Why isn't pathology done during surgery

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Regular Member

Date Joined Jul 2007
Total Posts : 86
   Posted 2/10/2008 8:18 AM (GMT -6)   
I have seen some high end private clinics that offer pathology report during the surgery.  With all the nerve sparing procedures going on today the positive margin scenario is more and more likely.  If you had the pathology available during the surgery you could make the choice to go after more margin or  take your chances with followup radiation.  It just seems like it should be standard procedure but maybe the logistics are just to difficult.
DX 8/05 Gleason 5, Mayo clinic Second Opinion Gleason 6, PSA 2.8
Da Vinci surgery Dr. Dasari, Centennial Nashville 9/24/05
Pathology Report Gleason 6, 15 % on left side only very near to the edge of capsule, too close to call on margins, doc's said to watch it very closely, final decision T2A
PSA's have basically ranged from <.04 to .05 for two years.
no E.D. and no Incontinence, feel very blessed
PSA Nov 07 = .06
PSA Dec 10th 07 =.07
Started Guided IMRT on January 7th, 2008 to treat prostate bed and lymph nodes

Veteran Member

Date Joined Apr 2006
Total Posts : 1732
   Posted 2/10/2008 9:18 AM (GMT -6)   
The surgeon did 4 apical sections while I was in surgery to diagnose safely sparing the nerves.


Veteran Member

Date Joined Nov 2006
Total Posts : 1464
   Posted 2/10/2008 2:54 PM (GMT -6)   
My surgeon had my lymph nodes tested during the surgery.

Age 73. Diagnosed 11/03/06. PSA 7.05. Stage T2C Gleason 3+3.
RRP 12/7/06. Nerves and nodes okay.
Catheter out on 12/13/06.  Dry on 12/14/06.
Pathological stage: T2C N0 MX. Gleason 3+4.
PSAs from  1/3/07 - 1/17/08 0.00. 
Next PSA test on 7/17/08
"Patience is essential, attitude is everything."

Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 2/10/2008 3:22 PM (GMT -6)   
They do for the most part. But not always (yea, I think they should)
Many surgeons will halt a surgery if lymph nodes are or appear to be involved. But my take on that is that they should continue anyway. (Tony's opinion mired in a contraversial discussion again). In reality, how can you really pathalogically test a prostate thouroghly without physically damaging it anyway? In my case my highly experienced surgeon told me after surgery that my prostate felt normal, and my seminals appeared and felt normal. So he might not have been able to tell where the cancer was completely anyway during the procedure. He did tell me that there was suspicious tissue he could not remove without damaging my rectum, so he couldn't take more margins. Then a week later, not only was he right about that area, but elsewhere as well I was positive for carcinoma in the margins and had SVI bilaterally. So should he have stopped the surgery? I am glad he didn't. Studies are beginning to show that when the cancer becomes hormone refractory, it starts doing so mostly in the diseased prostate area before elsewhere, (Dr. Myers, Mayo Clinic, et al). That matters to me at my stage. So side effects and all, good riddance to that prostate.

Age 45 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007
Post-Op Pathology: Gleason 4+3=7, positive margins, Stage pT3b (Stage III)
HT began in May, '07 with Lupron and Casodex 50mg
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (1/08): <0.1
I will continue HT until May '09. 
Visit my Journey at:

Regular Member

Date Joined Jan 2008
Total Posts : 276
   Posted 2/10/2008 3:24 PM (GMT -6)   
My surgeon also had frozen sections examined during surgery to be assured of negative margins, although the final path report takes some additional time, it is usually presented with node info and final staging. Just my experience...
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