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lewvino
Regular Member


Date Joined Jul 2009
Total Posts : 384
   Posted 8/19/2009 2:44 PM (GMT -6)   
Today is 1 week post surgery and got call the call from the Dr. Office on my path report.
 
Final report
20% Of the prostate was involved with cancer. Overall Gleason score was assigned 7 (3+4)
Positive margin at the right apex.
 
I don't see the Dr again until Early October which is when they will do a first PSA.
Does this mean I will need to start radiation now or what?
Very depressed,

Larry
Age at diagnosis 54, PSA 5.1
Father treated for Prostate Cancer in 1997 with Proton Beam - Still doing well.
My Stats
Biopsy 04/08 12 cores, 5 positive
Gleason 3 Cores at 4+3=7
              2 Cores at 3+4=7
Perineural Invasion Noted on biopsy

Robotic surgery 08/12/09 at Vanderbilt, Nashville TN. 
 
Post Surgery - Dr. Spared 100% of Nerves on the left side.
Estimated that 50 - 70% of the nerves were spared on the right side.
Waiting on final Pathology reports


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 8/19/2009 3:20 PM (GMT -6)   
Larry.

I am sure you will find opinions saying you should, and you will find others who have chosen tro wait and see.

I think your PSA's will help you decide. Some studies suggest that you may increase your odds of nonreoccurence by 5 % and upwards by doing adjuvant radiation within 4 months of surgery.

I am a wait and see guy. I have a Gleason 9 which syas I should be pursuing adjuvant radiation now. I just can't pull the trigger yet with zero PSA's.

Just try to gert over the surgery first, and worry about the next steps in a few months. You really do have lots of options.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck.  Try 3 tubes where no tubes are supposed to be for 2 weeks !
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/19/2009 3:22 PM (GMT -6)   
Larry, it could mean that, but its way too early to make that call. You haven't even had your first post surgeyr PSA yet, you said that would be in October. Despite your pathology report, you may pull a zero and pull one for some time. One thing I have been learning in the past year, is despite certains numbers and percentages and statistics, don't assume the worse case. There are too many variables with PC and too many differences and exceptions. What looks bad sometimes is good, and good can go bad without any rhyme or reason.

Right now, you got some serious healing to do. You only had your surgery one week ago. Listen to your body, and take the time to recover properly.

David in SC
Age 57, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, 8/14 met with Rad Oncl, still talking option, 8/18 - had laser scope surgery to clear blockage, now on Catheter #7
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 8/19/2009 3:31 PM (GMT -6)   
Larry,

I think the other positive thing about having surgery is that you know. If you had elected for other nonsurgical treaqtments, you would not know about the positive margin. Now you are aware of the potential risks and plan for it .
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck.  Try 3 tubes where no tubes are supposed to be for 2 weeks !
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)


texican
Regular Member


Date Joined Jan 2009
Total Posts : 36
   Posted 8/19/2009 3:32 PM (GMT -6)   
Larry,

As you see from my information below, I also had a positive margin 1-2mm and the same Gleason and my Surgeon said that was very small. He compared it to trying to round up a hive of bees and there is still one out there somewhere. Chances are it won't survive on its own without the prostate. Anyway, it sounded good to me. I have just had my second undetectable PSA. I think you should have the path report in your hand when you visit with your Urologist. If they didn't give you a copy to study you should ask them to send it to you.

Be patient and think good thoughts until you know more.

John
Dx December 22, 2008
Age 69
PSA 1998 5.2, 2000 2.5, 2003 5.4, 2004 7.4, 2005 15.9, 2006 20.5, 2007 31.5, 2008 34 and 32.9
Biopsy 1998-no cancer, 2003 - no cancer, 2006 - 12 samples, no cancer but PIN, Dec. 2008 - 12 samples, 2 positive with Gleason 4+3 = 7 on each. PIN on 3 others.
Di Vinci surgery on 2/10/2009, Austin TX
Pathology post surgery T3a, Gleason (4+3)7 with tertiary pattern 5.
NX,MX,R1, margin involvement 1-2 mm
Catheter removed on February 23.
First PSA followup on April 6, 2009 with 0.01 (lowest they can measure)
April 20 - no more pads
Second PSA August 10, 2009 0.01


lewvino
Regular Member


Date Joined Jul 2009
Total Posts : 384
   Posted 8/19/2009 3:48 PM (GMT -6)   
I'm waiting for a call back from Vanderbilt on what it all means. Since my next appt is early October up there. They are faxing the path report to my local urologist.
His staff will pull the cath on Monday Aug 24th and then I set up an Appt to see my Local Urologis on Aug. 31 to discuss in detail with the local urologist. I know I have to wait for a psa.
Age at diagnosis 54, PSA 5.1
Father treated for Prostate Cancer in 1997 with Proton Beam - Still doing well.
My Stats
Biopsy 04/08 12 cores, 5 positive
Gleason 3 Cores at 4+3=7
              2 Cores at 3+4=7
Perineural Invasion Noted on biopsy

Robotic surgery 08/12/09 at Vanderbilt, Nashville TN. 
 
Post Surgery - Dr. Spared 100% of Nerves on the left side.
Estimated that 50 - 70% of the nerves were spared on the right side.
Waiting on final Pathology reports


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 8/19/2009 4:00 PM (GMT -6)   
If you look at the nomgrams, you will find that the chances are 70%-30% that you will have no recurrence of PC. I have similar numbers and my three month PSA was 0.0. My urologist said that since it was most likely that I had beaten PC there was no reason to start with further treatment.
For now, you need to wait, believe and work towards healing.
We will keep you in our prayers.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 8/19/2009 4:10 PM (GMT -6)   
Larry,

Don't let the word "positive margin" alarm you. Most men will never see a recurrence based on the positive margin indication by itself. Too many other factors need to be calculated in, and your stats are very promising that you will be in the group that never sees a recurrence.

Right now, just concentrate on the healing aspect.

Best to you,
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month Apr 2009 .06
                   9 month Jul  2009 .08


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 8/19/2009 4:15 PM (GMT -6)   
Larry,

Here is what my oncologist told me. There is statistically no difference in recurrence rates between negative margin and a single positive one. I also read that margins less than 3 mm are not significant. Finally, while contravecial, there are studies that show no difference between adjuvant and salvage radiation outcomes, as long as PSA was undetectable post op and salvage started before a certain PSA (I don't recall exact number - 0.3, 0.4, or 0.5).

Bottom line - there is nothing to be depressed about. If you PSA post op is zero your chances are great! Focus on your recovery!

Greg

Father died from poorly differentiated PCa @ 78 - normal PSA and DRE

5 biopsies over 4 years negative while PSA going from 3.8 to 28

Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8

Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere+Avastin)

PSA prior to treatment on 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60

RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins

PSA undetectable for 8 months, then 2/6/2009-0.10, 4/26/2009-0.17, 5/22/2009-0.20, 6/11/2009-0.27

Salvage IMRT + 6 Months ADT: Casodex started 6/12/2009, Lupron 6/22/2009, PSA 6/25/2009-0.1, T=516, 7/23/2009-<0.05, T<10, IMRT to start mid-Aug


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/19/2009 4:24 PM (GMT -6)   
Greg, the radiation oncologist I just met with Friday said his magic number for effectiveness is .50 for salvage radiation. That number seems to vary from practice to practice.
Age 57, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, 8/14 met with Rad Oncl, still talking option, 8/18 - had laser scope surgery to clear blockage, now on Catheter #7
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


CPA
Veteran Member


Date Joined Feb 2008
Total Posts : 655
   Posted 8/20/2009 6:15 AM (GMT -6)   
Greetings, Larry.  I'm glad that you are making good progress and I know that you are looking forward to having that catheter pulled on Monday.  Stay vigilant on those 90 day PSAs and they will guide you in any follow-up treatment you may need.  You could have a lifetime of zero's with the treatment you already have and that's exactly what we will pray for on your behalf. David

Diagnosed Dec 2007 during annual routine physical at age 55
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 pos; 2 marginal
Gleason 3+3; upgraded to 4+3 post surgery
RRP 4 Feb 08; both nerves spared
Good pathology - no margins - all encapsulated
Catheter out Feb 13 - pad free Feb 16
PSA every 90 days - ZERO's everytime!
Great wife and family who take very good care of me

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