doctor greeting patient

Image by Vic (CC by 2.0)

Yes, I had prostate cancer and, yes, I chose surgery to treat it. You may choose another form of therapy for your case, but there is one thing I found quite interesting about the surgical choice.

After prostate surgery, you learn your WHOLE cancer story. How much prostate cancer did I actually have (volume)? How widespread was it (staging)? How aggressive was it (grading)? Did the cancer leak out of the prostate gland and possibly spread or was it “organ confined?”

These are questions that can only be answered fully after the entire gland is removed during surgery and examined under a microscope in a lab. There the pathologist can analyze your entire prostate gland including other nearby tissue like seminal vesicles and/or lymph nodes. The pathologist will weigh them, measure them, slice them up, and examine the length and breadth of the tissue under a microscope to give you the whole story – that is, a post surgical biopsy report that details the true nature, grading, staging and extent of your disease.

Why is that important? To me, it gives you and your doctor much better information for deciding what additional treatment you may need, if any.  And it gives both of you this information early on, when it’s probably most effective.

How accurate was my initial “clinical” biopsy taken in the doctor’s office? Now that I have had surgery and received the final story with my post operative “pathological” biopsy report, I can compare the two.

Did I make the right choice?  Or did I jump the gun and remove the gland too early when I shouldn’t have? Did I make a mistake? Should I have waited?

To answer those questions, let’s take a look at what my PRE-surgical biopsy said and compare it to what my POST-surgical biopsy said, to see if they tell the same story.

These reports apply to me and my case only. All cases of prostate cancer are different.


Biopsy report prostate cancer before surgery


Above is an excerpt from my PRE-operative biopsy performed in the doctor’s office. The doctor removed 12 needle core samples, 6 from the right side of my prostate gland and six from the left. The results: only one of the cores (selected from the right side) showed any signs of prostate cancer. And of that one core, only about 5% contained cancerous cells.

The Gleason score, a measure of prostate cancer’s “aggressiveness,” was a middle-of-the-road 6 (3+3).

So let’s recap: before surgery, the doctor took 12 tissue samples from various locations around the gland, 6 from the right side or lobe and 6 from the left, and 5% of one of the samples showed signs of prostate cancer. The other 11 needle samples were all negative-benign-clear-no problem. The Gleason score of that one-positive sample was a moderate 6 (3+3).

To my way of thinking, this case sounds pretty mild and non threatening.   For various reasons, I chose to treat my disease with surgery – for me and for my case only.

After surgery …


Biopsy report prostate cancer after surgery


Ok, now let’s take a look at what the FINAL story was by reviewing my biopsy report after surgery, and after my whole gland was removed and examined thoroughly in a pathology lab.

Uh… different story here.

After my tissues were delivered to the lab, the pathologist inspected them, measured them, weighed them, and then proceeded to slice them up into sections. Each lobe (left and right) of the prostate was sliced into 17 sections.

Post Op Biopsy Results: on the right side (or lobe), 9 of the 17 samples contained prostate cancer (that’s over half the tissue) and in the left lobe, 3 of the 17 sections contained prostate cancer. Remember: cancer was detected only once on my right side before surgery, but was now detected on BOTH sides after surgery and in many more places.

My Gleason score, a measure of prostate cancer’s aggressiveness, stayed level at 6 (3+3), even though the pathologist did find a tertiary (third) pattern of Gleason Score 4.

After surgery, I was also able to learn that my margins were clear or negative for prostate cancer – a good sign. This means that as part of the final, post op biopsy, the pathologist was able to examine the cells on the outer edges or periphery of my prostate gland and found no cancer there.  This suggests that my case of prostate cancer was still confined within the organ and had not spread.

But most importantly, the staging (extent or advancement) of the disease, post op, was upgraded to a more serious level of pT2. That is the last stage before prostate cancer breaks out of the “capsule” and is no longer confined to the organ.

So in actuality, my case was much further along than one would have thought or predicted from my original, doctor’s office biopsy.

I emphasize that this is my case. Every case of prostate cancer is different.

I could certainly imagine a scenario where the final pathology report reveals the same or even less aggressive or lower staged cancer than originally thought. Any outcome from A to Z is possible – good, bad and everything in between.

Am I happy I chose surgery for my specific case? Absolutely – but that applies to me and my case only.