Hi,
I had a RP two weeks ago (radiation was ruled out because of severe existing urinary symptoms) and have concerns with regard to my pathology report. My surgeon, who I carefully selected because of his extensive experience in prostate health and PC (over 4K RPs) does not share my concern and says it is not material. Somehow, I am still concerned. I would appreciate if I can receive feedback from experts on this panel if anything can be done at this stage to prevent or lessen the severity of a possible BCR because of the positive margin identified in the pathology report. Here are excerpts from the pathology report:
A,B.C multiple Lymph nodes , negative for metastatic carcinoma
D- Bladder neck margin, benign fibromuscular tissue, no prostatic gland or carcinoma identified
E- Prostate and seminal vesicle prostatectomy
Prostatic adenocarcinoma, GS (3+4=7)
Tumor focally extends to right anterior resection margin ( focal Gleason pattern 3
, <3mm in length)
Specific Data:
Grade: Grade Group 2 (GS 3+4 = 7), % Pattern 4 = 30%, Minor Tertiary pattern 5 (less than 5%)
Estimated % of prostate involved by tumor : 11-20%
EPE, Bladder neck invasion, Seminal Vesicle invasion, Lymphovascular invasion
NOT Identified
Margins Status: Invasive carcinoma present at margin, right anterior
Primary Tumor pT2, pN category pN0
I read that anterior PSMs have less chance of recurrence compared to posterior PSMs, but still, positive margins increase the odds of recurrence few years down the road. I cautioned my surgeon in my pre-op visit regarding my concern on surgery in general and PSMs and the use of intra-operative frozen sections. He assured me that he routinely utilized that, and a pathologist would be standing by. Seems it has not been the case. As far as other components of a perfect trifecta he promised, he has done a great job with the other two so far. No incontinence and ED improving 2 weeks after surgery.
Any advantage of sending the slides to Epstein for second opinion? I didn't see any reference to PNI in the report. Thanks.