0

Number of Lymph Nodes Examined: 9

Pathologic Stage Classification (pTNM, AJCC 8th Edition)

Primary Tumor (pT): pT3a

Regional Lymph Nodes (pN): pN0

CAP eCC February 2020 Annual Release

Gross Description:

Received in five parts

Source of Tissue: 1. Labeled #1, "periprostatic fat"

Gross Description: Received fresh labeled, "Thomas G. King, MR# 1213910,

periprostatic fat." It consists of multiple soft yellow-tan lobular

fibrofatty tissue fragments measuring 2.7 x 2.5 x 0.8 cm in aggregate. The

specimen is sectioned to reveal a soft yellow-tan lobular fibrofatty cut

surface. Entirely submitted in one block as 1A.

___________________________________________________________________

Source of Tissue: 2. Labeled #2, "right perivesical bundle margin"

Gross Description: Received fresh labeled, "Thomas G. King, MR# 1213910,

right perivesical

bundle margin." It consists of a soft red-brown

irregular tissue fragment measuring 0.2 x 0.1 x 0.1 cm. Entirely frozen in

one block as 2FS. The residual frozen section tissue is very tiny and may

not survive processing.

___________________________________________________________________

Source of Tissue: 3. Labeled #3, "prostate and seminal vesicles"

Gross Description: Received fresh labeled, "Thomas G. King, MR# 1213910,

prostate and seminal vesicles." It consists of a 21 gram, 3.0 x 2.5 x 2.5

cm red-tan hemorrhagic prostate with intact capsule, patent urethra, and

bilateral seminal vesicles and vasa deferentia. The right seminal vesicle

measures 3.2 x 1.5 x 0.7 cm, right vas 4.0 x 0.5 x 0.5 cm, left seminal

vesicle 3.0 x 1.0 x 0.5 cm, and left vas 4.5 0.5 x 0.5 cm. The right side

is inked black and the left side is inked blue and the specimen is

sectioned from apex to bladder neck to reveal tan-pink soft to firm

nodular cut surface. Sectioning of the bilateral semina

l vesicles and vasa

deferentia reveals tan fluid filled spaces. Representative sections are

submitted as designated for microscopic evaluation.

Designation of Sections: 3A- right apex, 3B- left apex, 3C- right base,

3D- left base, 3E- right anterior mid, 3F- right posterior mid, 3G-3H-

right posterior superior, 3I- left anterior mid, 3J- left posterior mid,

3K-3L- left posterior superior, M- right seminal vesicle and vas deferens,

3N- left seminal vesicle and vas deferens.

*Tumor and normal are given to Tumor Bank.

**90% of the specimen is submitted.

___________________________________________________________________

Source of Tissue: 4. Labeled #4, "right pelvic lymph nodes"

Gross Description: Received fresh labeled, "Thomas G. King, MR# 1213910,

right pelvic lymph nodes." It consists of a soft yellow-tan lobular

fibrofatty tissue fragment measuring 4.0 x 3.0 x 1.5 cm. The specimen is

sectioned to reveal three firm yellow-tan lymph nodes ranging from 0.3 cm

up to 1

.0 cm in diameter. The specimen is entirely submitted in 4A-4C.

Designation of Sections: 4A- one bisected lymph node, 4B- two small lymph

nodes, 4C- remaining fibrofatty tissue entirely submitted

___________________________________________________________________

Source of Tissue: 5. Labeled #5, "left pelvic lymph nodes"

Gross Description: Received fresh labeled, "Thomas G. King, MR# 1213910,

left pelvic lymph nodes." It consists of a soft yellow-tan lobular

fibrofatty tissue measuring 4.5 x 3.5 x 2.0 cm. The specimen is sectioned

to reveal multiple firm yellow-tan lymph nodes ranging from 0.5 cm up to

2.2 cm in diameter. The specimen is entirely submitted in 5A-5D.

Designation of Sections: 5A-5B- one large bisected lymph node in each

cassette, 5C- four small lymph nodes, 5D- remaining fibrofatty tissue

entirely submitted

RA/mm 3/30/21 2300

___________________________________________________________________

Intraoperative Diagnosis:

2FS: Fibrous tissue and

nerves, no tumor seen.

Intraoperative Pathologist: Douglas B. Flieder, MD

Pathology Fellow: Ashley Lentini, MD

Pathologist(s): Min Huang, MD, PhD

Electronically Signed By Min Huang, MD, PhD

Pathologist

4/1/2021 18:38

This case has been personally examined and interpreted by the attending

pathologist.

[Tall_Allen]

Why does it matter?

[twostrats in reply to Tall_Allen]

I'm learning a lot in this forum. I'm assuming that eventually it might determine the course of action for my next treatment

[tango65]

The cancer is high risk, it is T3a. It has extended outside the prostate into the bladder.

[twostrats in reply to tango65]

That's what I thought. My surgeon said he removed anything that went into the bladder during the RP thanks

[Justfor_]

A more sensitive PSA test will give you earlier warning in case of BCR. This is actionable, the rest is semantics.

[LearnAll]

High or low risk can not be determined just by pathology report alone. You need a plethora of biomarkers and other data to ascertain risk level. If you just want to guess based on this detailed pathology report alone ..I would say you are in intermediate risk level category.

[doc1947g]

"Prostatic adenocarcinoma, Gleason's score 7 (4+3) [Grade Group 3]. This means Intermediate advanced risk, like I was.