Can anyone review pathology? Shows IDC but negative everything else. Doctor is not recommending radiation. Thoughts? Life expectancy? Chance of reoccurrence?
TUMOR Histologic Type: Acinar adenocarcinoma, conventional (usual) Histologic Grade: Grade: Grade group 2 (Gleason Score 3 + 4 = 7) Percentage of Pattern 4: 11 - 20% Intraductal Carcinoma (IDC): Present IDC Incorporated into Grade: No Cribriform Glands: Present Treatment Effect: No known presurgical therapy TUMOR QUANTITATION: Estimated Percentage of Prostate Involved by Tumor: 6 - 10% Extraprostatic Extension (EPE): Not identified Urinary Bladder Neck Invasion: Not identified Seminal Vesicle Invasion: Not identified Lymphatic and / or Vascular Invasion: Not Identified MARGINS Margin Status: All margins negative for invasive carcinoma REGIONAL LYMPH NODES Regional Lymph Node Status: : All regional lymph nodes negative for tumor Number of Lymph Nodes Examined: 10 pTNM CLASSIFICATION (AJCC 8th Edition) Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the time the report is issued. As per the AJCC (Chapter 1, 8th Ed.) it is the managing physician’s responsibility to establish the final pathologic stage based upon all pertinent information, including but potentially not limited to this pathology report. pT Category: pT2 pN Category: pN0 ADDITIONAL FINDINGS Additional Findings: High-grade prostatic intraepithelial neoplasia (PIN)
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Granolaberry
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Biopsies only are a small sample, so we figure there is probably a lot more where it came from. With whole-mount pathology, you see all of it, and all of it was removed. It's similar to PNI - it adds to risk if found on a biopsy, but not in post-RP pathology (where it is a very common finding).
I agree with the others, your pathology looks very good. No adverse features. My Urologist told me the #1 thing is to have negative margins. You have about 15% G4 which is low and I believe is a very good thing. No EPE, no bladder neck invasion and if TA says IDC is not a big deal with 3+4, you can take that to the bank. My RP was in 2018, pathology similar to yours and all is good. My suggestions: Take it real easy for a while. No lifting anything over 10 pounds, no exercise other than walking and no sex. Do your kegels 3X a day. IMO. you should start your penile rehab. 4-5 weeks after surgery, that's what I did anyway. Good luck.
The treatment course with IDC or without is the same. Some oncologists do think it is represents adverse pathology. For example, sometimes with IDC and crib form AS is not recommended. In your case it means nothing.
I'll trade you! Can we do that? Seriously, 65% pattern 4, 4+3, less than 10% of PV involved, with IDC. 2nd pathology says 4+4 no IDC. I'm working on my 3rd year of <.02. Penile rehab is important...don't sell it short (pun intended..lol). Buy a pump and work it at least 3x's a week. 5mg of Tadalafil every day. If you do not get a decent result in 6 months, get on injectables. You need blood-flow. Get your mind off your diagnosis and start getting your mind on resuming life!! Good luck to ya!!
Congratulations! No one wants this disease of course, but your situation compares favorably to nearly all of us.
Good advice on the kegels and penile rehab. While you odds of permanent incontinence are low, your odds of permanent ED are far greater. With the rehab you have a decent opportunity to regain function, without it not so much.
A pathology second opinion would be helpful. From UPTODATE: The controversy lies with the difficulty in distinguishing neoplastic cells in high grade PIN from malignant cells in IDCP and the reproducibility in recognizing loose cribiform patterns where IDCP and high rate PIN overlap. You appear to have both on pathology. However IDCP is associated with a coexisting invasive cancer 90-100 percent of time. It goes on to say that IDCP may represent one of two distinct entities 1. adjacent advanced invasive prostate cancer, 2in situ carcinoma when associated with minimal low-grade or non invasive carcinoma; the seconds only a small subset of patients. Further reading:; IDC by it self is not an aggressive invasive disease it could be the product and indicator of a highly aggressive disease." I think that is what you doctor must think is present. I would have a review at Hopkins.
That would imply that anyone with clear margins should not reoccur. Clear margins means no tumor was seen at the edges that were looked at. Not every millimeter of every edge is viewed and if there are only a few cells of cancer the submicroscopic disease can will not be visible and can reoccur. Alternatively when there is a small positive edge not all those patients reoccur--my friend is 11 years post surgery with a positive margin (small one) followed with PSA and negative--the immune system can take care of small amounts of cancer in many patients. Patients with clear margins do reoccur--whether microscopic tumor was at areas not seen or had already gone through lymphatics is not always known.
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Recent Radical Surgery
Recurrence six-years after surgery
Post Radical Prostatectomy on 5/9/17
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