POSITIVE MARGIN OR ARTIFACT

Almost a week after OMR created this thread inquiring about Capsular Incision (CI), this interesting note was posted at The "New" Prostate Cancer InfoLink site about a related topic...copied/pasted here:

 

So here is an interesting tale of a clinical development that could, perhaps, be truly revolutionary for surgeons … if the actual implementation is as good as the early results.

According to a story on the Medscape web site, a research team working in England and Hungary has developed an “intelligent” electrosurgical scalpel (which they have dubbed the “iKnife”) that integrates electrosurgery with a form of mass spectrometry to be able to carry out very rapid analysis of the precise type of tissue that the knife is cutting through. (Click here for the abstract of the original paper by Balog et al. in Science Translational Medicine.)

Let us be clear that, as yet, this technology has only been used on about 90 patients, as far as we can tell from the available information, and there is no specific statement that it has been used yet in the surgical treatment of prostate cancer. However, it will be interesting to see if this technology does come to market in the next few years.

Certainly the theoretical potential is considerable, and the system developed really does seem to be able to discriminate between cancerous and non-cancerous tissues with a very high degree of accuracy. Furthermore, such a system would certainly allow a skilled urologist to be able to minimize the need to remove non-cancerous tissue within and around the prostate and to maximize the probability of removing cancerous tissue without leaving positive surgical margins.

I think the integrated technologies discussed here is fascinating, but it's also going to make an already costly operation even more expensive...raising the importance that urologists/surgeons screen out the men with favorable risk PC for active surveillance programs so as to reduce the economic burden of unnecessary surgeries.

questionaboutit said...
my pathology report said focally positive. my surgeon wrote beside it "artifact??". I asked him to explain it and he said that the samples are so thin they sometime get distorted during handling and making slides and the cancerous area can appear to be on the margin when it actually was not. not explaining it as well as he did.

Yes Walsh discusses this phenomenon in his book. I was told by a RALP surgeon that it may occur more commonly for RALP due to the specimen being dropped in a bag and squeezed out through a small hole.

OMR Get another doctor period. Im sorry, but here I go again. Are you more afraid to confront your doctor or are you more afraid to get zapped and suffer unnecessary S/E. You do not Have a recurrence, you do not have a trend for recurrence. you have a psa that every member here whose psa is higher would live for. Good Grief, Charlie Brown, I would draw you a picture, but no can.

Earlier I wrote… Casey59 said... One more remote question:  Does this urology practice also have their own radiation clinic (owned by the same practice)?  Just a remote possibility, but these have been rapidly sprouting up across the country and have been under INTENSE ethical scrutiny for self-referrals.  Just a remote possibility to be aware of.  (May be difficult for a layperson to identify business entity ownership...may be different practice names & different locations.) Several others suggested (putting it mildly) that you might want to seek another opinion. Then you wrote… OMR said... Yes this practice has it's own radiation clinic makes you wonder if there is a motive behind all of this ! Thanks for adding that.  I think that this thread can be an incredibly valuable lesson for many... This just goes to show…[And here’s all my caveats—I think that doctors are generally compassionate and caring, good people.   I have several friends & relatives who are doctors; my next door neighbor is a surgeon.  I’m also definitely not a conspiracy theorist believing that evil doctors are out to get us    Also, OMR, you have not asked the doctor to clarify this apparent inconsistency.   There are probably a few more appropriate caveats to keep this comment from going off the rails…]   BUT , medicine is a business, and some of their decisions/recommendations can sometimes be about , or be influenced by revenue generation…  While it is not necessary for one to be overly consumed with this realization...to ignore it, or believe it just doesn't happen at all, is simply naïve. BTW, OMR, I think that the basis — in the opinion of this PC-savvy layperson — of your decision to wait and see is very sound...but of course you realize I'm no doctor, nor do I play one...    

Do you think it's because of my positive margins that he is being aggressive in his approach to treatment ?

You said...
My next psa test is in september and if he is still talking secondary treatment with radiation once those results come back in the low and stable range then I will definitely find another urologist !

A quibble: Nothing we say on this site rises to the level of medical advice. We have a lot of smart guys here but all we know about your case is what you tell us and there could easily be things your doctor knows that we don't. What you want to do first is get a second opinion from a different doctor who has access to all your records. If you find a doctor whose story makes more sense to you then switch if you want to. But you are going to need a doctor of some sort. Don't burn your bridges before you have somewhere else to go.

I don’t have medical advice, only information…and I agree with Peter's comment... As I previously mentioned, for many years (unfortunately) you will want to keep your pathological features in mind, and keep track of which factors you have working in your favor, and which are working against your odds knowing that you had positive surgical margins (PSMs)…these are the factors which make it more or less than a “toss-up” (in other words, not just a "toss-up"). ·          With PSMs, the higher your Gleason score, the higher the risk of biochemical recurrence (BCR) ·          Extraprostatic extension (and the degree of EPE) and seminal vesicle invasion are both predictors for BCR ·          The size of PSM or extra capsular extension (focal-small, or extensive-large) is a factor