53 years old. Initial diagnosis: prostate cancer ISUP 2 (Gleason 3+4), PSA <10, small lesion (~14x7 mm), apparently organ-confined. Underwent robotic radical prostatectomy.
Final pathology:
pT2NxMx
No extraprostatic extension
No seminal vesicle invasion
No lymphovascular invasion
No cribiform
No intraductal
Perineural invasion: present
Pattern gleason 4: 6-10%
Prostate volume total afeccted: 6-10%
Low tumor volume
Positive left apical surgical margin (4 mm + 1.2 mm)
Gleason pattern at the margin: pattern 3
The pathology report specifically states twice:
“Extraprostatic extension: not identified”
“Positive margin associated with extraprostatic extension: not identified”
Intraoperative Histolog Scan was negative.
First postoperative PSA: 0.22 ng/mL.
My main concern right now is whether this is more suggestive of microscopic local residual disease (due to the apical margin) or if occult lymph node involvement is still possible despite the otherwise relatively favorable pathology.
Has anyone had a similar case (pT2 + apical positive margin + low persistent PSA) and can share their experience regarding outcome and response to early salvage radiation therapy?
Hello Henry1972
Like David2017 above I was waiting with someone with specific experience to pop along with a reply.
Yes there's evidence of spread at the margins and the PNI (perineural invasion - where the cancer gets into the nerves) isn't always good news but what makes you think it's in your lymph nodes?
I am sure your team will be checking this and if there's any evidence I am sure the Radiotherapy will be directed not only at the Prostate Bed but the Pelvic lymph nodes too.
I hope the above helps.
Kind regards - Brian.
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