Surgical Pathology Question

Some non-cancerous prostate tissue was left at the margin. Benign tumors are non-cancerous.

randallrrs,

I'm not a pathologist, just a guy who has read a bit about it, but here's what I see and would ask my surgeon about...


Clinically, you had only one positive core and were Prognostic Grade Group II...favorable-intermediate risk case with 3+4 Gleason. Pathologically, there was a positive margin found (and a large one, at that) in the mid posterior, around where the super delicate neurovascular bundles "saving" took place, but you had "organ-confined" (pT2A) outcome.

It seems likely to me that this margin was an incision; an iatrogenic, or accidental, cutting into the prostate by the surgeon during the RP. (Capsular incision, or intraprostatic incision) It's not all that uncommon, but often (not always) reflects the skill and experience level of the surgeon...and as such, they sometimes don't even mention it directly to the patient as the true "surgical error" that it is (sometimes masking it in other fancy words). You would not be the first guy here to have this. Do you know how experienced with RPs your surgeon was?

In general, when this occurs, the exposed margin could have cut into either cancerous or benign tissue. I believe that if it cut into cancerous tissue, that would have been reported and may be the "Margins involved by tumor." Your biopsy did not show a lot of cancer (1/12) so all the more likely that it would have cut into benign tissue; furthermore, and I would see the fact that benign tissue was part of the report as the favorable thing that you are suspecting. The exposed margin could have had both.

But, I would ask my surgeon these two direct questions:
1) was the margin caused by the surgical incision?
2) was there cancer found at the margin? (based on what I said above, I don't think so, but I would definitely ask)

Post Edited (JackH) : 1/12/2017 1:26:54 PM (GMT-7)

I would understand you having a feeling of allegiance to him, but once a basic level of experience is attained (at 500 he has reached that, although quite a number of doctors have 10X that many), the continence and recovery has more to do with one's personal anatomy, luck second, and surgeon skill third.

pT2 with +(large) margin after clinically a single core of 3+4 has all the markings of an iatrogenic incision. It seems to me that the only remaining question is whether there was cancer at the ink in the incision. Ask for clarification.

Thanks, Tall Allen. Would this indicate that at the least, I have benign prostatic tissue that remains in me?

I would thing the word benign would cover a multitude of sins here...less it was benign positional vertigo...thats no fun tho it eventually does go away...I hope ypur concern will as well.