Shocked at Post Op Pathology Report

Small size/focal and low grade at the margin are mitigating factors.

I had one small, one millimetre, surgical margin. I have since seen one scientific paper which found no difference in outcome for a single very small positive margin versus no margin at all. (Of course next week another paper may come out saying the opposite). But it seems to be agreed that lots of positive margins or a large positive margin is less desirable than no positive margin at all. So, you could ask for more details about the magnitude of the positive margins. That said, no one is ever completely out of the woods. A few people with negligible cancer suffer recurrence. Others in which cancer had spread to lymph nodes and seminal vesicles never see recurrence. It seems to be an issue of the probabilities of recurrence increasing with greater spread. But nothing seems to be 100% in either direction.

If you really want to get a better handle on your status, in a few months have an ultrasensitive PSA test done. It seems that recurrence is very rare if that number comes out below 0.003. Some studies have found that below 0.05 has a large proportion of benign prognoses. Mine was 0.009, which seems to be associated with a 15% risk of recurrence within five years. But again, different studies done on different groups of patients come out with differing results.

Obviously, the less the cancer seems to have spread the better the outlook. And bear in mind the following: After PSA rises again above 0.2 (if it ever does) on average it takes 8 to 10 years before metastasis can be detected in bone. And after that, people live on average about five more years. This is why, while 60% of men in their 70s HAVE prostate cancer - although the vast majority never know about it - only ~3% of men die from it, simply because, at that age, they die from something else first. It is MUCH MUCH better to have prostate cancer than almost any other type of cancer.

Hope this helps clarify a bit.

"In addition, note in the table further down that page, that while it is estmated that in 2017 161,360 people will be diagnosed with the disease, 26,730 will die from it. Think about what this means: only 16.6% of people who are diagnosed with it will die from it."

I know I'm a little late coming to this thread, but I wanted to put a more positive spin on the above. Mortality rates per 1,000 are dropping for prostate cancer. It is being diagnosed earlier, and treatment is getting better. Most of the 26,730 dying from PC this year were diagnosed 5, 10, or 15 years ago, if not more. The percentage of the 161,360 diagnosed this year who die from PC will be much lower.

PC is so slow (even high grade PC), and treatment is evolving so fast, that the studies and statistics cannot keep up with developments. Just remember, no matter what statistic you are looking at, things are better now.

Weightloss- I think you are right. The normal MRI is T1 or T2 which, as you say would account for only the first statement. They are often done with and without contrast. But "restricted diffusion" is probably from a DWI. You are right that MRS is seldom done as part of mpMRIs. The lesson is that even the best mpMRIs will sometimes have false negatives for high grade cancer, and that TRUS biopsies often miss significant cancer. IMHO, AS candidates should always have a confirmatory biopsy within a year of the first biopsy, template mapping if they can get it, before "officially" being on AS. mpMRI alone without a biopsy is not reliable enough to confirm candidacy.

What I was referring to when I wrote "Small size/focal and low grade at the margin are mitigating factors." was in direct response to the OPs question: "Does anyone know whether there are mitigating factors for positive margins?" The comment had nothing to do with the tumor size.

Hi AZ Guy:

Your case seems very similar to mine, just age is different. I suggest an ultrasensitive PSA test periodically. My recent result - nine months after surgery - came in at 0.009. That is a little ambiguous as I still have not been able to determine if that means "undetectable" meaning less than 0.01 (which is how some test assays work), or if it means "the test measures below 0.009 and yours was calculated to be 0.009, specifically." If/when I get a response to my inquiries I will post, jftr.

BillyBob, yes I changed labs. I moved from east-central Illinois, where my PSA's were done at the Uro's office, to the Philly area, where I'm going with Labcorp.

AZGuy, keep on hangin on, brother. How's the rest of recovery going?

Got my first PSA test post-RP yesterday. At nine weeks out it is 0.4.

So spent the better part of the evening feeling sorry for myself. It was hard to tell the wife but with the positive margins its not the biggest surprise in the world. I have an appointment scheduled with Mayo Clinic RO for Wednesday next week. Appointment with my surgeon is scheduled for the end of this month but I suppose its time to say goodbye to him. My recovery has been excellent as I have no ED and seem to have my continence back (just seems like the bladder volume is less than before). At Mayo Clinic we'll go through my case and I've seen a great list of questions on this site to ask about. I think I'm good to go with SRT as soon as it makes sense. Looks like the battle continues....

Sorry about that news, but as you said it wasn't necessarily surprising. The good news is that SRT should have an excellent chance of killing off any stray cells in the area. And anecdotally, there's been several stories here of SRT guys that have sailed through it. I'm sure if you post about getting ready for that, they'll give you lots of good feedback.

And great news on the ED and continence front!

AZ, are you sure that wasn't .04, rather than .4?
Even with the positive margin, .4 seems like an unlikely post op number considering your Gleason go (3+4) and a pre-op PSA of only 6.6.

You're right Gary, thanks for correcting me.

Still, as Andrew stated, a confirmatory retest is in order. I got a result of 3.8 at 9 months, turned out to be an error and retest was <.02.

Not trying to give you false hope AZ, but wait for the retest.

Actually, I decided, I've done so in the past, also ran a 5k to honor Movember, with my daughter.
But this year, I've been growing my hair out (back to my "yout(h)", and it might look pretty unprofessional with a fuzzy stache. Normally I wouldn't care, but I've got a ton of client appointments in the next few weeks, that I need to get done in advance of heading down your way for the winter.

I haven't shaved yet this month, so I'll see what it looks like on Monday, maybe I'll trim it , if it looks ok, I'll go for it.

Pratoman said...
AZ, are you sure that wasn't .04, rather than .4?

I think you are right. AZ should ask for a printed lab report to verify the PSA value.

The surgeon apparently did a nerve-sparing operation and so there is some benign tissue left which will cause a detectable PSA value. A value of 0.04 is no need to worry.

George