What is the treatment plan for a patient with prostatic adenocarcinoma (Prostate Cancer) with a Gleason score of 7, pT2 N0 classification, and perineural invasion, after a prostatectomy (Prostate Removal Surgery) with no lymph node involvement?

Understanding Your Pathology Report

Your pathology report shows favorable intermediate-risk prostate cancer (Gleason 3+4=7, pT2N0) that was completely removed with negative surgical margins, indicating you have an excellent prognosis and likely need only close PSA monitoring without immediate additional treatment. 1, 2

What the Pathology Results Mean

Cancer Characteristics

• Gleason Score 3+4=7: This indicates intermediate-risk disease where the cancer cells show moderate abnormality. The "3+4" pattern (rather than "4+3") is prognostically favorable, as patients with the primary pattern being grade 3 experience significantly lower rates of PSA recurrence. 3, 4

• Tumor Extent (12% of parenchyma): The cancer involves a relatively small volume of the prostate, which is a favorable prognostic indicator. 5

• pT2 N0 Classification: The "pT2" means the cancer was confined entirely within the prostate capsule with no extraprostatic extension. The "N0" confirms that all 7 examined lymph nodes (6 right pelvic + 1 left pelvic) were completely free of cancer. 5, 1

Critical Pathologic Features

• Surgical Margins: Negative - This is the most important finding. No cancer cells were seen at the edges of the removed tissue, meaning the surgery achieved complete removal. 5

• Extraprostatic Spread: Not identified - The cancer did not breach the prostate capsule. 5

• Lymphovascular Invasion: Not identified - No cancer cells were found in blood or lymphatic vessels. 5

• Perineural Invasion: Present - Cancer cells were found tracking along nerve sheaths. While this finding is associated with slightly higher risk of biochemical recurrence in organ-confined disease, it does not change your immediate management when margins are negative and disease is organ-confined. 5, 6

Your Treatment Plan Going Forward

Immediate Post-Operative Management

You should have PSA measurement at 2 months post-surgery to confirm it is undetectable (<0.1 ng/mL), which is the expected outcome after complete cancer removal. 5, 2

Surveillance Protocol

Follow this structured monitoring schedule: 2

• PSA testing every 3 months during year 1, then every 6 months through year 7, then annually thereafter
• First follow-up visit at 3 months should include PSA measurement, digital rectal examination, and assessment of urinary and sexual function recovery 5, 1
• Biochemical recurrence is defined as PSA ≥0.2 ng/mL on two consecutive measurements 2

When Additional Treatment Would Be Considered

Adjuvant radiation therapy is NOT routinely recommended for your favorable pathology (pT2, negative margins, Gleason 3+4). 1, 2

Additional treatment would only be considered if: 2

• PSA becomes detectable and rises on serial measurements (biochemical recurrence)
• Salvage radiation therapy works best when initiated at PSA <0.5 ng/mL
• The median time between PSA rise and metastases is 8 years, allowing ample time for intervention if needed 5

Prognostic Expectations

Short-Term Outcomes

• Your PSA should be undetectable (<0.1 ng/mL) within 2 months of surgery and remain so. 5, 2
• Recovery of urinary continence typically occurs over 3-12 months, with <5% of men requiring more than 2 pads daily at 1 year. 2

Long-Term Prognosis

With organ-confined disease (pT2), negative margins, and Gleason 3+4 pattern, your risk of biochemical recurrence is substantially lower than patients with Gleason 4+3 disease. 3 The presence of perineural invasion in organ-confined disease with negative margins does not significantly alter your excellent overall prognosis. 6

A minimum 15-year follow-up is necessary to fully evaluate treatment efficacy for localized prostate cancer, as the median delay between PSA rise and metastases is 8 years. 5

Critical Points to Remember

• The negative surgical margins are your most important favorable feature - this indicates complete cancer removal. 5
• Do not be alarmed by the perineural invasion finding - in the context of organ-confined disease with negative margins, this does not warrant immediate additional treatment. 5, 6
• Maintain strict PSA surveillance - early detection of biochemical recurrence (if it occurs) allows for highly effective salvage radiation therapy. 2
• The Gleason 3+4 pattern is significantly more favorable than 4+3 - studies show lower recurrence rates for your specific pattern. 3, 4