Talked to Doc, Initial Path

Ok, question ( I may be over thinking this). Surgical path has Bob staged at T2C that means both lobes. Since he has a positive margin doesn't that mean the cancer is "out" in nearby tissue and it was also grown into the urethra(but the part that runs through the prostate) shouldn't he be staged at a T3?

Hi Angel,

I agree with others that the G6 is GREAT news and, given that, there is no need to panic just due to the positive margin!

With that said, if it were me I might want an expert second reading (e.g. from Epstein @ Hopkins) of the biopsy -- especially if location of the PSM was close to the one biopsy core that came back 3+4=7. If the biopsy is downgraded, great, then I wouldn't worry too much about the PSM.

However if the biopsy remains 3+4=7 then I would probably want a second opinion on the entire surgical specimen and, in any event, even if the G6 is confirmed on that, I would be more wary about watching it closely and considering adjuvant or eventual salvage radiation options.

But none of this is an immediate concern. Right now Bob just needs to focus on post-op recovery and the unexpected great news of G6!

Here are several publications that should give you both substantial peace of mind:

www.ncbi.nlm.nih.gov/pubmed/23706588
www.ncbi.nlm.nih.gov/pubmed/18304619 (full text: www.ncbi.nlm.nih.gov/pmc/articles/PMC2603620/pdf/nihms59462.pdf )
www.ncbi.nlm.nih.gov/pubmed/22531173 (full text: www.sciencedirect.com/science/article/pii/S0302283813001267 )
www.ncbi.nlm.nih.gov/pubmed/23117005 (full text: www.thelancet.com/pdfs/journals/lanonc/PIIS1470-2045(12)70388-1.pdf )

Post Edited (njs) : 12/12/2014 11:32:33 AM (GMT-7)

You really should read walshes book it would give you so much comfort. His section on PSM is enlightening. The GS6 should tell you to, in no way be talked into any additional tx. I would wait for the standard definition of BCR of ,2 and three consecutive rises from there before considering other tx. To be honest I would go with MSK's definition of .4, pretty sure it is MSK that has end point. When a facility decides an end point, they have taken in all the contradicting studies including morbidity, with that endpoint, arguably. Njs advice is good on rechecks, not great,imo. A shade of overkill to me, but I can't see it hurting anything. Unless your path came from Podunk General in which case his advice is priceless.

Miki,
This is a great report -- really. You and your husband have cause to celebrate. As for Bob worrying about a death sentence, I can say for sure he's going to die of something one day but it is very unlikely to be from prostate cancer. FWIW I was Gleason 7 and T3b 12 years ago when I was 56. I'm now nearly 69 and doing fine.

Jim

@Andrew, that's why I come here, you always keep me in check. Yes I'm overreacting and thinking of what ifs. I'm a worrier. Your post made me smile. I need the reality check! @ logoslidat what page of Dr. Walsh's book is that on? I've scoured every page of that book and am not finding anything that is making me calm down. Every single one of you are right. I know it could be so much worse. It's just my nature or my OCD (and yes I am clinically diagnosed) to worry over things. I'm always the pessimist looking at the glass half empty. I love all of you guys! You are such a comfort to me and help me when I start getting panicky over this stuff!!!@Ashley did you ever get your breast looked at? I've been wondering how that is turning out.

Miki, you and I should go into business together. We could be soooooo successful packaging and selling half emoty glasses, OCD chemicals, and what of scenarios. We'd get rich in no time, if we could just find people who want to buy that stuff. ;-)

This is good Miki, I made you laugh and you made me laugh.
No decision yet. MRI next week, follow up appointment with surgeon same day, follow up appt with RO the week after (with MRI results). Self imposed decision deadline DECEMBER 24th.

I have no idea, Miki, I do not even have the book anymore. check those pages in the back, glossary maybe. Go alphabetically and find margins or positive margins. It should have it with all the different pages that the topic is on thru out the book. Well it takes a lot to calm you down, so did you find any pages that discussed positive margins. Nothing in PCA is going to jump out at you and say everything is going to be just fine. If you want to know a lot about Pca you must use what has been given you to find, read and study, deduce, speculate, ya know believe in yourself and your ability to solve the problems life presents to you. You are the final arbiter of your self., there can be no one else. Thats just the way things are. The following is not directed to you necessarily. It amazes, how folks who come here think they can find perfection. I remember training newbies in my pre retirement life , they always wanted , specific answers on all the what if's in the profession. I could train anyone to do the job unless they lacked the key to it all. The key was to accept the responsibility{ can I respond in and of myself to this situation right now,cause now is all I got, keeping the legal requirements of separation... whole} of the job. The ones that wash out, and there are many, could never get that concept in their being. No scold involved here, just sound advice. Have faith in your own ability. More than you asked, I suppose….

Miki, re Walsh's book, page 371 (and surrounding pages)

"There are several different reasons why when the margins are positive, the tumor may still be cured"

"He (Dr Epstein at Johns Hopkins) studied men whose tumors were particularly close - less than .2mm - to the surgical margin. Even though there wasn't a comfortable cushion of tissue between the tumor and the edge of the Prostate, those patients do just as well as if there's more separation between the tumor and the margin"

Oh, and here is a comment from Dr Epstein, pulled directly from an email that he sent to me in response to some questions I asked..........

" Even if not organ confined can still cure the vast majority of cases depending on the grade"
Ok, so it depends on the grade...ummmm I think you said Bobs final path was. .... G6? Isn't that the least aggressive grade? Hmmmm

Hope this helps