After a robotic prostatectomy, the removed prostate is sent to the laboratory, where a pathologist examines it in detail. The results usually arrive a couple of weeks after surgery. The pathology report is one of the most important documents in your care, because it gives the most accurate picture of your cancer and guides what happens next.
Why the final report is more accurate
Before surgery, information about the cancer comes from biopsies, which sample only small parts of the prostate, and from scans. After surgery, the whole prostate can be examined. This means the final results may be slightly different from the biopsy results. This is expected and does not mean the biopsy was wrong; it simply sampled a smaller area.
Final Gleason score and Grade Group
The report gives the final Gleason score and Grade Group, based on the whole gland. In some men, the grade is the same as on biopsy. In others, it is higher or lower. Our guide to Gleason scores and Grade Groups explains what each grade means.
Pathological stage
The stage after surgery is written with a small "p", such as pT2 or pT3. It shows:
- pT2: the cancer is confined to the prostate.
- pT3a: the cancer has grown just through the outer layer of the prostate, known as extraprostatic extension.
- pT3b: the cancer has grown into the seminal vesicles.
Our guide to TNM staging explains these categories in more detail.
Surgical margins
The margin is the edge of the tissue that has been removed. The pathologist paints the outside of the prostate with ink and checks whether any cancer cells touch the inked surface.
- Negative margin: no cancer cells at the edge. This is the aim.
- Positive margin: cancer cells are present at the edge, suggesting some cells may remain in the body.
A positive margin does not necessarily mean the cancer will return. Many men with a small positive margin never have a recurrence. The significance depends on the length of the margin, the grade of cancer at the margin and PSA after surgery. Your team will usually monitor PSA closely and discuss whether radiotherapy is needed.
Our article on how MRI helps plan your prostatectomy explains how surgeons try to reduce the risk of positive margins.
Lymph nodes
If lymph nodes were removed, the report states how many were examined and whether any contained cancer. This is written as pN0, meaning no spread, or pN1, meaning cancer was found. Our guide to lymph node removal explains why nodes may be taken.
Other details
Your report may also mention:
- the size and weight of the prostate
- the amount of the prostate affected by cancer
- whether cancer was found in the nerves or blood vessels around the gland
- features such as cribriform pattern or intraductal cancer
What happens next
Your surgeon will go through the report with you, usually at your first follow-up appointment. Ask for a copy so you can read it again at home and refer to it in future. Together with your first PSA result, normally taken around six weeks after surgery, it guides your follow-up plan.
Most men with confined cancer and clear margins need only regular PSA tests. If the report shows higher-risk features, your multidisciplinary team may discuss:
- closer PSA monitoring
- early radiotherapy
- radiotherapy if PSA starts to rise
- hormone therapy in some cases
Questions to ask
- Was the cancer confined to the prostate?
- Were the margins clear?
- Did the lymph nodes contain cancer?
- Do I need any further treatment?
Prostate Cancer UK and NICE guidance on prostate cancer have more information on follow-up.
Professor Prokar Dasgupta reviews every pathology report in detail with his patients at The London Clinic. Please contact the clinic to arrange a consultation.