POSITIVE MARGIN OR ARTIFACT

I have questions about the meaning of these positive margins in particular . 1. APEX: Positive , focal , right side. What does focal mean with this margin ? 2. PERIPHERAL: Positive , right lateral toward apex in area of capsular incision. What does capsular incision mean with this margin ? Could this positive margin be an artifact ?

I’m about 95% confident in this answer…I hope that this does more good than harm… Your second question first:   Capsular incision (CI) refers to the urologist transecting either benign or malignant prostatic tissue, where the edge of the prostate in this region is left within the patient.   In other words, the surgeon cut across the prostate itself during the procedure. Was it iatrogenic?   Certainly it was i nadvertent.   It happens...although more commonly in obese patients, or with inexperienced surgeons…all part of the learning curve.   The apex is the most common location for a  capsular incision because it is hardest to access.  Would you care to comment on either your BMI or your knowledge of your surgeon’s experience level performing RPs?   Perhaps it will difficult to get a clear picture of exactly what happened on the operating table at this point…although the surgeon will certainly have an answer for you when you ask him about it.  If tumor was transected, it appears that that could have an unfavorable impact on outcome (see THIS report); but if benign tissue only was at the margin, it seems that the outcomes are less clear…but probably not so much of an issue. I’m not sure what your question means, “Could this positive margin be an artifact?”     Your first question was what “focal” means.   A focal positive margin is a small area which “just touches the edge.”   The opposite of focal in this regard is “extensive” which covers a large area.       Post Edited (Casey59) : 7/16/2013 3:29:10 PM (GMT-6)

Great answers guys ! This probably explains my low but detectable psa ( .028 -.030 ) on the ultrasensitive psa test ! The capsular incision may have left a large or small amount of prostate tissue in me how much i don't know  hopefully it's benign ! I'm not as concerned about the focal margin as i am about the capsular incision !

Yes this is from my post surgery pathology report !

My p-stage is pT2c . So are you saying this was caused by the inexperience of the surgeon and not aggressive disease ?

Well im not obese 5'5 144 pounds pretty small guy ! Because of these adverse findings on my path report i now understand why the surgeon seems to be rushing me off to secondary treatment ( radiation ) eventhough my psa is low ( 0.028 - 0.030 ) and stable almost a year after surgery ! I still do not want to have secondary treatment until it's evident that im approaching BCR and i pray that is never !

I know you are not a doctor but since my psa is low and there is now evidence of increase do you think it's ok to put off secondary treatment until there is evidence of BCR ?

What's your PSA history?

As you said, I'm not a doctor...but I am a savvy PC layperson.  That reminder is important.

 

Note that 0.030 is also less than 0.05 (<0.05)...so this absolutely does not indicate any movement.  It simply indicates a change in the lower threshold of the test.

 

First thing is to triple check that you've got the decimal point in the right location...this is an error which happens more frequently that you might want to think.  You could call the surgeon's office and ask the nurse to read it to you if you don't already have it in writing yourself...make sure the nurse read it out two different ways to get it right.

 

Second, be aware that there is absolutely no such thing as "zero PSA."  The "zero PSA club" is a misnomer which sometimes causes undue anxiety amongst HW/PC members because their PSA is reported as something other than "<0.xxx", or "undetectable."  After surgery, and especially nerve sparing surgery, some tissue is left behind which can throw off measurable amounts of PSA. 

 

You have pT2c, an extremely low level of PSA one year after surgery (and no indication at this point of any increase).  I'm a bit flabergasted as to why your surgeon is talking about secondary radiation despite your PSMs. 

 

 

 

OMR, I've been following your thread for some time now, and wanted to weigh in again.  Casey has been providing good information, I'll simply try to add to that.

First and foremost BE SURE that your decimal place is correct, meaning that your recent PSA results really were 0.028 and 0.030.  If that is correct, you do not have biochemical recurrence.  I too am not a doctor, but from everything I've read those PSA values at this point in your journey are not a concern.

To help out I found this table on the Harvard Medical School / Harvard Health Publications website:

Table 2: Guidelines for determining biochemical recurrence
Initial therapy	PSA threshold	Comments
Radical prostatectomy	0.2 ng/ml on at least two successive tests	Some physicians continue to use a higher threshold of 0.4 ng/ml or greater
Radiation therapy (external beam or brachytherapy)	Three successive elevations in PSA compared to nadir (low point), regardless of actual reading, according to the American Society for Therapeutic Radiology and Oncology	Many oncologists use a working definition that biochemical recurrence has occurred if PSA levels are greater than 1–2 ng/ml 12 to 18 months following initial treatment. Ideally, post-treatment PSA levels should be less than 0.5 ng/ml, but this is rare; levels of 0.6–1.4 ng/ml may occur.
Neoadjuvant hormone therapy and radiation therapy	Unknown

Here's the link to that page:  http://www.harvardprostateknowledge.org/how-to-handle-a-relapse-after-treatment-for-prostate-cancer

Hope this helps. . . .

 

Again the decimals are in the correct place , I have copies of the results and have talked to the surgeon about the results . It makes me feel as if he know he hasn't done something right to want and rush me into secondary treatment this soon when there is no evidence AT ALL of any increase ! I hate to think that way but it's just the way i feel !

Probably because of the simple fact that I don't personally know you OMR, I have to say that I'm having a hard time understanding your concerns here - at least based on the facts of your PSA results. The numbers are what they are, and we've given you a ton of information that supports your PSA readings are not evidence of BCR.

At this point the only other thing I would suggest is that you find a new urologist and get another opinion from the medical world - to add what we have tried to support you with.

@ Yooper , I already knew and understand the numbers when it comes to BCR and trust me i really appreciate all of you guys reminding me , it's just that i wanted to get another point of view as to why the surgeon would be talking secondary treatment now when clearly 0.028 eventhough detectable and 0.030 are both less than 0.05 NO EVIDENCE OF INCREASE AT ALL !Am I missing something ?