Margins question

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Ricky2
Regular Member


Date Joined Dec 2009
Total Posts : 97
   Posted 2/3/2010 10:49 AM (GMT -6)   
I am getting close to my first post-op PSA test and my anxiety is increasing. I keep going back to my post op pathology report and wondering what my margin involvement meant. My uro told me not to worry about that because it was so small and said that I would not die from PC. Here is what the pathology report said "margins involved by tumor, right mid anterior lateral margins: posterior left mid and base margins range from <0.1 to 0.25mm from tumor" Does that mean I had positive margins or does it mean it was that close to the very edge of the the prostate. Also when I input my Gleason score, PSA and positive margin into the Sloan Kettering nomogram it shows a 93% chance of non recurrence in 10 years..Those sound like great odds that I would take any day. Do you think I can "hang my Hat" on that?

This has been a great forum and I have gotten a lot out of the info here. Thanks for all you guys have done and thanks for answering the above questions. I wish you all the best of luck in your battle with PC and I have added you all to my prayers.

Ricky
Age 70

PSA 5/2008- 3.6, PSA 7/2009- 6.1, retested 9/2009-5.1.
Biopsy 9/2009. 4 of 12 positive. Gleason 3+4=7
CT and bone scan negative.
Robotic De Vince Surgery 10/29/2009. 1 night in hospital. No pain. Cath out on 11/6
Pathology Report: Gleason score 3+4. Margins slightly involved <.1mm to .25mm. Perineural invasion present, stage pT2c. Tumor 18%. Seminal Vesicle - absent, Lymph Nodes 0 of 6.
Continence- first 4 weeks after cath out Dry at night, rest of time, bladder held nothing. 6-7 pads per day. as of 12/30 no pads most of time. almost dry except for a few drips. I keep doing Kegels.
ED. Started VED on 12/17. 15 min every other day. 20mm cilias twice a week. No sign of life yet.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/3/2010 11:13 AM (GMT -6)   
Ricky,

That first post OP PSA is always a nerve wrecker. I think we all understand what you are feeling. Try not to read too much into your pathology report. I look forward to seeing you getting accepted into the all inclusive, all executive, grand Zero Club. That's what I am expecting for you.

David in SC
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
Post SRT PSA: 1/10 .12
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 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/10 - Corrective Surgery #4, and Caths #11 and #12 in at the same time


Ed C. (Old67)
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Date Joined Jan 2009
Total Posts : 2458
   Posted 2/3/2010 11:18 AM (GMT -6)   
Ricky,
PSA anxiety is something we all go through every time we get tested. It gets better after getting a bunch of zeroes but it never goes away. Hopefully, you will get a zero when tested and we will welcome you into our zero club.
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 in circumference.
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
11.5 months test 1/21/10 result 0.004


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 2/3/2010 12:39 PM (GMT -6)   
Ricky...in answering your question, I would say that you had positive margins based on your path report. The good news is in fact very very small amount. In fact 35 to 45% of the time, positive margins will be noted with nerve sparing radical surgery. And you are correct, the partin tables will indicate that 93% of the time in those with positive margins will never show progression of the disease.

It will be certainly nerve racking waiting on those psa tests from now on, but remember that the odds are definitely in your favor.

Take care,
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
                 12 month Oct 2009 .09 


geezer99
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Date Joined Apr 2009
Total Posts : 990
   Posted 2/3/2010 1:19 PM (GMT -6)   
First of all, remember that .25 mm is getting pretty close to microscopic. My hypothesis is that if the pathologist fails to find any positive margins in the surgeon's work for a week, then the pathologist has to buy the beer.

Remember that your (former) prostrate got pretty mashed being dragged out of you and sometimes this moves cells towards the edge.

Finally, the popular wisdom is that if any cells were left, they were likely cut off from their blood supply and died shortly after surgery
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
6 mo. PSA 0.00 -- 1 light pad/day


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 2/3/2010 2:05 PM (GMT -6)   
And... even if you do have positive margins, there is nothing you can do about it, and worry doesn't seem to help much.

Go, enjoy, life life, thankful for every day you have.

Got me waitimg for the PSA results too.

Good luck on your journey !
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 injection
No pads, 1/1/10,  9 month PSA < .01


Radical
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Date Joined Mar 2009
Total Posts : 739
   Posted 2/3/2010 2:16 PM (GMT -6)   
 
Ricky, check out the article below, may bring some answers to you...............Cheers Kev
 
 
 
 
http://urology.jhu.edu/newsletter/prostate_cancer410.php
Age 51yrs
6 out of 8 cores positive 3 X 60% / 3 X 10%
PSA 4 Gleason Score 3+4=7 Stage T1c
Robotic Surgery 24/12/08
Upgrade Gleason Score 4+3=7 Gleason Differential 60%/40%
Stage T2c Three small foci total volume <10%
Neg Margins and Nodes
Nil - Extraprostatic Extentions
Dry less than 1 week. ED- okay with Meds.
PSA at 12mths no change remains 0.03
"Everyday in Everyway I get better"


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7203
   Posted 2/3/2010 2:47 PM (GMT -6)   
Ricky:
 
I am in almost the exact same situation. My margin was 0.5 mm (worse than yours) but it was focal (ie: just one spot). For me, it is very depressing. But then when I try the Sloan nomograph, the percentages look very good. I am also sweating the first post-op PSA, on or about 3/1/10.
 
(Read the last part of my signature for the details!)
 
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. Result of biopsy:

5 out of 12 cores 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

REVISED BIOPSY REPORT: The previous was read by Umich. Slides were then sent to Dr. Menon at Ford Hospital. Here is their report (much better) -- changes in bold print below:

5 out of 12 cores positive. Gleason 3+4. More specifically: 2 cores were 3+3 (one 5% and the other 20%) on one side. On the other side, 3 cores were 3+4 (5%, 5%, 20%)

 Surgery with Dr. Menon at Ford Hospital,  1/26/10. He says all looked good. Spared nerves. Awaiting pathology report, set for 2/2/10.

Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland.

Lymph Nodes: Clear

Perineural Invasion: yes. Seminal Vessical Involvement: No

Extraprostatic Extension: yes

Positive Margin: Yes-- focal-- 1 spot .5mm

Final Weight is 52.7 gms

Incontinence: just joined that club-- definite leaks-- my guess is 1 pad during the day -- at night??? First night tonight!

 

 

 


zampilot
Regular Member


Date Joined Aug 2009
Total Posts : 152
   Posted 2/3/2010 3:36 PM (GMT -6)   
Ricky2,
My path report showed one positive margin, one doctor called it a 'close' margin, the other said it was "in the orange peel but not out". I did radiation anyway, just in case a cell or two did escape.

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 2/3/2010 4:39 PM (GMT -6)   
Found this interesting article on margins

http://urology.jhu.edu/newsletter/prostate_cancer410.php
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 injection
No pads, 1/1/10,  9 month PSA < .01


RickyD
Regular Member


Date Joined Dec 2009
Total Posts : 163
   Posted 2/3/2010 11:37 PM (GMT -6)   
Does Extraprostatic Extension imply a positive margin. Seems that if you have Extraprostatic Extension you must have positive margins.
Correct?
Age 55,  PSA = 4.97 on 11/17/09, DRE negative,
Biopsy 12/2/09: 1 of 12 cores positive with less than 5% volume
Gleason 3 + 3 = 6
Prostate Size Estimate on 12/2/09 = 28 cc


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 2/4/2010 7:14 AM (GMT -6)   
Ricky, your question about EPE is one I've asked myself many times since my husband's surgical path report showed a single focus of EPE in the posterior left. However, when I spoke to the surgeon initially about the path report, he stated that he was reasonably sure from the biopsy report that he would need to cut a wider-than-necessary margin around this part of the prostate. While the surgical path report stated the single focus of EPE, it went on to say that margins around apex and bladder base were free of tumor. In my husband's case, it would appear that all margins were negative for any cancer cells.

FYI: the surgeon's feeling about EPE in the posterior of the gland came about because one of the 10 cores taken during the biopsy was very close to the edge of the prostate. He went in figuring that something this close to the edge meant that the cancer had likely escaped the capsule. He decided beforehand where to cut, from what angle to approach the gland to avoid cutting too close, and to remove as much fatty tissue in that area as he could. So far, his strategy has worked. It would seem that our surgeon did an excellent job of studying the results of my husband's biopsy knowing exactly where each positive sample was and mapping his surgical strategy accordingly.
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. PSA: 0.0 til July 2009. August 2009- 0.1, September 0.3, October back to 0.0, December 0.0. Thank you God!


Ricky2
Regular Member


Date Joined Dec 2009
Total Posts : 97
   Posted 2/4/2010 9:27 AM (GMT -6)   
Rickyd,

It seems from other members path reports that you can have EPE without having positive margins. The question is how do the cell get beyond the capsule without going through the margin? My guess is that the cancer cell get into the blood stream and settle close to the prostrate. Everybody that has EPE has a stage 3 cancer. This can be still very localized and curable. Once the cells travel to the seminal vesicles, it becomes harder to cure because the cell have shown they can establish in other areas. Initially the cancer cell like to stay in the area that they are more comfortable with i.e.. the prostate. That is what I gotten out of my readings so far. One thing for sure, it is all a very complex subject.

Ricky
Age 70

PSA 5/2008- 3.6, PSA 7/2009- 6.1, retested 9/2009-5.1.
Biopsy 9/2009. 4 of 12 positive. Gleason 3+4=7
CT and bone scan negative.
Robotic De Vince Surgery 10/29/2009. 1 night in hospital. No pain. Cath out on 11/6
Pathology Report: Gleason score 3+4. Margins slightly involved <.1mm to .25mm. Perineural invasion present, stage pT2c. Tumor 18%. Seminal Vesicle - absent, Lymph Nodes 0 of 6.
Continence- first 4 weeks after cath out Dry at night, rest of time, bladder held nothing. 6-7 pads per day. as of 12/30 no pads most of time. almost dry except for a few drips. I keep doing Kegels.
ED. Started VED on 12/17. 15 min every other day. 20mm cilias twice a week. No sign of life yet.


Jstars
Regular Member


Date Joined Oct 2005
Total Posts : 489
   Posted 2/4/2010 11:21 AM (GMT -6)   
Ricky,

Yes I think you have a good handle on what PCa cells can and can't do. For one thing they don't have little legs that allow them to just get up and go wherever they want. They are cells and they will grow in a certain direction (and their descendants might then bust out down the line) but they don't just jog or slither out into the bloodstream. I know the pathologist also checks nerve sheaths as well as a means of escape -- not just blood vessels. As you said certain routes are probably more agreeable to cancer cells and other routes are downright dangerous since immune cells might attack them (although immune cells are not confined to any one area .. they can move in and out of blood vessels, nerve sheaths, lymph nodes etc -- wherever they are called to. Fascinating stuff for sure.
Age 58, 57 at DX, PSA Aug2008 7 4 ... June2007 4.7 (BPH + LUTS)
11/2008 Biopsy: 1 of 12 cores 5%, Gleason 3+3 - Sona showed size 140+ cc (110 grams post op).
02/03/09 open RRP surgery , Nerve sparing both sides, 1 day in hospital, Day 4 first BM,
Pathology Report: All margins clear - No Invasive spread - no change in Gleason score.
02/18/09 Cath out, passed a 1cm oblong STONE within hours.
03/06/09 Started Levitra@20mg / Viagra@100mg / (04/01) Cialis@20mg -- no real effect (thru 01/2010).
04/01/09, 07/07/09, 10/01/09, 01/15/10 PSA <0.1
08/09 MUSE@1000mcg +pump&plump - (80-90%) (alpro ache).
09/09 MUSE@500mcg +pump&plump + 2 advil - (80-90%) - (less Alpro ache).
10/09 TrimixGel@(500/300/100mcg): 1st:60%, 2nd:(pump&plump) 60%, 3rd(added 500mcg muse):70-80% --
12/09 MUSE@500mcg+Cialis@20 working well (>90%) and useful erection.
02/10 TrimixGel@1000/300/100mcg - first squirt -- 80-90% - just barely @ useful level. Needs Cialis I think.


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 2/4/2010 11:27 AM (GMT -6)   
Ricky....you are confusing positive margins with the membrane around the prostate called the capsule. A margin is edge where the surgeon dissects the tissue. So you can have capsule penatration (EPE) and have a surgeon cut large enough away to have a clean margin (surgical cut)

Latest thought is that if there is a positive margin, then there was no way to accurately determine if there was any EPE or not at that location. That is why they are beginning to call postive margins as a T3 disease.

Progression of the disease with positive margins or with EPE are basically the same. Still a 90 to 95% recurrance free and if the psa begins to rise after surgery, it will most likely be local. T3 with seminal or lymph node involvement is in a higher risk catagory and psa progression maybe more systemic, rather than local.
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
                 12 month Oct 2009 .09 


Ricky2
Regular Member


Date Joined Dec 2009
Total Posts : 97
   Posted 2/4/2010 12:03 PM (GMT -6)   
Thank you Les,

You greatly increased my understanding of the terms.
Age 70

PSA 5/2008- 3.6, PSA 7/2009- 6.1, retested 9/2009-5.1.
Biopsy 9/2009. 4 of 12 positive. Gleason 3+4=7
CT and bone scan negative.
Robotic De Vince Surgery 10/29/2009. 1 night in hospital. No pain. Cath out on 11/6
Pathology Report: Gleason score 3+4. Margins slightly involved <.1mm to .25mm. Perineural invasion present, stage pT2c. Tumor 18%. Seminal Vesicle - absent, Lymph Nodes 0 of 6.
Continence- first 4 weeks after cath out Dry at night, rest of time, bladder held nothing. 6-7 pads per day. as of 12/30 no pads most of time. almost dry except for a few drips. I keep doing Kegels.
ED. Started VED on 12/17. 15 min every other day. 20mm cilias twice a week. No sign of life yet.


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 2/4/2010 3:28 PM (GMT -6)   
Les, thanks for that great explanation of EPE...certainly puts my mind at ease!
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. PSA: 0.0 til July 2009. August 2009- 0.1, September 0.3, October back to 0.0, December 0.0. Thank you God!


Radical
Veteran Member


Date Joined Mar 2009
Total Posts : 739
   Posted 2/4/2010 3:35 PM (GMT -6)   
 Les -   Yes once again Les thankyou for that explanation regarding positive margins, certainly makes it a little easier to understand.
 
Q.    Does it mean then that all positive margins are in effect, EPE or has the surgeon accidently cut into the prostate capsule, now creating a positive margin ?
 
Kev
Age 51yrs
6 out of 8 cores positive 3 X 60% / 3 X 10%
PSA 4 Gleason Score 3+4=7 Stage T1c
Robotic Surgery 24/12/08
Upgrade Gleason Score 4+3=7 Gleason Differential 60%/40%
Stage T2c Three small foci total volume <10%
Neg Margins and Nodes
Nil - Extraprostatic Extentions
Dry less than 1 week. ED- okay with Meds.
PSA at 12mths no change remains 0.03
"Everyday in Everyway I get better"


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 2/4/2010 5:29 PM (GMT -6)   
Kev...honestly don't know exactly the answer to the question...however it has been thought that the surgeon cut across the boundary of the capsule during surgery...or due to handling of the prostate. Keep in mind, this membrane around the capsule is very microscopic. That is why when a surgeon tries to save the nerves, he has to shave very close to this membrane and often times will cut into the membrane or when removing and handling the prostate, the membrane gets worn away and exposes the cancer cells. If the membrane gets worn away during handling, it will show up in pathology as a positive margin...but the truth is that no cancer cells actually remained behind. Regardless, the outcome is the same, so don't put too much into the positive margins until there are three consective rises in the psa following the surgery.

This is one of the reasons for obtaining the most skilled surgeon for the method of surgery performed to reduce the chances of a positive margin.
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
                 12 month Oct 2009 .09 


Radical
Veteran Member


Date Joined Mar 2009
Total Posts : 739
   Posted 2/4/2010 7:58 PM (GMT -6)   
Cheers Les, Thanks for you time in explaining that, makes sense................Kev
Age 51yrs
6 out of 8 cores positive 3 X 60% / 3 X 10%
PSA 4 Gleason Score 3+4=7 Stage T1c
Robotic Surgery 24/12/08
Upgrade Gleason Score 4+3=7 Gleason Differential 60%/40%
Stage T2c Three small foci total volume <10%
Neg Margins and Nodes
Nil - Extraprostatic Extentions
Dry less than 1 week. ED- okay with Meds.
PSA at 12mths no change remains 0.03
"Everyday in Everyway I get better"


Radical
Veteran Member


Date Joined Mar 2009
Total Posts : 739
   Posted 2/5/2010 3:34 PM (GMT -6)   
 
Ricky -Just found another interesting article, all good positive stuff...............Kev
 
 
 
 
http://www.medwire-news.md/381/86221/Prostate_Cancer/Positive_surgical_margins_after_RP_do_not_predict_prostate_cancer-specific_mortality.html
Age 51yrs
6 out of 8 cores positive 3 X 60% / 3 X 10%
PSA 4 Gleason Score 3+4=7 Stage T1c
Robotic Surgery 24/12/08
Upgrade Gleason Score 4+3=7 Gleason Differential 60%/40%
Stage T2c Three small foci total volume <10%
Neg Margins and Nodes
Nil - Extraprostatic Extentions
Dry less than 1 week. ED- okay with Meds.
PSA at 12mths no change remains 0.03
"Everyday in Everyway I get better"


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7203
   Posted 2/6/2010 11:17 AM (GMT -6)   

NOTHARD:

 

That article was interesting, but I have some concerns. First of all, they defined reoccurence as 0.4 PSA. I think the true yardstick is 0.2.

Also, I don't like that 57% figure. It seems the Sloan-Kettering nomograph gives a much higher percentage. Am I missing something?

 

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. Result of biopsy:

5 out of 12 cores 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

REVISED BIOPSY REPORT: The previous was read by Umich. Slides were then sent to Dr. Menon at Ford Hospital. Here is their report (much better) -- changes in bold print below:

5 out of 12 cores positive. Gleason 3+4. More specifically: 2 cores were 3+3 (one 5% and the other 20%) on one side. On the other side, 3 cores were 3+4 (5%, 5%, 20%)

 Surgery with Dr. Menon at Ford Hospital,  1/26/10. He says all looked good. Spared nerves. Awaiting pathology report, set for 2/2/10.

Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland.

Lymph Nodes: Clear

Perineural Invasion: yes. Seminal Vessical Involvement: No

Extraprostatic Extension: yes

Positive Margin: Yes-- focal-- 1 spot .5mm

Final Weight is 52.7 gms

Incontinence: just joined that club-- definite leaks-- my guess is 1 pad during the day -- at night??? First night tonight!

 

 

 

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