What exactly does a Positive Margin mean?

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lewvino
Regular Member


Date Joined Jul 2009
Total Posts : 384
   Posted 8/19/2009 5:27 PM (GMT -6)   
Could some explain to me in laymens terms?
 
Can't seem to find much about it.
 
Thanks,
 
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


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 8/19/2009 6:11 PM (GMT -6)   
A positive margin means that when the prostate gland or one of the attachments were removed surgically and examined by the pathologist, there were cancer cells seen at the cut margin or edge of the organ or attachment. Usually this implies that there was still cancer cells left on the other or body side of the incision made to remove the organ or attachment. It could be microscopic scattered cells, or it could be more evident. This is something that will probably be explained when you meet with the urologist to review the path report.
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
22 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix 30/1/20-.05ml 2X week continues
PSA's: .04 each test since surgery


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 8/19/2009 7:12 PM (GMT -6)   
Dr. Walsh says there are several reasons for having positive margins even though no cancer is left behind. He estimates about 40% of positive margins are in this category. Reasons include damage to the specimen while handling it prior to pathology, the prostate surface "glued" to surrounding tissues gets torn out during surgery exposing the cancer, but leaving nothing behind and more that I don't remember. I also remember a discussion that even if some cells are left behind, the disturbance of the blood supply and tissue damage due to surgery will kill them.

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


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 8/19/2009 7:51 PM (GMT -6)   
Geebra said it well, wait to talk to your doctor
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


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 8/19/2009 8:26 PM (GMT -6)   
From the AJCC (2007) for staging manual for prostate cancer, a positive margin (PM) is defined as cancer extending to the edge of the dissection cut of the surgery. It is possible to have a postive margin and no residual disease but the odds are small for that. Also note that cancer can be outside the prostate capsule and there not be a positive margin. This is termed as Extra Prostatic Extension (EPE). Commonly EPE extends beyond the cut of the dissection.

Unfortunately, I had to do my homework on this one. I had both to go along with bilatteral seminal vesicle invasion (SVI)...

Tony


 Age 47 (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 (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!

Post Edited (TC-LasVegas) : 8/19/2009 9:50:32 PM (GMT-6)


lewvino
Regular Member


Date Joined Jul 2009
Total Posts : 384
   Posted 8/20/2009 6:20 AM (GMT -6)   
Thanks all. At least I can get answers here faster then via the Dr.
On Monday I get the cath pulled, hoping for the best.
On Aug. 31 I am talking to my local Urologist about the Positive Margins.
Then on Oct. 12th (I think that is the date) Back up To Vanderbilt to Talk to my Doctor there about his take on the Positive Margins and to get my first Post surgery 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.
 
Final Path report
20% of the prostate Invovled
Overall Gleason 3+4 (7)
Lymph Glands Clear
Positive Margin Noted in Right Apex


CapnLarry
Regular Member


Date Joined Apr 2009
Total Posts : 75
   Posted 8/20/2009 7:24 AM (GMT -6)   
For the effect of positive margins on the prognosis/risk of recurrence, see Figure 2 in jco.ascopubs.org/cgi/reprint/23/28/7005.pdf. I believe that the nomogram in the article has been cooked into the Sloan Kettering online tool at www.mskcc.org/applications/nomograms/Prostate/PostRadicalProstatectomy.aspx. See also the Han tables at urology.jhu.edu/prostate/hanTables.php. There's tons more, but those should give you a feel for the impact.
Larry Shick
Personal homepage incl. PCa story: www.sv-moira.com.
01/09: Diagnosed (age 60) biopsy PSA 4.4, free PSA 9%, T2c stage, Gleason 7 (3+4), 7 of 14 cores; 6'2", 200 lbs.
03/09: Robotic surgery (Dr. Kawachi, City of Hope) 47 gms, 10% involved, staging/Gleason unchanged (pT2cNXMX), margins clear, no ECE/sem ves involvement, fully continent from day 1, some success w/Viagra 50mg/day.
Followup: <0.01 at 05/09, 08/09


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 8/20/2009 8:40 AM (GMT -6)   
Larry,
The PDF is outdated and uses AJCC1997 tables which can confuse a stage 3 guy. The major change in AJCC2002 was the rolling of Stages 3A and 3B into simply 3A. Stage 3C has been deleted and is now 3B (SVI positive). The MSK nomagram is the best. If you want to look up probabilities then look at the MSK nomagram. Make sure if you use any nomagram what AJCC table was used in the pathology ~ 1992, 1997, 2002, or the current 2007.

Lew, you are going to look at them we all do. You will see your prognosis is good. But the bottom end numbers can scare you a bit. Remember that these are probabilities and they take in account of where we were with treatment many years ago in order to show 10 year probability. We have come a long way in recent years and these numbers will drop in time. My biggest line here at HW I thought valuable enough to put in my signature ~ Stay Positive.

Lew one more thing. If you can, have your slides went to Johns Hopkins for a second opin on the margins and Gleason. Jon Epstein is considered one of the best PCa pathologists, and he will review anything prostate cancer when sent to JHU...

Tony
 Age 47 (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 (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!

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