......From time of BCR

Pratoman said...
Thanks Allen. You make good points. With that said, Progressing also makes a valid point that there is a fine line between being our own advocates and not being anxious. More specifically, I think being our own advocate, by definition, does require some "preparing". When I say preparing I'm not meaning preparing mentally I'm referring to preparing by gathering knowledge.

It has been very interesting for me to note that while I am quite anxious about this whole thing generally speaking in New York, currently I am spending the winter in Florida, and I am much more relaxed about everything. And as a result while I do think about the possibility that my next PSA , which will be end March when I return to NY, will be a rise, leading to SRT, I don't obsess over it and I am not at all anxious about it. Or at least I don't feel anxious about it. Not sure why that is

I do continue to work on trying to be mindful of the present, not an easy task

It's amazing how this can work. When I left the hospital for the second time with a cath...(I'd been in there 5 days).....I had my friend take me to my boat....instead of my home. I had to be where I felt the most alive...where there was life....as I knew "me". Not as a sick guy....but....a guy who was sick. (big difference)

It's also why I'm looking for another boat. When I'm at my house... I tend to *think*. And thinking isn't good for yours truly. On a boat....it's not at the fore front of my mind. On a boat....things are put into perspective.

I'm sensing your acceptance. (smile)

NKinney said...

Pratoman said...
I had positive intraoperative margins AT THE APEX, and negative final margins after further resection.
Dr Zelefsky at MSKCC stated that my "negative margin, is questionable"

I agree with Dr Zelefsky. It seems that you described pT2+. This is not the first time I've heard of pT2+ being mislabeled as pT2...perhaps it is not as uncommon for hospital staff pathologists as it seems it should be (see example next paragraph). All of the "official" prostate pathology specimen examination documentation (from the College of American Pathologists; latest 2017, but also the 2009 and 2012 version which was the latest when your surgery took place) specifies this designation for an intraoperative, intraprostatic incision (iatrogenic; or the PSM created by an accidental slip of the knife) to include the "+" sign. The apex, btw, is the most common location (along with the "backside" or posterior) for a PSM caused by knife slip—the apex contains the least amount of capsule.

Here's a great example of what I'm talking about as far as "mislabeling." The American Joint Committee on Cancer published THIS Prostate Staging Form—it was obviously made for hospital pathologists to fill-in—and it doesn't even include the "+" designation anywhere on the sheet.

Jack & Diane said...
My husbands pathology is a pT2+ with his margin at the bladder neck. When PSA starts to increase can you help me understand how the intraprostatic incision is meaningful? I was hopeful after learning about that rihgt after surgery that that meant the cancer cells may die due to being cauterized, but it looks like maybe that's not the case since there's a rise in his PSA. Is that an accurate thought?

It is meaningful because the outcomes are not as good as if this hadn't occurred. pT2+ frequently gets compared to outcomes with EPE, but for the primary reason that tumors are typically significantly more extensive and with higher Gleason score in patients with EPE, those (EPE) outcomes are typically worse.

Nkinney, yes, after your original comment referencing pT2+, I googled and found many references to the term, as you describe it. Interesting that it was never discussed with me, I was panted a rosy picture, being told that my chances of recurring are "less than 5%"

I did ask my surgeon, if positive intraperative nargins respected to obtain negative FINAL margins are as good a result as just negative margins in terms of prognosis. And when pressed, he told me that it's not quite as good a prognosis, but it's a better prognosis than positive final margins. DUH....

In any case, it is what it is, and on some level, however obtuse, maybe it's a good thing because if I do continue to official BCR, it m9ght mean a better chance if successful SRT.

NKinney said...
island time, you oughta share your personal pT2+ experience with Pratoman and Jack & Diane (see their post from yesterday). Your doc did a little bit of "hide the weenie" (not immediately forthcoming with his perhaps embarrassing error) too, didn't he? I know you've also done some research on pT2+ outcomes...is my explanation to Jack & Diane (addressing "meaning") in-line with your experience/findings?

My surgeon stated flat out....."That margin does not alter your prognosis". Well....whatever. lol I don't care if he believes that and I don't care if he's lying (with good or bad intentions). I just don't trust that doctor.

the reason I don't talk about margins is because ... well....what's to say? It's not the path you wanted. But you play the hand you're dealt. Yeah...half my bookmarks on my computer have to do with PSM's.

But....I don't do well with studies. (that's where TA comes in). My thing is listening to people who know more than I know. There's something about studies that I do not trust....and I don't know exactly what that's about. It's almost as if....I let them become .... the end all, be all.....of a given subject. And I find myself...in the weeds...and lose a bigger picture that I need in order to make informed decisions.

So....what I do is....I listen to as many experts (of which I consider TA one to be)....as possible....let them do the reading and interpreting for me...then take their educated opinions....and make a call for myself. I guess that's just a long winded way of saying....I don't understand studies.....I understand people.

Thank you NKinney. IT has also been thoughtful and sharing his experience with me after I posted about my husband's uptick.

When I asked about our margin the surgeon made me feel hopeful that he killed it when cauterizing.

IT I bet I have the same bookmarks as you do

There is some risk attached to incision into a tumor. The risk goes up with the Gleason score at the incision because of the higher probability that viable cancer cells might be released, or (probably more importantly) inoculated into adjacent tissue. I stress viable because most prostate cancer cells in the prostate are not viable outside of the prostatic environment. The risk is probably small - there are a lot more incisions than their are recurrences (every positive biopsy is an incision). Surgeons routinely add this to their report (or should) if there has been an incision.

For a review of the subject, you can read the section on surgery:

/pcnrv.blogspot.com/2016/08/can-invasive-procedures-spread-prostate.html[url]

Allen, at bit OT but here is an update for your blog section on biopsy

/www.ncbi.nlm.nih.gov/pubmed/24958224

My thought is that it would suggest that doing a MRI before a biopsy is useful because if it looks like an aggressive tumor on MRI, then additional care should be exercised when targeting the tumor so that there is no spread.

You have a blog?

What's it about?

The blog link has been on TA's signature for a long time. I read it regularly and I suggest other do as well.