RP Evaluation
> Dear Dr. Oppenheimer,
>
> As a very recent RP patient, first Urologist visit and biopsy end June,
> RP July 23, I have observed PPML for the last three days and feel
> encouraged to write to you since your plain English explanations of
> technical subjects really stood out amid all the emotion floating around.
> As a research manager, I studied most of the night after I got the
> biopsy results and was prepared to OK the RP the next day - with a
> Gleason score of 5, T1c in both nodes
You mean both lobes of the prostate, don't you? Not lymph nodes. Right?
at age 52, it looked like the right
> thing to do. My problem is how to interpret just a couple of words in
> the final pathology report which follows. My Kaiser HMO surgeon is truly
> top-class and really really busy, God bless him, but "everything is OK
> now" seems borne out by the report which I had released to me, but the OK
> words are not enough detail for me given the news I was suddenly exposed
> to just a month and a half ago. So, Please help if you can direct to this
> E-Mail address. Here is the pathology report, my questions are at the end
> of the report.
> Pathology Report Adrian D’Souza Walnut
> Creek Hospital
>
> History Prostate
> Cancer 7/23/97
> Gross Desc
> A: Received fresh is a 4x2.5cm aggregate of fatty tissue with multiple
> lymph nodes. All as frozen section. The rest tissue as 1, 2 and 3.
> B: Received fresh is a 2x1cm aggregate of fatty tissue. Multiple lymph
> nodes are identified. All as frozen section. 1 and 2.
> C: A 30 gram total prostatectomy specimen with seminal vesicles measuring
> 3cm in length each. Margins are inked. Step-sectioning the prostate
> reveals multiple tan nodules ranging in size from 0.1cm to 0.5cm in
> diameter. Representative sections as: 1= seminal vesicle margin, 2=
> anterior urethral margin, 3 and 4= right apex, 5 and 6= left apex, 7 and
> 8= right base, 9 and 10= left base.
>
> SP FINAL RPT
>
> SPECIMEN
> RIGHT OBTURATOR NODE
> LYMPH NODE NOS
> LEFT OBTURATOR NODE
> LYMPH NODE NOS
> PROSTATE
> PROSTATE NOS
>
> DIAGNOSIS:
> A: FIFTEEN OUT OF FIFTEEN LYMPH NODES NEGATIVE FOR METATSTATIC DISEASE,
> RIGHT OBTURATOR LYMPH NODES.
> B: TEN OUT OF TEN LYMPH NODES NEGATIVE FOR METATSTATIC DISEASE, LEFT
> OBTURATOR LYMPH NODES.
> C: INFILTRATING PROSTATIC ADENOCARCINOMA, GLEASONS GRADE 2-3; TUMOR DOES
> NOT EXTEND THROUGH THE PROSTATIC CAPSULE; SURGICAL INKED MARGINS FREE OF
> TUMOR; NONREMARKABLE, SEMINAL VESICLES; ANTERIOR URETHRAL MARGIN FREE OF
> TUMOR; TOTAL PROSTATECTOMY SPECIMEN.
>
> 07/25/97/prv
> LYNNE K. FINLEY, M.D.
> STAT DIAGNOSIS:
> FROZEN SECTION DIAGNOSIS:NO EVIDENCE OF CARCINOMA, RIGHT AND LEFT
> OBTURATOR, LYMPH NODES
>
> Please tell me if I should be worried by the word "infiltrating" given
> all the other verbiage that says the tumors do not extend beyond the
> prostatic capsule, and that surgical margins are free of tumor.
The "infiltrating " term merely means that there was cancer present in the
specimen.
This is no cause for concern. The rest of the report is squeeky clean.
Congratulations.
It would have been helpful to get a description of the size of the tumor,
its location(s), and nuclear grade/ploidy status. Was there any indication
of perineural or intravascular involvement. These are important prognostic
factors. One can always just wait and see what the future PSA levels show.
From what I can tell. You have obtained EXCELLENT results.
JR Oppenheimer
**************************************
>. I have been wondering
>if there is any value in comparing the orig Bx slides with the path
> slides to:
Now that we have the specimen from the RP, I believe it is these slides
that will be of more value. I would like to evaluate whether the 4+5 seen
at Columbia represents artifact or progession to worse tumor.
>
> 1. Determine the % of Gl grade 4
This would be important to know on the RP. It might be difficult to
evaluate after the CHT, however.
>
> 2. Confirm if you agree with the original Gl of 3+4 or with the
> Sloan grade of 3.
The presence of Gleason pattern 4 does make a difference in
prognostication. If there was a decent percentage of this on the RP, it
would be significant. A large percentage of it on the biopsy (unlikely,
given Sloan's report) would also be useful information.
>
> 3. See if the higher gleason score reported in the path report
> can be the result of the CHB as was stated to me or whether
> the more aggressive cells were indeed there as the surgeon
> seemed to suggest.
Yes, this would probably be the most useful thing I could do. It would also
be useful to know the degree to which the CHT was effective in
killing/inhibiting cells.
>
> 4. Whether there may be any other prognostic value from comparing
> the pre RRP Bx slides with the post RRP path slides.
Margin and capsular involvement would be useful if hnot already evaluated.
>
> I would be glad to send the slides to you if you feel there is any
> value to the type of review I am suggesting or whether in the scheme
> of things it will not change the bottom line at this point - other
> than to possibly give me more peace of mind (which is subject to change
> with the next PSA).
I would like the opportunity to review your slides, but your prognosis is
more definitively forecast by continued monitoring of PSA levels. It's your
call.
>
> Once again my thanks for spending some of your precious time on line
> with us - I am sure there are plenty of other listers that do not often
> post but truly appreciate your time & thoughts.
Thank you. Receiving the income from second-opinions actually helps me to
try to rationalize spending as much time as I do on the computer. If I look
at it economically, it certainly doesn't "pay." It gives me "spiritual"
rewards, however.
Regards,
JR Oppenheimer