Two days post-op and trying to understand the pathology report. It’s been quite a journey so far, but the journey may just be beginning.

[Stereo1]

Two days post surgery and feeling better than I thought I would. I can walk around the house and up stairs without any real problem. I’m a bit tender when setting in, or getting out, of my chair. All in all, I’m pretty satisfied with my progress so far.

With “MyChart” I receive test results when they are released.

I received my pathology report today. I does indicate they found cancer in one of four lymph nodes tested, labeled pN1, and Extraprostatic extension or microscopic invasion of bladder neck labeled pT3a. I’m not sure what this means exactly. No Seminal Vesicle Invasion.

They labeled the staging as pT3a N1.

It will be a long week waiting to get back to see the doctor and get some explanation of this report.

Anyone have a similar report that can shed light on the seriousness of this report. I’m prepared to do what is needed to fight this disease but my ignorance with all of this is my greatest frustration.

Thanks in advance for any information that can be provided.

Thanks

[Hidden]

Well yes you are correct to think that your journey is not yet over. There will likely be hormone therapy and radiation in your future, but if the PCa is limited to relatively near where your renegade prostate was you are still curable.

A psma pet will help identify hot spots that remain.

4 weeks you should get a upsa test

Nothing to do now but heal up and perhaps start looking around for a radiation oncologist.

[Tall_Allen]

It means that you should not wait to have whole pelvic adjuvant radiation. Do not wait for a PSA test. You should start on ADT immediately for 3 years with abiraterone for 2 years. If you need time for continence recovery, you can start hormone therapy now and give tissues up to 7 months to heal before starting the radiation.

Alternatively, you might consider this clinical trial:

classic.clinicaltrials.gov/...

[Stereo1 in reply to Tall_Allen]

thank you for your advice. I’ll get on this now.

[Bret5]

You don’t say who is treating you but if like me, it was only a urologist and surgeon up until RP. That was my mistake. You can’t be too careful at this point … at time of my RP I had 12 lymph nodes biopsied, all negative, and yet 90 days later had numerous bone Mets and PSA of 156. Gleason 10. If not doing so already, get to an oncologist or better yet a dedicated cancer center. My guess is they will start you on hormone deprivation therapy at a minimum, right away. In my case, I’m now on triple therapy. That means for me, Eligard and Nubeqa, Zometa and supplements for bones, and Chemo (Docetaxel). My RP was only Jan 31 of this year. 11 months prior to RP I had an MRI guided biopsy and all was negative. So that’s how fast things can move in some cases. Don’t assume this is slow moving … most are slow but mine certainly was not. Be aggressive on this.

[maley2711 in reply to Bret5]

Your Docs goofed......you qualified for PSMA PET/CT to be done BEFORE decidng on treatment, Likely would have found tgose lymph nodes and radiation and not RP would have been an excellent option as 1st treatment.......anyway, hope ita all works out !!! we should be able to rely on Docs to be current on SOCs!

[Bret5 in reply to maley2711]

Yeah, I know they goofed and I think I said as much in my prior comments. But my job now is to focus on moving forward since I’m not capable of time travel lol. I’m getting excellent care at City of Hope. I also try to share the experience as appropriate to help others. When people first get cancer, they don’t know much. And even if you do the basic reading, you typically get the infirmstion that applies to the more common cases. That’s why a forum like this is really useful.

[Woodstock82]

Reference: ncbi.nlm.nih.gov/pmc/articl...

Scroll down to Table 3

pT3a = "Extraprostatic extension (unilateral or bilateral) or microscopic invasion of bladder neck"

N1 = "Metastases in regional lymph node(s)"

[Justfor_]

"Extraproststic extension or microscopic invasion of bladder neck". Two different cases, they may get the same pathology score but, in the long run the latter is more serious than the former. You better clarify which one of the two applies.

[Stereo1 in reply to Justfor_]

understood - thank you for that. I will add that to my list of questions.

[Jimbo59]

I was pT3a 'only' over 8 years ago. None of my 8 lymph nodes recovered came back as cancerous but were a bit enlarged. However taking a belt and braces approach I chose adjuvant radiotherapy done within 5 months. The tertiary 5 to my 3+4 case as well as 'established' EPE and PNI increased the chances of a future recurrance in my mind. Still working with all PSA tests to date undetectable at<0.025 One bit of advice I wish I had been given was to get an authorative second opinion on my pathology report. A lot rides on its accuracy.

PS Didn't do ADT.