OK, Now I'm Worried

First of all, be thankful you elected surgery. It is still my primo argument for the benefits of surgery. Now you know what it is.

We have many guys on here who had positive margins and have had no problems. We have many guys who have had negative margins, and have had problems.

Of course, it is a potential for the PC to get out of the capsule and will merit a watchful eye. Depending on who you talk to, and what their specialty is, I would say many will recommend adjuvant radiation. Others will recommend a wait and see approach.

It is my personal opinion that first you need to get healed up and get your continence and ED under control.

Jonathon, we have seen worse pathology, and we have seen better. I would begin to research it, set up consults with an oncologist, and a radiation oncologist. Certainly Cleveland has many very good specialists. I don't think you need to act next week, but with the three open margins, you will need to consider some type of adjuvant treatment, or wait until PSA rises and then under go salvavge therapy.

You certainly are in a good place to ask questions here.

How were you given your pathology results, Jazzman?  I hope they didn't just hand the report to you and send you on your way.  I don't know enough to say anything intelligent about your results, but I hope you have a doctor who will take the time to explain everything in detail.   Wish you all the best.

Thanks for the information, commiseration and reassurances.

Clocknut: The Cleveland Clinic has an online resource called MyChart. It allows you to access your test results, among other things. I got an email saying I had new test results. I had asked my doc to release the report to MyChart, but he said he wouldn't because I might misinterpret it and be overconcerned or underconcerned. I didn't think he was going to release it, so it may have been some sort of snafu. I'll see him Thursday to get the catheter out, so I'm sure I'll hear his opinion then. Thanks for the good wishes.

142: That's very helpful; thank you. If T2 means there's no detectable spread through the capsule, what's it mean to have a positive margin? That point has confused me from the beginning. Are they saying there's cancer at the edge of the organ, but they have no evidence it's gone beyond the capsule? To answer your question, they did not take any lymph nodes. It was an open surgery and perhaps my doc felt that his tactile examination was sufficient.

Goodlife: You're the coolest, man. Thanks for the reassurance. You've been a huge help to me from the beginning. My initial, somewhat freaked out, impression is that you're right. Unless they insist I begin immediate therapy, I'd like to heal up, take a deep breath and see what the PSA scores look like.

And I agree; this is a great place to ask questions. People here are the coolest.

"Gleason 3+4=7 (up from 6)
% of 4 and/or 5: 5%
% of 3: 95%"

This is good news...the cancer that graded 4 & 5 only made up 5% of the total..95% of the cancer was 3, (Gleason 6)

Your next big moment comes in 6 or 8 weeks when you get the first post-op PSA results..If it drops to undetectable, they may not push to hard for adjunct radiation..There is a lot of controversy on this point..Some doctors are content to wait for a detectable PSA while others others push for adjunct radiation just as a matter of principal with positive margins..

You can move from the front half of Walsh's book to the back half with frightening speed..

Jazz,

Here is the next line:

T2c: the tumor is in both lobes
T3:  the tumor has spread through the prostatic capsule (if only partially, it is still T2)

Now, I can't say what that qualification means. I am a T3, so it wasn't in scope for me. I had full blown EPE in multiple spots.

The problem with positive margins, as Walsh says in the book, is that you don't know if the cell they found on the margin was the last one cut in half, so dead, or if there were more. The optimist says it is half of the last one.

I'm with you on the failure to prepare. I had two biopsies totalling 25 cores, two of which were Gleason 6 with less than 5% in each core positive. I was told by the best of the best, "take your time." And I did. 4 months later, I had the surgery, Dr. Menon did the Super Duper VIP, and I was up and walking in 4 hours. Things were really great and optimistic until I got the pathology (that was delivered by a PA) That day was the worst in my life, but now, with some help (yes counseling), I understand that we can't control what we can't and am trying to move on. It takes time and I'm not there yet, but as each day passes and things feel normal (no leakage post op but ED), we understand and reflect on what's important and what's not. This forum is great, but you have to keep it tightly boxed and dedicate a set amount of time to read and reflect. If you subsume yourself on this forum or in the research, you'll kill yourself way before the Pca does. Don't take me wrong, this is a great place with lots of good information, but once you're fairly certain you have what you need to make decisions, step back, do what you think is best, and enjoy what life is all about. This is what I'm learning now. You have legitimate questions to ask and future PSAs to worry about, but it's in G-d's hands to some extent but I know you'll do everything you can to improve your chances of cure. I believe in the diet, I believe in the exercise (despite a lazy past), and I believe in faith. If you consume yourself with the disease, you won't enjoy life's pleasures and will just be waiting for more bad news. Let the news come to you, don't bring it to yourself before it's time. This biopsy versus pathology discrepency is something maybe one day science will help us to solve. Don't second guess like I did on the delay in deciding what treatment to undergo. You are here and that's telling about how you went about deciding on a doctor, diagnosis, and treatment. We are all here to help. Things always have a way of working out.

My path report was similar to yours. My uro discouraged me from any further treatment. The best that I can determine is that with positive margins you have about a 60% chance of not having a reoccurrence. The Sloan Kettering nomogram is even more optimistic. With a GS of 3+4 and positive margins it shows only a 7 % chance in 10 years. With a lot of possible side effects from radiation, I am waiting for reoccurrence before I do anything and that is a good chance of never. Good luck to you.

Ricky2

Jazzman,

My pathology was pretty nasty. However, my post PSA has been undectable for 3 wk and 6 wk. Radiation oncologist wanted to start adjunct with two shots HT during radiation. Then told me he would feel comfortable waiting till PSA went up a notch. Say from .03 to .04. AJ47 has a good outlook.

Mr. Bill