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Tumor location--is one spot worse than another?

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Posted 2/10/2010 5:41 AM (GMT 0)

Just curious: is one location any worse than another?

What about for a positive margin?

Mel

Posted 2/10/2010 8:13 AM (GMT 0)
Good question. I don't know the answer. I have read recently that a positive margin does not automatically mean anything, and SRT should be determined by PSA levels in the future. Others here may have more information on this. Don't look at this margin as a certain indication for anything other than watching the PSA. What did your doctor say about it?
Posted 2/10/2010 10:36 AM (GMT 0)
I don't think the location of a positive margin can be as important as the fact that it is there.

Seminal Vesicle Invasion (which I had) is for example seen as worse as it indicates that the cancerous cells have been able to establish themselves outside the prostate.

Alf
Posted 2/10/2010 2:18 PM (GMT 0)
It appears that apical margins and tumors are worse than one that is in the middle of the prostate. A margin alonside the nerves is also bad because the cells can get into the nervous and lymph systems and have a pathway to other parts of the body.
Posted 2/10/2010 2:32 PM (GMT 0)
My Guess: Tumors on the Outside are worse then the ones on the Inside.

but - then you have to factor in "when detected" /size etc.....

As usual - there probably isn't a one size fits all answer.

Posted 2/10/2010 2:42 PM (GMT 0)
Found on www.pubmed.com, a paper titled: "Zonal location of prostate cancer: significance for disease-free survival after radical prostatectomy?"

http://www.ncbi.nlm.nih.gov/pubmed/12837427

I suspect that with the right search words, you could find additional reports on pubmed. I stopped looking when I found this concluding statement which appears to directly answer your question: "The location of prostate cancer in the TZ was associated with a greater overall biochemical cure rate after radical prostatectomy." (TZ is the Transitional Zone)
Posted 2/10/2010 2:50 PM (GMT 0)
OK, I found another one on pubmed that you'd be interested in, Mel.

This one says in the conclusion, "Although longer followup and validation studies are necessary for confirmation, patients with a positive margin less than 1 mm appear to have similar recurrence rates as those with negative margins." (Yours, I've noted, was 0.5mm.)

The paper link is here: http://www.ncbi.nlm.nih.gov/pubmed/19450829?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=1

You might want to do your own pubmed search...probably better technical info than from a chat room environment on the internet. To find the paper above, I used these search terms: "prostate cancer" location "positive margin"

It looked to me that there were other papers with relevant info...the quote I extracted was from the very first paper that popped up. I didn't look further.
Posted 2/10/2010 3:52 PM (GMT 0)
Tumor location only has value prior to surgery. The surgeon wants to know where it is at in order to make a wide as possible margin around the tumor growth in an effort to remove the cancer. Sometimes the location near the apex and the base can be a bit tricky, so the surgeon needs to know to avoid any surprises.

Tumor location after surgery generally is meaningless for prognostic value.

As others have already stated, the positive margin in your case is very small and should be viewed in the same light as a negative margin at this point.
Posted 2/10/2010 5:06 PM (GMT 0)
When I interviewed surgeons before my surgery, a common theme they discussed was that a minimal protrusion beyond the margin was regarded as basically contained from a future prognosis point of view. Yours sounds like the equivalent of contained if I had to guess. The good news which you get from surgery is that you know exactly where the tumor was located and your future psa blood tests will tell the rest of your story.
Posted 2/10/2010 5:21 PM (GMT 0)
Les is right on, but I would expand it futher to the fact that tumor location is importantant in eliminating surgery as the best option.
If a tumor is in the peripheral zone and shows extra capsular extension, surgery may not be the best option.
Also transition zone tumors have a very high probability of being contained, but are problamatic for surgeons.
Tumors next to the seminal vesciles are also problematic.
I also understand that tumors in the Apex have a high degree of positive margins.
Dr Bahn considers tumor location one of the most important elements in clinical staging and in many cases will dictate the treatment option.
JT
Posted 2/10/2010 5:37 PM (GMT 0)
John & Les, you guys are both correct regarding knowledge of tumor location going into surgery...but Mel has already had surgery, and so I interperted his question to be having to do with the implications of tumor location after surgery.

With regard to the paper I referenced above ("Zonal location of prostate cancer: significance for disease-free survival after radical prostatectomy?"), I agree with Les's comments that location was not determined to be a statistical independent variable (in predicting BCR). Rather, the independent variables for BCR reported here were lymph node involvement and Gleason score. One would say that it "just happened to turn out" that most tumors were located in the TZ when there was BCR.

The follow-up comment & report on size of margin is the more important factor on BCR.

Post Edited (Casey59) : 2/10/2010 10:46:14 AM (GMT-7)

Posted 2/10/2010 11:51 PM (GMT 0)
Mel, mine was right at the edge but did not escape. My guys exact words were " I dont think further treatment will be necessary" Don`t get freaked out brother, Tim
Posted 2/11/2010 12:09 AM (GMT 0)
Tim,

One thing I think we have to learn in this game ( or at least I have ), is that doctors sometimes say the darndest things. Fact of the matter, there is a lot they don't know. That is why we politely say thanks, and then examine the pathology, the surgical report, the follow up PSA's and any other thing we can to insure that they indeed did get it all, or if they didn't, what our next step is.

I hear too many times on this forum where the doctor said this or that , and he/she was wrong, misinformed, or confusing us with one of his other 20 patients of the week. We must insist on 3 month followup PSA's, (ultrasenisitive in my opinion), and be ready to act when we start to signs of reoccurence.
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