My path report shows positive margins at proximal & distal urethra ...

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New Member

Date Joined Mar 2009
Total Posts : 2
   Posted 3/29/2009 12:36 PM (GMT -6)   
had ralp on march 11th at Nortons Louisville, KY and now home with some incontenance.  The pre sur biopsy was T1a with 6 0f 12 pc.  post surg path reported pT2c with both the proximal and distal urethral margins as positive.  Also with PIN.  Also tertiary grade 5.  Tumor 25% of prostate with maximal measure of 2.6cm.  Having trouble finding other (or infor) on these type positive margins.  Not sure if surgical issue or something related to tumore outside prostate.  Any response appreciated
PC Jan 09 pre=6/12 with 3 each side postive T1a
DaVinci Mar 3 09; Louisville,KY
Path: pT2cNXMX ; positve margins rpximal & distal urethral + positev for PIN
Leaks: 'ugy' tube out Mar 11; working with only two pads a day; stay mostly dry at night.

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4237
   Posted 3/29/2009 9:10 PM (GMT -6)   
A tumor near the uretha is very difficult to get a positive surgical margin because of possible damage to the uretha. If this happens you are incontinent. The prostate tissue surrounds the urethea and the surgeon tries to get as close as possible but there is almost always tissue left. In your case it appears to contain PC.
I knew that the location of my tumor was near the uretha because of a color doppler and an exotic MRI. I knew a positive margin was very likely and that's why I chose radiation. It is very important to know where your tumor is located before choosing an option.

64 years old.

I had an initial PSA test in 1999 of 4.4. PSA increased every 6 months reaching 40 in 5-08. PSA free ranged from 16% to 10%. Over this time period I had a total of 13 biopsies and an endorectal MRIS all negative and have seen doctors at Long Beach, UCLA, UCSF and UCI. DX has always been BPH and continue to get biopsies every year.

In 10-08 I had a 25 core biopsy that showed 2 cores positive, gleason 6 at less than 5%. Surgery was recommended and I was in the process of interviewing surgeons when my wife's oncologist recommended I get a 2nd opinion from a prostate oncologist.

I saw Dr Sholtz, in Marina Del Rey, and he said that the path reports indicated no tumor, but indolant cancer clusters that didn't need any treatment. He was concerned that my PSA history indicated that I had a large amount of PC somewhere that had yet to be uncovered and put me through several more tests.

A color doppler targeted biopsy in 11-08 found a large tumor in the transition zone, gleason 6 and 7. Because of my high PSA Dr. suspected lymph node involvement, 30% chance, and sent me to Holland for a Combidex MRI, even though bone and CT scans were clear.

Combidex MRI showed clear lymph nodes and a 2,5 cm tumor in the anterior. I was his 1st patient to come up clear on the Combidex which has a 96% accuracy,

I've been on a no meat and dairy diet since 12-08 and PSA reduce to 30 while I awaited the Combidex MRI.

The location of the tumor in the anterior apex next to the urethea makes a good surgical margin very unlikely. Currently on Casodex and Proscar for 8 weeks to shrink my 60 mm prostate. Treatment will be seeds followed by 5 weeks of IMRT while continuing on Casodex and Proscar. So far no side affects from the Casodex.


Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 3/29/2009 9:49 PM (GMT -6)   
Welcome to HealingWell. Sorry you have to join this illustrious group, but we're glad to have you along. While I had positive margins, they were not where you describe. I am doing well however. We certainly hope the same for you as well. You have left out some information and maybe you can help us help you. Your age and Gleason is important stuff. I understand the teriary grade but what were the primary and secondary grades?

I hope your healing continues to improve, and most of all I hope you are done with this...

Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (January 13, 2009): <0.1
My Journal is at Tony's Blog  

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