Focal Positive Margin Information

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Frank1205
Regular Member


Date Joined Feb 2008
Total Posts : 308
   Posted 11/7/2008 8:54 AM (GMT -6)   
Thursday, 06 November 2008
The significance of focal positive margins (FPM) following radical prostatectomy is unclear, particularly in patients with otherwise organ confined disease.

The implication in pathologically organ-confined tumors is that FPM are surgically induced, may not represent true tumor extension beyond the prostate, and thus would not impact on disease-free survival (DFS). Our objective was to investigate the significance of FPM in patients with organ-confined disease in terms of DFS.

Data was prospectively collected from 2074 patients undergoing radical prostatectomy from January 1996 to December 2006 who signed an informed consent. Clinical and pathologic stage and margin status [negative (NM), FPM, and extensively positive (EPM)] were compared with the log-rank test to determine differences in overall mortality and DFS. FPM was defined as less than or equal to 3mm. EPM was greater than 3mm.

1688 patients (81.4%) had NM, 292 (14.1%) had FPM, and 94 (4.5%) had EPM. Mean preoperative PSA for NM, FPM, and EPM was 6.45, 7.88, and 11.81, respectively. The difference in DFS was significant between the three groups (p< 0.0001). The 10-year DFS for all patients was 90%, 62%, and 41% for NM, FPM, and EPM, respectively. When evaluating patients with organ-confined disease, the presence of FPM led to significantly higher risk of PSA recurrence compared to NM. The 10-year DFS for organ-confined disease was 93%, 84%, and 55% for NM, FPM, and EPM, respectively.

Focal and extensive positive margins on radical prostatectomy specimens confer a decreased disease-free rate. Importantly, focal positive margins significantly decrease disease-free survival in patients with otherwise organ-confined disease. These data suggest surgically induced focal positive margins are important. The trade-off between sparing the neurovascular bundles and a focal positive margin must be balanced.



Frank

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 11/7/2008 11:14 AM (GMT -6)   
Hi Frank,
I hope you are doing well. The origins of this study are missing, can you post the link where you saw it?

Thank you much!

Tony
Age 46 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007 @ The City of Hope
Post-Op Pathology: Gleason 4+3=7, positive margins, Extra Prostatic Extension (EPE)
Bilateral seminal vesicle invasion (SVI); Stage pT3b, N0, Mx
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (September 17 '08): <0.1 ~ Undetectable!
 
You can visit my Journey at:
 
STAY POSITIVE!
 
 


JEKNY
Regular Member


Date Joined Aug 2008
Total Posts : 23
   Posted 11/7/2008 2:34 PM (GMT -6)   
Frank,
Thanks for sharing the information, if I am reading correctly my focally positive margin may have been a result of the surgery and not necessarily the spreading of the disease.

Born 10-13-1952 Age 55 when diagnosed
Biopsy 5/08 2 of 12 cores positive
Gleason 3+3=6 Stage T1c
Da Vinci RP 7/31/08
Post Op visit 8/7/08 Cath removed, Patholigy Gleason 4+3=7 Stage T3A Extraprostatic extension: Present (right mid, right base and bladder neck area) Seminal Vesicles: Negative; Peripheral resection margin: Focally positive.                                                         9/1/08 One pad per day for strain or movement leakage.                                           9/4/08 PSA <0.05                                                                                           10/30/08 PSA < 0.05 ED-Still recoverying nothing usable at 3 months post op.


Frank1205
Regular Member


Date Joined Feb 2008
Total Posts : 308
   Posted 11/7/2008 5:25 PM (GMT -6)   
Hi Tony,

I am doing pretty good thanks, this margin thing still bothers me, too much at times. Somtimes I think I am goofy. Doc told me to start taking 1,000 units of Vitamin D because of recent or trending research. Now 10 days later , aster taking it, I think I am feeling stronger and have less muscle type aches and pains. Go figure.

Here is the site I got this margin informaton from. I registered here once I found out I had pc and ever since get daily updates. I have found it to be very informational and alot of times to technical for me.

Frank

Written by:
Wood DP, Lake AM, Labo J.

LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 11/7/2008 5:50 PM (GMT -6)   
JEKNY...from what I read, that Positive margins can usually occur when the surgeon cuts across a small section of the tumor, because the tumor was close to the edge to start with. It is impossible to know "exactly" how much tumor cells were left behind, however for the most part any small amount (<3 mm) will not typically survive and will die out due to the loss of blood and the resulting scar tissue. So in most cases roughly 80% of the time it isn't a concern. In your case you had evidence of extention and that will be the area of concern and the reason for higher stage on the pathology report.

Frank's is close to the bladder and is of some concern. His doctors recommendations are inline with with what I have read about the positive margins and the location of the margin. The location seems to be the greater factor in his case.

Hopefully this won't be a problem for either one of you.
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base)
Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1,2008
Gleason 7 (4+3) Staged pT2c NO MX
Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
4 tumors in prostate - largest being 6 cm 
PSA Oct 08 <.05


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 11/9/2008 7:04 AM (GMT -6)   
great post Frank thanks so much for the research on this. My cancer had spread to my lymph nodes so I watch post like these closely.

peace to you my friend
Dale
My PSA at diagnosis was 16.3
age 46 (current)
My gleason score from prostate was 4+5=9 and from the lymph nodes was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11
PSA July 24th, 2008 is 0.04
cancer in 4 of 6 cores
92%
80%
37%
28%
 

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