Hello, I'm a brand new member

Hi everyone, I am 57 years old and just had a RP (Davinci robotic surgery) on 4/30/07. Had a gleason score of 3+3 and a pre-op psa of 5.4 down from 10.1 a month prior to my biopsy. I have been particularly interested in the pathology report questions in this forum. Mine came back and left me a little shaken because It indicated that the PC had penetrated the capsual but the surgeon says he is 100% sure it is gone. I haven't been able to discuss it with him yet but it makes me wonder. All pre op scans were negative. What does "positive margins" mean. I was not told that that was my situation but it sounds like it might be. Nice to be with others slogging through the same swamp. DAN 

Dan,

Like you I was looking for negative margins but my pathology report came back with 2 focal positive margins... But the Doctor's explanantion to me was that in my case, focal point meant than only a couple of cells were touching the edge and that maybe only 1 cell or so was "outside". I also read a John Hopkins report (Epstein) about positive margins and how many really do not indicate any need to worry as many times a cell or two outside end up dying anyway just due to the surgical trauma. The overall article and nomogram I got relieved many of my serious concerns.
http://urology.jhu.edu/newsletter/prostate_cancer410.php
My final pathology diagnosis was T2c which suggests "organ confined". The good thing were that it was still a Gleason 3+3 (6) and was not "upgraded", and seminal vesicles and lympth were also OK. The nomogram for my final pathology indicates a 95% chance of no re-occurence for 7 years. Doctor also indicated no further treatment indicated at this time. We will just monitor my PSA like most of us on this board will be doing for the rest of our lives. My signature has most of the statistics of my journey so far.

Read up on pathology reports and margins (I did a lot of googling) before your appoinment for discussion with the doctor and write all your questions down so when you are there, you can go over all your concerns. You can also request a copy of the actual report. With my questions and his answers resolving them, I left the office much more at ease as this overall journey can really spin you up.

Take care and God Bless!

Ray

Hi Dan,

It sounds like you are almost in the same boat that I'm in. I also had davinci surgery (4-24) and received my post op pathology report last week. The report indicated that I had a positive margin and also one of the seminal vesicles involved, the other plus lymph nodes were okay. My surgeon said that I need to get started with radiation asap and made me an appointment with the radiation oncologist for next week. I'm sure that I will have to heal from surgery and become continent first before any treatments are started. My surgical arena has healed good in the last ten days and my continence has improved greatly in just the last couple of days. Down to about 3 pads per day now, did use 7 or 8 for a couple of days. Keep reading this site, I check in daily and always learn something. There are some really great people here. Keep your chin up, and think positive!!! jwb

I had laparoscopic surgery in March of 2006 at the Moffitt Cancer Center in Tampa, Florida. PSA was 5.6. Gleason prior to surgery was 6; it was 3 + 4 (7) after surgery. My doctor said I had a cancer cell right on the margin, and my chance of the cancer coming back was increased by 10 percent. Recent PSA was less than .01 ... John Hopkins did a study about positive margins; Here's an excerpt:

"And, even if the surgical margins are positive, this does not necessarily mean that the cancer is left behind. How can this be? "There are several different explanations why, when the margins are positive, the tumor may still be cured," says Hopkins pathologist Jonathan Epstein. "One is that literally you cut across the last few tumor cells" -- that what appears to be remaining cancer is actually a cross-section of the perimeter of the tumor. "And even though it looks like it's a positive margin, there's really nothing left in the patient."

Another explanation is that the act of surgery itself finishes the job, killing any remaining cells. No cut or injury to tissue happens in a vacuum; the area around the cut is affected, too. (Think of lightning striking a tree; the tree dies, but so does a ring of grass around it). "When the surgeon cuts across tissue the blood supply is cut off, there's dead tissue, and that can kill off the last few tumor cells that might have been left behind," Epstein says.

Thank you to all of who replied to my questions. It was very helpful and even comforting. I will keep you informed and will probably have many more questions. Looking forward to further dialogue. God Bless, <I:)~DAN

Hi ~ Dan,   We were away when you first signed on….   But we are back now and you’ll definitely be hearing from us!   And we definitely want to hear from you….. Okay!!        Stay Close …. This Journey is best traveled with friends at every stepping-stone on our path…   Welcome New Friend…   I think you’ll find some interesting information on the Thread below… (Direct Link ~ just click on the title below and a new window will open!   Reminder … click on the REFRESH icon once you get there) Helpful Hints ~ & ~ Direct Links to Important Topic Threads ~ Hope this helps you!! :)   See the 3 rd Posting….. There is a thread started by Raheeb….. What about Perineural Invasion?   We are here helping each other as we all move forward in our journeys…   We’re glad you joined us!!!!  Take care for now.   In Friendship ~ Lee & Buddy