Margins question

Ricky,

That first post OP PSA is always a nerve wrecker. I think we all understand what you are feeling. Try not to read too much into your pathology report. I look forward to seeing you getting accepted into the all inclusive, all executive, grand Zero Club. That's what I am expecting for you.

David in SC

Ricky...in answering your question, I would say that you had positive margins based on your path report. The good news is in fact very very small amount. In fact 35 to 45% of the time, positive margins will be noted with nerve sparing radical surgery. And you are correct, the partin tables will indicate that 93% of the time in those with positive margins will never show progression of the disease.

It will be certainly nerve racking waiting on those psa tests from now on, but remember that the odds are definitely in your favor.

Take care,

And... even if you do have positive margins, there is nothing you can do about it, and worry doesn't seem to help much.

Go, enjoy, life life, thankful for every day you have.

Got me waitimg for the PSA results too.

Good luck on your journey !

Ricky:

I am in almost the exact same situation. My margin was 0.5 mm (worse than yours) but it was focal (ie: just one spot). For me, it is very depressing. But then when I try the Sloan nomograph, the percentages look very good. I am also sweating the first post-op PSA, on or about 3/1/10.

(Read the last part of my signature for the details!)

Mel

Found this interesting article on margins

http://urology.jhu.edu/newsletter/prostate_cancer410.php

Ricky, your question about EPE is one I've asked myself many times since my husband's surgical path report showed a single focus of EPE in the posterior left. However, when I spoke to the surgeon initially about the path report, he stated that he was reasonably sure from the biopsy report that he would need to cut a wider-than-necessary margin around this part of the prostate. While the surgical path report stated the single focus of EPE, it went on to say that margins around apex and bladder base were free of tumor. In my husband's case, it would appear that all margins were negative for any cancer cells.

FYI: the surgeon's feeling about EPE in the posterior of the gland came about because one of the 10 cores taken during the biopsy was very close to the edge of the prostate. He went in figuring that something this close to the edge meant that the cancer had likely escaped the capsule. He decided beforehand where to cut, from what angle to approach the gland to avoid cutting too close, and to remove as much fatty tissue in that area as he could. So far, his strategy has worked. It would seem that our surgeon did an excellent job of studying the results of my husband's biopsy knowing exactly where each positive sample was and mapping his surgical strategy accordingly.

Ricky,

Yes I think you have a good handle on what PCa cells can and can't do. For one thing they don't have little legs that allow them to just get up and go wherever they want. They are cells and they will grow in a certain direction (and their descendants might then bust out down the line) but they don't just jog or slither out into the bloodstream. I know the pathologist also checks nerve sheaths as well as a means of escape -- not just blood vessels. As you said certain routes are probably more agreeable to cancer cells and other routes are downright dangerous since immune cells might attack them (although immune cells are not confined to any one area .. they can move in and out of blood vessels, nerve sheaths, lymph nodes etc -- wherever they are called to. Fascinating stuff for sure.

Thank you Les,

You greatly increased my understanding of the terms.

 Les -   Yes once again Les thankyou for that explanation regarding positive margins, certainly makes it a little easier to understand.

Q.    Does it mean then that all positive margins are in effect, EPE or has the surgeon accidently cut into the prostate capsule, now creating a positive margin ?

Kev

Cheers Les, Thanks for you time in explaining that, makes sense................Kev

NOTHARD:

That article was interesting, but I have some concerns. First of all, they defined reoccurence as 0.4 PSA. I think the true yardstick is 0.2.

Also, I don't like that 57% figure. It seems the Sloan-Kettering nomograph gives a much higher percentage. Am I missing something?

Mel