Question about positive surgical margin

Hi JF-58 NO QUESTION IS BORING HERE.THE POSITIVE MARGIN MEANS THE TUMOR
PENETRATED OUT FROM THE PROSTATE.ONE POSITIVE MARGING IS NOT VERY SERIOUS
BUT IF YOU HAVE TWO OR MORE IT IS A CONCERN.
I AM SURE THE OTHER GUYS WILL SHARE MORE LIKE.GOOD LUCK.

Welcome, John, to HW, sorry you have a need to be here.

You got to remember, then when your surgeon did the surgery, he wasnt' following a dotted line or the ability to see where cancer cells were located. Even with a wide margin surgery on one or both sides, its possible and not even uncommon to have one or more positive margins. And even with a positive margin, its doesn't ever mean for sure you will have recurrance, often the remaining cancer cells at the cut so to speak, die off and don't cause a problem.

I had one positive margin, and unfortunatley had recurrance within 9 months, then went on to salvage radiation, and that has since failed to.  Certainly doesn't mean it will happen to you.

If you post a signature here, it will be easier for the rest of the gang to know what you are dealing with in your particular case.

Good luck, and the real test, will be when you start getting your post surgical PSA tests.

David in sc

John,
Positive margins in the Apex are very common. 51% of all positive margins occurr in the Apex. You may or may not have a clinical reoccurrance as sometimes cells die on their own. Especially if you have G6 as these types of cells have a difficult time matastizing to other areas. Best thing is to get psa tested every 3 months and react if it starts to consistantly rise.
JT

David, My prayers are with you, I've read quite a bit on this forum and you are always there for everyone else. I'll keep following your story for updates and just wish you all the best.

JT, thanks for your information. My post op Gleason is also a 6 so this does give me more hope. Appreciate it.

Thanks guys

Post Edited (runner48) : 5/13/2011 4:01:03 PM (GMT-6)

JF-58,
I had positive margins on the left side. Post-surgery pathogy report called it 'extraprostatic extension'. You should have a detailed pathology report which would have the specifics. Since the cancer made its way out, I'm undergoing adjuvant radiation therapy (calypso) to hopefully kill any remaining cancer cells. I have 12 treatments to go. After surgery, my PSA is <0.1 which is a good start. Good luck. <bobr>
__________________________
Age: 54
Routine Physical on 10-20-2010 DRE Normal
PSA 4.3, up from 0.6 5 years prior
PSA 0.6 on 10-25-2005
PSA 0.4 on 7-30-2004
PSA 0.5 on 5-9-2002
Followup with Urologist on 11/10/2010 after elevated PSA; DRE noted slight bump
November 30th, 2010 had prostate biopsy.
December 9th, 2010, Biopsy results 3 of 12 cores positive.
LLB: Gleason's 4+3=7, 11 MM Tumor Length/15MM Core Length (73%)
LLM: Gleason's 4+4=8, 12 MM Tumor Length/15MM Core Length (75%)
LM: 0.1 MM Tumor Length (1%)0.1 MM Tumor Length
RALP Surgery 12/27/2010 Released: 12/30/2010
Thunderbird Banner Hospital, Glendale, AZ
Post-Surgery Pathology: GS 4+5=9
Pathologic Staging: pT3a, N0, MX; location: Left Side; Volume: 10%
Margins: Left posterior inked margin focally involved
Extraprostatic Extension: Observed
Seminal vesicles: Not observed
Lymphatic/Vascular Invasion: Not observed
Catheter: Removed 15-days after surgery
Post-OP Followup on 1/11/2011; Catheter/Staples removed
Adjuvant IMRT 8 Weeks Post-OP.
Radiation Oncologist Initial Consultation on 1/18/2011
Arizona Prostate Cancer Center
Calypso Procedure on 2/17/2011; PSA <0.1; Bone Scan Clear
341 Testosterone
CT Simulation on 2/24/2011.
Calypso IMRT started on 3/8/2011 - 40 Treatments.

JF-58,
I had to wait 8 weeks after my surgery before I could start radiation. In your case, it sounds like you got a good gleason score going for you and chances are, the cancer would have a hard time living now that your prostate is gone. I feel in my case, even with a post-surg gleason 9, that its gone, but didn't want to chance it - so followup radiation was in the cards. My radiation oncologist even thought I could wait and see, but my chances were better to have adjuvant rather than salvage radiation.

You have some time to examine your options and probably a 6 week PSA. Aren't you glad you got that catheter (ball and chain) out? I had mine in for 15 days - worst part of the overall experience. I've gained most of my continence back (except when I go running). According to my uro, he said that adjuvant radiation is done within an 8 to 12 week post surgery period. Has that even been a discussion with your pathology? So far, I haven't had any major side effects (knock on wood). <bobr>

Adjuvant radiation means getting Radiation as soon as possible after prostectomy, due to disturbing post op pathology and prior to " official reccurence", even with a undetected psa. SRT salvage radiation therapy is done after " reccurence " indicative of a rising psa

logo and brampy.... thanks for the info about radiation. I guess I still don't understand the differences. Is there a difference between the two types in how much radiation you get with each? Also, once you have adjuvant can you get salvage radiation if things continue to show there is cancer present?

Also, what is the best timing for psa testing to begin post- op, and how often is it repeated? My doctor has scheduled my first post-op psa at almost 8 weeks (rather than what I told you previously). I thought it was supposed to be done 6 weeks post op....

Post Edited (runner48) : 5/13/2011 4:02:09 PM (GMT-6)

Thanks for all your helpful information. I guess I'll call the doctor's office Monday to doublecheck if that's what he wants. I'd just like to know at 6 weeks but if it doesn't make much difference I won't worry about it.

Good luck with your treatments..hope all goes well from this point on for you.

Post Edited (runner48) : 5/13/2011 4:02:55 PM (GMT-6)

JF-58,
Your Uro probably can bump up your appt. or you can get your PSA done prior to seeing him at your appt. You might want to visit the nomogram site/tool. It might give you a better feel for your odds:

http://www.mskcc.org/mskcc/html/10088.cfm

The more info you can research, the better off you will be when your options are presented to you. I also found that it was good to have someone (I had my wife) go with you just to take notes. It was helpful for me since I lost my train of thought (when my Uro 'slapped' me in the face with stuff so-to-speak).

JF-58,
When and shortly after my robotic surgery, I was so sure and overly confident that I would have been free of this ugly cancer. When I got my pathology results, I was surprised that I had positive margins...why? It was the same feeling I had when I got my biopsy results which I was not ready for also. It is like somebody slapping you in the face when you don't expect it. Much like you, I only had 10% cancer...so why did it decide to go out of the prostate instead of inbound. I can truly understand your trust factor...this crap is humbling. Good luck to you...and beat the crap out of it.

JF,

You may not get your old life back as you knew it, but it'll be pretty darn close. You'll adapt and have a new normal life.

Other than you having nerves removed, I had exactly the same pathology report you did and I chose to have adjuvant radiation when my PSA showed an ever so slight trend upward.

In my case I was continent for only a couple of weeks before starting radiation, so a few weeks in I had to bring out the pads again. Four years later I still have stress incontinence and wear one pad a day. The rad doctor told me that whatever my continence and erectile functions were before radiation that's what they would be like after and that's been an accurate prediction.

Hope1 - The prostate gland is "upside down", the base is on top abutting the bladder and the apex is on the bottom closer to the penis. The way it's been described to me is at the apex the prostate, soft tissue, and the urethra kind of blend in a little and the doctor is trying to save as much of the urethra and nerves as possible. Also the apex is deeper into our bodies and less accessible. I assume that's why there's a high percent of positive margins in that area.

Ken