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No Celebration yet - BAD Path Report !!!

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Posted 10/25/2007 1:12 PM (GMT 0)
Well day 8 came and catheter removed (a Blessing), but we were not prepared for the bad pathology report. We were devastated :

"Margin-focally involved left anteroapical by adenocarinoma, specifically section F (Gleason 3+3+6) focally contacts the orange inked anterior left apical margin of resection . Extraprosatic Extension - Focally Identified . Seminal Vesicle - Not Identified ".

No Lymph nodes were taken to be evaluated.

The biopsy showed a higher 3=4=7 Gleason on the rt side but was all within the margin. (I couldn't help but notice that the left section of prostate taken was smaller than the rt side -don't know if this indicates a bigger area should have been removed during surgery? Oh well can't change that now.)
I guess we were swayed by all the diff. Dr.s assurances that my biopsy results (3 of 12 samples,3+3=6 gleason and PSA of 3.9 were early stage and high chance of organ containment. It definely took the wind out of our sails!
The surgeon said that only about 20% of patients will have a recurrence. I have learned to hate statictical evidence, since I always seem to fall in the small group! (It's like watching a close football game and hearing the announcer say that the other team's kicker has never made a 53 yd. field goal in his career - of course it insures he makes it to win the game.) The doc said there was nothing to do but wait for the 8 wk PSA test. If it is not 0 he would re-do to confirm and then recommend me to a radiologist.
Physically I seem to have recovered fairly well although I am going through quite a few pads rt now. I got a whoopee cushion for long ride home cause I am still a little tender.
I feel pretty lost as we pack up to return home - (about a 5 hr drive). I just hope surgery still served some purpose even though cancer is still there.
So the journey takes yet another unexpected turn. I'm sure I will be more positive once I've had time to digest it all.
Please share any knowledge, experiences w/ bad margins, and of course any advice, comments in general. Thanks.

I won't be able to reply until we arrive back home this evening.

Laswell
Posted 10/25/2007 1:38 PM (GMT 0)
Laswell,

Sorry to hear of the not so good pathology report. I have only just recently been diagnosed. I am still waiting to meet my doctor for initial consultation at Vanderbilt. I wish I was as far along as you are now. Your experience makes me want to beg the doctor doing this surgery to take more than he thinks necessary. That sounds stupid I guess but I would rather them error on the side of to much as to little. Hindsite is always 20/20.

It is good that only 20% have a recurrence. Think positive and hope for the non-detectable PSA. I was a high school football coach in Kentucky for 15 years and I would have never tried to kick a field goal with only a 20% chance. You are going to be the winner in this game.

My wife and I will keep you in our prayers

Educator

Posted 10/25/2007 2:06 PM (GMT 0)
Laswell, I am in the same boat as you. The waiting game really sucks but there's nothing we can do. I had my initial PSA at 6 weeks which came up goose eggs but the PSA my Dr. will use as the official check will happen Nov. 12. According to him if he see's anything numbers but zero's I'll be off to the Oncologists, so I'm sure that might happen. The one thing I'm wondering is if my PSA is real low (.05) or something like that will the Oncologists take a wait and see approach. I will probably get my PSA checked every 2-3 months anyways. I hate waiting but why expose your body to radiation if you don't have to.
Posted 10/25/2007 5:30 PM (GMT 0)
Hi laswell,
Hang in there. You can still be just fine. And you have to stay on the 80% with positive attitude. I was aware what I may have as a pathology after surgery, but look at my numbers. I understand your disbelief when you heard your doctor speaking. Your trek looks very similar to kdnoles. As you have time to get your PSA down, now is the time to get that second opinion on the pathology slides. You can look into RT and an oncologist without waiting. You don't need to make a decision but rather be ahead of the game. I guess to continue the analogy, that kicker may have made the kick, but you are still in the first half. The game is not decided by any means.

Tony
Posted 10/25/2007 7:50 PM (GMT 0)
Laswel,

Stay POSITIVE!  "Focally involved" is much better than "Locally involved" as it means only a small area.  And the focally involved area was Gleason 3+3 which was less than the overall Gleason 3+4.

In my post-op pathology, I had 2 positive margin "focal points" which were explained to me as only a contact area of one or two cells which most likely were also removed in the overall sugical traumas to the tissues.  My initial "no-reoccurrence" numbers for 7 years were 94% then.  Anyway, my first post-op psa at 3 months was < 0.1... which is "zero"...  Note that my doctor does not do a 6 week psa as there may still be some pre-op psa still in my system and he does not like the chance of that occurrence to unneedingly worry patiernts.   Anyway, with that 3 month psa at "zerro", the stats get much better for no re-occurrence.

There are also other factors as to which lobe the contacts are in...  You can always ask your doctor for more info or sites to look up this information...  to better define focally and which lobes and what that means...  Beside the doctor's info, I found a lot of additional info on this site and also seaching with google...  Comforted me a lot...

One of our members, sorry, forgot which one :-( , has the quote "Cancer feeds on fear...  Starve it!"

I have found the more I ask questions and understand this stuff, the better my brain and emotions handle it...  Information lessened fear...  I become more part of the team actively fighting this darn disease!

God Bless!

Ray

 

Posted 10/25/2007 8:54 PM (GMT 0)

Laswell-

First and foremost, I am sorry! We too (my father) had a poor post op pathology report! He had one positive node and one focally positive margin.  The Friday night we got the call was the worst day of my life.  My dad and I were watching a movie and I had taken him to get his hair cut earlier in the day because he was feeling so much better and we were all very optimistic.  I will never forget the look on his face as he heard the news from the doctor.  We took the weekend to be sad and come Monday we regrouped and headed down for the CT and bone scan.  (Both were negative) I told him that we were hoping for a sprint, but got a marathon.  He will begin HT this month and hopefully radiation soon.  I am very hopeful and like Tony stated earlier, this is the first half!  Use half time to do your research, and prepare mentally and physically for the second half! You can win this! We will all be supporting you in this fight!

PS also check out the article link for positive margins on this site! 

Chayna

Posted 10/26/2007 6:48 PM (GMT 0)
Hi, Las - hope you're settled in at home by now. We, too, went in with a biopsy report that said only 5% of one core out of 12 indicated cancer. What a surprise at our followup visit. With such a low percentage, there's really no way to think otherwise going in. You can't look back - a path report is the best way to let you know exactly where you stand with this cancer. Sometimes, you just can't tell - and no doctor can feel - those "nuances" that show up under a microscope.

We know you'll imagine the worst while you wait for that first all-important PSA. As others on this board encouraged us, believe that you'll be in the 80%.
Posted 10/26/2007 10:56 PM (GMT 0)

Laswell,

We seem to have a group who have gone through the same thing.  Don't be afraid to think about the fact that you may need adjuvant radiation therapy.  While Dr. Walsh's book states that waiting until a possible reoccurance and then getting RT is just as good as geting it early, a couple of newer studies don't agree.  I always approached this with the mindset that I was going to fight it aggressively.  The first decision was getting the surgery, even when some said that since my biopsy was so small, the seeds could be a better choice.  After receiving the poor pathology report, I too had the "why me?" feelings, but I had to be thankful I took the surgery.  Even when my first PSA was .01, there was discussion of adjuvant therapy, because of my positive margins.  I fought that idea, since it comes with hormone therapy as well - you want to weaken those little B*$#%@s before you zap them.  My second PSA of .08 helped make up my mind.  Thankfully, so far after 4 months the hormones haven't caused any really visible side effects.  I completed my 32 radiation sessions two weeks ago, and also suffered very little.  I feel that keeping physically active is the key.  I still take morning walks, and am officiating high school sports.  In fact, I'm just about to change my clothes and head off to a game.

My advice is to let things settle down for awhile, and realize that there are still many paths you can take.  In the meantime for me, I'm doing all I can - keeping my weight down, exercising, taking selleneum, pomegranate extract, and putting flaxseed on my morning cereal.  All of these things are simple to do, and help me emotionally know that I'm doing everything I can to fight this disease.

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