Another penetrating question

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compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 12/13/2009 8:50 PM (GMT -6)   
If the PC penetrates the gland, is it still possible for a good surgeon to get clear margins.
 
In other words, can the surgeon take some tissue from slightly beyond the gland?
 
In fact, can the surgeon actually make an educated guess regarding the state of the margins?
 
Mel
63 years old
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro! DREs have always been normal.
 
History of BPH/prostatitis.
 
PCA-3 test: 75.9 (bad news, guaranteeing I have to do....):
 
Biopsy on 11/30/09
 
Biopsy Report—Prostate Cancer

5 out of 12 positive

Gleason 4+3. More specifically:

2 cores were 3+3 (one 5% and the other 30%) on one side. On the other side:

2 cores are 4+3 (5%)--

1 core 3+4 (30%)

no peri-neural invasion

prostate is 45 grams

Stage: T1C

 Latest: Have set up an appointment at Umich with surgeon, radiation guy, general medical oncologist on Monday, 12/14. Trying to also set up appointment with Dr. Menon at Ford Hospital. Looking at another reading of the slides.


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 12/13/2009 9:48 PM (GMT -6)   
Mel,

The answer I believe is yes. In my case, I had and EPE, which by definition is a penetration of the prostate capsule.

My surgeon was able to remove the adipose tissue surrounding the entire organ, and I had clear margins. That is also why the nerves are either removed, or partially removed. A good surgeon can remove the bad portions of the nerve that have been penetrated by the PC.

Based on my 6 month PSA, I am cautiously optimistic that he got most all of the PC.

Goodlife
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injections


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2461
   Posted 12/13/2009 10:12 PM (GMT -6)   
Mel,
As you can see from my signature, I had EPE yet I had clear margins. My Uro surgeon removed both nerve bundles and enough tissues to increase my chances of getting all the cancer out. So far I have had 3 PSA tests all showing undetectable PSA. It doesn't mean I'm cure but so far I'm happy.
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Pathology report:
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 4 months
8 weeks PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1
8 months PSA test 10/9/09 result <0.1


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3742
   Posted 12/14/2009 5:49 AM (GMT -6)   
I am also a pT3a. Hopefully, the Doc got it all. He took one nerve bundle and part of the other.
My 3 month PSA was 0.04 -undetectable. Only time will tell.
Jeff
DX Age 56. First routine PSA test on April 8th: 17.8. Start 2 weeks of Cipro to rule out protatitis.
May PSA: 22.6, 3 weeks later: PSA: 23.2.
Biopsy 6/10/09: 7/12 scores positive, Gleason 6=3+3. Bone scan and C/T scan negative.
RP DaVinci -7/21/2009 @ Univ of Roch Medical Center
Left nerve gone, right partial spared.
Catheter removed - 7/31/2009 Pathology report received:
Gleason 3+4=7 Tumor size: 2.5 x 1.8 cm location: both lobes and apex. No Malignancy in Seminal Vesicle, vasa deferentia, lymph nodes 0/13
Extraprostatic extension present; Perineural invasion: present, extensive
Prostate mass 56 grams. Pathologic Stage: pT3aN0MX
Post Surgery Status:
Potency - 12/11 5 months, Still no activity, zip. Using pump daily since 11/11.
Incontinence - 8/20 4 full pads per day
.. 9/7 3-4 full pads per day (I'm going to try cutting down on fluids. Bad idea. I know.)
. 9/27 2 months: Still 3 pads per day.
11/14 4 months: Still 3 pads per day. 420ml/day, 91 um leak.
12/11 5 months: Still 3 pads per day. 400-450ml/day Experimenting with Nyquil.
Post Surgery PSA - 9/3 6 weeks - 0.05; 10/13 3 months - 0.04 undetectable.


Carlos
Regular Member


Date Joined Nov 2009
Total Posts : 486
   Posted 12/14/2009 7:32 AM (GMT -6)   
Mel,

Ask your surgeon if he uses intra-op pathology. I think it is refered to as frozen section pathology. It takes about 15 minutes and includes checking the bladder neck and capsule margins. The uro can remove more tissue before closing you up if necessary. I knew the status of my margins before I left the recovery room.

Good luck,

Carlos
Diagnosed 2/2008 at age 71, PSA 9.1, Gleason 8 (5+3)and stage T1c.  CT and bone scan neg.
Robotic surgery 5/2008, nerves spared, bladder neck spared with pelvic floor reconstruction.
All margins, SV and lymph nodes were neg. 
Staged pT2c, Gleason sum 8 (5+3).
Continent at 6 weeks. 
PSA <0.1 at 18 months, Nov. 2009.


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 12/14/2009 7:39 AM (GMT -6)   
Mel, in a word "yes." My husband had EPE and the surgeon was pretty sure of the situation when he went in due to the location of the one of the positive cores on the biopsy. The EPE was in the posterior of the gland and the surgeon told me that he cut a much wider margin than he needed too around the entire gland to ensure clean margins. The nerve bundles were spared.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (single small EPE in posterior left). Perineural tumor infiltration present. Apex margin, bladder neck and SV negative. Final Gleason 3+4 SA. PSA: 0.0 til July 2009. August 2009 PSA was 0.1, in September it was 0.3 Met with radiation oncologist, CT scan and bone scan clean. Third PSA on October 16 - PSA BACK TO UNDETECTABLE! Next PSA scheduled for early December. No radiation treatment at this time!


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 12/14/2009 9:59 AM (GMT -6)   
Mel,
Yes, yes, and yes, in the hands of an experienced surgeon.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sess/72 gys ,cath #8 33 days, Cath #9 in 35 days, 12/7/9 - Cath #10 in place


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 12/14/2009 12:22 PM (GMT -6)   
It depends,
If the surgeon can see the extension or know exactly where it is he can get it. It doesn't mean that there are some PC cells that get left behind in the bed. You can't see microscopic cells. There are also other areas, not just the prostate bed in which positive margins can occur and these are limited as getting it all will cause permanent side affects, ie impotance, incontinence or rectal problems.
Positive margins don't necessarrily mean reocccurance and negative margins don't mean you are in the clear. They just up the probabilites in high risk PC. They have very little predictive value in low risk disease.
If there is any indication of probable positive margins from scans, DRE ect. Radiation would be a much more effective treatment choice as up to 15mm of the bed can be radiatied and hard to get to places near the bladder neck, seminal vesciles, and nerve bundles can be radiated without problems.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT

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