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Positive Margin - what should I expect in future?

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Posted 12/22/2011 10:41 PM (GMT 0)
Hello,

I received my Surgical Pathology report today from my doctor. Here is the part of the report:

GS 3+4 (raised from 3+3)

Tumor size: 35% of prostate

T2C pNx pMx, lymph node and distant metastatis cannot be assessed.

Margins: Can be assessed, Multifocal, Microscopic, <1mm

Perineural Invasion present

Venous and Lymphatic Invasion absent.

Does this report mean the cancer has penetrated the capsule or not? Doctor said positive margin is very small and cancer cells on the edge should have been killed during the time of surgery. He expects undetectable PSA.

I am really feeling down today after getting the report. I was thinking that with GS 6 and PSA 5.8, I will be OK after the surgery. But it doesn't seem so.

What you guys think is ahead in my future? What should I be prepared for? If my PSA is undetectable, will I still need Radiation? Any knowledge of positive margin < 1mm and rising PSA? Please let me know.

 

Posted 12/22/2011 11:15 PM (GMT 0)

Yes,

My little brother had a positive margin.  It was slightly more involved than a "microscopic" margin but none the less it was a very small margin and it was only located in one spot.  His surgeon (same as mine) also gave the hopeful report that the cancer could have been eliminated during the surgery, but in full disclosure he admitted that this may not be the case. BTW the surgeon was just as concerned about all of this as my brother was.  After lot's of consideration and conversation between he and the surgeon he opted for the lets just monitor the PSA path.  He just got his latest PSA 21 months out and he is still pulling zeros.

Best of luck with your journey.

Hero

Posted 12/22/2011 11:47 PM (GMT 0)
I had three positive margins 13 months ago and my PSA is still undetectable. My doc wasn't any more concerned about it than yours was. There are a number of reasons why a positive margin may not amount to anything. Dr. Patrick Walsh explains it all very well in his book, which I highly recommend.

Just from all the anecdotal evidence I've seen on this board, it doesn't look like there's a lot of rhyme or reason to who has a recurrence. In a sense, we all live from one PSA test to the next, but I think it's far better not to let it control your psyche. The best thing is to enjoy your holiday, live your life and put cancer out of your mind until it becomes something you have to deal with again. That day may never come.
Posted 12/23/2011 12:00 AM (GMT 0)
Thanks Zazz and Hero.

I am still not clear on this - does positive surgical margin means capsular penetration or not?

Regards.

Posted 12/23/2011 12:17 AM (GMT 0)
Maybe someone better informed than me will chime in on this, but I think the answer is not necessarily.

I had three positive margins, but my pathology report said I had no extraprostatic extension. As I understand it, extraprostatic extension means the spreading of the cancer beyond the prostate gland.

This has always been a murky area to me too. Hope this helps.
Posted 12/23/2011 2:31 AM (GMT 0)
Actually you can have EPE and a Negative margin. What they they did was cut wide around away from prostate. It's not just hanging in free space there. They just did not cut wide enough. This is NOT an error, nor necessarily a " bad surgeon" It happens!
I was going to explain margins and all but gots to go. I will gently say this. You need to educate yourself other than thru forum , such as books, support groups, etc cause tho we are smart, we are layman, some with more knowledge than most Gp's, and a fair amount of urologist.s but......... Walshes book has great explanation of margins. the upgrade ain't that bad, betcha mostly 3's. Relax you are going thru what we all went thru. You will realise this as time goes on, we are just trying to give you a shortcut to that point. Enjoy this season of Joy and Hope, you deserve it, Logo
Posted 12/23/2011 3:30 AM (GMT 0)
I had multiple positive margins, and multiple EPEs (Extra-prostatic Extensions, aka Extra-Capsular Extensions).

At least in my case, they were clearly and precisely identified, separately. I knew from my surgeon's visit after surgery that he was suspicious of an area and took more tissue, but we still got positive margins. ("Seeing" a cancer cell doesn't happen until you apply a microscope, but if things are bad, they may see inconsistencies, I'm told.)

Logo's description coincides with my experience.

Our pathologists make us victims of full disclosure. You'd not be surprised at how many guys report back here with questions.

Call the urologist and ask, just to calm the nerves, but I suspect that they would identify EPE if they found it. We are not qualified to read between the lines.

My gut feel is that if the surgeon were concerned, he would be talking about adjuvant radiation already.

Enjoy the holidays. Really.

Posted 12/23/2011 2:13 PM (GMT 0)
Thanks 142. Surgeon seems to be confident and said "You will get 0 PSA. Margin is like a dot  .. <1 mm, tumor will not survive the knife"

I feel much better after posting and reading on this forum about my + margin report. Thanks to all for your support.

Wish you all a very happy holodays!

Posted 12/23/2011 2:48 PM (GMT 0)
What is very important is the Gleason Score adjacent to the + margin.
I have a relative who is an MD and PhD, an Associate Professor of Oncology, Immunology and Urology at JH, and an associate of Epstein’s.
He told me last spring that according to a recent study at JH only 1 in 800 patients with Gleason 6 adjacent to the positive had recurrence.
I had my slides sent down to Johns Hopkins for verification that I was a Gleason 6 at my + margin.
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