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Prostate Cancer Path. Report Confusing

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Posted 5/18/2009 7:43 PM (GMT 0)
New Member, best of luck to all:

Radical done 2/24/09 at Hopkins, tumor upgraded to t3a by pathologist, organ confined throughout, extraprostatic extension, positive margin, right, apex, posterior, focal. Psa post op was 0.4, biospy& post op gleason 6, my pc physcian suggested I stop worring about pc due to low psa even though my father had it, the gastro DR. caught it during colonoscopy. Seminal vessel ,negative,lymphphatic small vessel, lymph nodes all negative for tumor. Path report note says the apical margin for the speciman is focally positive. However all additional tissues taken from this area are negative, indicating that the true surgical margin is most likely negative. It appears there is a lot of well informed writers out there. Any comments or similar diagnosis info would be greatly appreciated.

Posted 5/19/2009 4:00 AM (GMT 0)
First and foremost, Welcome to HealingWell!! Sorry that you have to be here, but glad that you found us. I just have a couple of questions. First, when was your post op PSA taken? (6weeks, 12 weeks post op) What was your preop PSA? My father also had a focally positive margin, which by definition means touching the margin, but not going through right?!! However, my father also had a positive lymph node on the opposite side. Which I couldn't understand if there was only one focally positive margin, but then again, cancer doesn't seem to follow a flow chart if you ask me. My father's case is probably a worse case scenario and I don't want to scare you, because there are a number of people that had focally positive margins where the cancer was removed and their PSA remained undectable.
What did your dr recommend? I imagine retesting your PSA to see if there is a change?! Unfortunately, PC involves a lot of waiting. Typically, most dr's will look for at least two-three consecutive PSA rises before initiating another therapy, others might recommend radiation since your PSA is above .1 or .2. I would definitely get a couple of opinions from local top PC oncologists. Keep us posted!!
Posted 5/19/2009 6:55 PM (GMT 0)
I won't pretend to diagnose you but you might want to plug your numbers into the sloan-kettering nomograms. I think the results will be reasonably encouraging. The odds are that you no longer have prostate cancer.

Let's assume that the part about positive margins is offset by the part about additional tissues and call this in favor of negative margins

Extraprostatic extensions tend to be microscopic. They do not mean that the cancer has spread beyond the prostate but it would be nicer if they wern't there.

The Gleason of 6 is good. There seems to be a lot of difference between 6 and 7 so, no matter what, you likely have (or had) a less aggressive form of cancer.

You and your doctor now need to plan for continued monitoring of your PSA levels. Not to mention your return to a normal, active life.
Posted 5/19/2009 11:31 PM (GMT 0)
Ideally, the three month PSA after RP should fall to almost zero. My PSA went from .02 to .09 and then at .15 months out. I am now beginning salvage radiation. Most radiation doc's prefer to do this for patients with positive margins, as you can see in my signature, as soon as a patient is continent. I would definitely seek a second opinion. Your best chance for a cure if you have a probable recurrence is now. I'm sure several guys who were in the same boat will respond. Just a thought.
Posted 5/19/2009 11:42 PM (GMT 0)
I reposted this to correct my latest PSA.
Ideally, the three month PSA after RP should fall to almost zero. My PSA went from .02 to .09 and then .18 at 15 months out. I am now beginning salvage radiation. Most radiation doc's prefer to do this for patients with positive margins, as you can see in my signature, as soon as a patient is continent. I would definitely seek a second opinion. Your best chance for a cure if you have a probable recurrence is now. I'm sure several guys who were in the same boat will respond. Just a thought.
Posted 5/20/2009 1:13 AM (GMT 0)
Thanks for the welcome & replies: sorry, but I made a serious typo error. My pre op psa was 0.4 in 2008 and was never higher than 0.6 in the last six years. I had my first post op psa blood work today, 12 wks after the surgery, results fortcoming. The doc said today that he is confident that my 10 yr disease free survival chances are reasonably good, maybe 90/95% but as we all know cancer is what it is. No guarantees
Age 66
Not fully continent yet, 1 pad just a drip here & there
No follow up therapies recommended as yet
Doting Daughter, I will also pray for your Dad
Hard to believe how many friends & aquaintances have gone through this in the last 18 months, my dentist told me this past monday he had his removed in December at Sloan with good results. Another friend retired on Feb 28 of this year and received his pc cancer diagnosis the same day.
Thanks, Geezer for the encouraging words, my Doc did say the extension was like a small dot that was taken out.
I feel more positive and hopefull just with these few exchanges from people who are in the fight or have friends and family going through this. It is very meaningfull to here from all of you. Thanks again
Posted 5/20/2009 2:02 AM (GMT 0)
Phewwww!!! Major typo, but fantastic news!!! I would hope for the best, which you have every reason to believe will happen and keep us posted on your healing and post op PSA! Nothing but zeroes!!!!
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