What will the future bring?

Hi Brad2513......welcome to HW. As others will say, sorry you had to be here, but you'll get a lot of support and info from the members. You're very early in the incontinence battle, and at 17 days post-op, your progress seems to be pretty good. I did some kegels before surgery, and some after, but mostly I let nature do its thing, and in 3 months I was completely dry 24/7. But everyone is different and it depends on many factors. As for your path report, your numbers are very similar to mine, but I didn't have any positive margins. Guys that have had such will no doubt begin to chime in......if your MD is suggesting a hold pattern, he probably wants to do so until after the first Post-op PSA check. If it's a statistical zero, he may then do another 3-month wait to see if there's a rise or not. Concentrate on what you can control which is walking at this point, eating well and resting. Keep posting to keep us posted--------P.S.-where did you have your suregery?

                    Arnie in DE

 

Statistically speaking, any margin less than 3mm does not significantly raise the chance of recurrence. Dr. Walsh in his book says that 40%+ of positive margins do not leave any cancer behind. So, wait and see may not be a bad idea.

Brad -

Welcome to the club. You are among friends here.

The positive margins you describe sound quite small - 0.8mm and 0.3mm. You nee to understand that what is seen on the glass slides is the best guage we have of what was going on in your body, but certainly does not tell the whole story and can sometimes be misleading. When a prostate is removed, it does not just shell out, billiard-ball smooth. It typically has to be bluntly dissected out or cut out, producing a much more ragged surface. The pathologist will often apply marking inks to the surface prior to doing the pathologic gross dissection. Then, under the microscope, if you see tumor cells with ink on them along the edge, it is presumed to represent a positive margin. But because the surface is ragged, some of those painted surfaces may actually represent redundant folds that were joined to each other in-vivo, meaning that they may not represent true margins at all. Seeing tumor there coulld represent a very close margin (less than 1mm), but possibly not be truly positive. On the other side of the ledger, consider that the sections the pathologist is looking at are typically 4 microns thick, and your prostate is maybe 5-7 cm from front to back. In order to sample ALL the margins, the patholgist would have to submit a minimum of 1,250 "whole mount" sections to see everything. This is never done - more typically, the patholgist may be looking at 30 - 60 sections, and you cannot report what you cannot see. So, you can have false negative margins due to sampling deficiency, and false positive margins due to ragged surface topography. That is why we all undergo testing for biochemical recurrence periodically after surgery.

Regards,

Doc

Doc, thanks for that great description of the path. report process and the details. If you don't mind, I'm gonna copy it for possible further use when the subject arises in the far future..

Brad, you've gotten a wide variety of the best advice you will find. Welcome, glad you found us, hate to see ya..

James -

No problem archiving the description of how the path exam is done. I see this all the time. More typically, it occurs in women who are undergoing lumpectomy for breast cancer. A few cancer cells are seen on a ragged inked surface, and have to be reported as a focally positive margin. So then the woman undergoes a second surgery to remove additional tissue from around the original lumpectomy cavity, and we never find residual cancer in that second specimen. I am always left wondering if this is because the first margin was not truly positive due to its topography, or it was truly positive but there is no way to sample the entire inner surface of the lumpectmy cavity in the re-excision specimen.

Doc

brad mny thanks for the post and doc and james tremendous thanks for the fine comments...on the eve of DaVinci I found this thread very reassuring and informative...I am thinking positive thoughts.....off to MSKCC in ayem for Dr Guillonneau to work his magic.

mbshine



AGE 62
DX 7/08
psa HAD GONE FROM 1.7 TO 4.3 IN THREE YEARS...DIGITAL AND ULTRA SOUND EXAM SHOWED NO ENLARGEMENT.
BIOPSY SHOWED 2 OF 12 CORES POSITIVE.
TWO TUMORS SHOWED GLEASON 4+3 AND 3+4
NO INDICATION OF ESCAPE FROM CAPSULE OR METASTASIS
STARTED CONSULTATIONS AT SLOAN KETTERING 8/09
DR GUILLONNEAU SAID NO SURGERY UNLESS MASSIVE WEIGHT LOSS.
AT DX 333 LBS, SLEEP APNEA, AND HIGH BP
BARIATRIC SURGERY RECOMMENDED.
LAP BAND SURGERY IN EL PASO, TX 1/23/09
10/1/09 276 LBS, TRIGLYC AND CHOL NORMAL, NO SIGNS OF SLEEP APNEA, ONE BP RX REMOVED AND OTHERS CUT DOSAGE IN HALF;

STARTED QUARTERLY ZOLODEX BY TAOS,NM UROLOGIST, WHO TRAINED AT MSKCC, INJECTIONS AND CASODEX 50MG DAILY 9/08

davinci scheduled 10/19/09