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Tumor location--is one spot worse than another?

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Tumor location--is one spot worse than another?  
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Posted 2/9/2010 10:41 PM (GMT -7)

Just curious: is one location any worse than another?

What about for a positive margin?

Mel

63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: 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: joined that club-- definite leaks—1 pad/day. Night is dry but using 1 pad at night for security.

Next Event: First post-op PSA on 3/1/10

Posted 2/10/2010 1:13 AM (GMT -7)
Good question. I don't know the answer. I have read recently that a positive margin does not automatically mean anything, and SRT should be determined by PSA levels in the future. Others here may have more information on this. Don't look at this margin as a certain indication for anything other than watching the PSA. What did your doctor say about it?
70 years old (1939) USA citizen
Prostatic carcinoma dxed June 2009 by PSA (7.0) and then Bx
PSAs yearly since 2001 ranged 1.52 to 7.0. Doubled from 3.5 to 7.0 in one year.
Neg. CT and Bone Scan
4 of 8 biopsies positive (all right side) Gleason Score 3+4=7
Robotic assisted total prostatectomy and node excision July 2009 in Luzern, Switzerland by Dr. A. Mattei in the Kantonsspital. New Gleason was 4+4=8
pT2c G3 pN0 (0/14 nodes +, Margins, etc. clear
Catheter out in 5 days (home in 3 days). No incontinence
Positional neurpraxia in hip and knee resolved 90+% in 5 months.
Potency: beginning tumescence??? at 3 weeks post-op. Still happens at 3 months PO. Nearly usable one month later. At 5 mo. with 100 mg Vitamin V, pretty good. Now beginning 5 mg Cialis daily.
3month PSA less than 0.01, 6 month PSA less than 0.01

Posted 2/10/2010 3:36 AM (GMT -7)
I don't think the location of a positive margin can be as important as the fact that it is there.

Seminal Vesicle Invasion (which I had) is for example seen as worse as it indicates that the cancerous cells have been able to establish themselves outside the prostate.

Alf
Posted 2/10/2010 7:18 AM (GMT -7)
It appears that apical margins and tumors are worse than one that is in the middle of the prostate. A margin alonside the nerves is also bad because the cells can get into the nervous and lymph systems and have a pathway to other parts of the body.
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

Posted 2/10/2010 7:32 AM (GMT -7)
My Guess: Tumors on the Outside are worse then the ones on the Inside.

but - then you have to factor in "when detected" /size etc.....

As usual - there probably isn't a one size fits all answer.

Age 54   - 5'11"   205lbs

Overall Heath Condition - Good

PSA - July 2007 & Jan 2008 -> 1.3

Biopsy - 03/04/08 -> Gleason 6 

06/25/08 - Da Vinci robotic laparoscopy

05/14/09  - 4th Quarter PSA -> less then .01

11/20/09 - 18 Month PSA -> less then .01

Surgeon - Keith A. Waguespack, M.D.


Posted 2/10/2010 7:42 AM (GMT -7)
Found on www.pubmed.com, a paper titled: "Zonal location of prostate cancer: significance for disease-free survival after radical prostatectomy?"

http://www.ncbi.nlm.nih.gov/pubmed/12837427

I suspect that with the right search words, you could find additional reports on pubmed. I stopped looking when I found this concluding statement which appears to directly answer your question: "The location of prostate cancer in the TZ was associated with a greater overall biochemical cure rate after radical prostatectomy." (TZ is the Transitional Zone)
Posted 2/10/2010 7:50 AM (GMT -7)
OK, I found another one on pubmed that you'd be interested in, Mel.

This one says in the conclusion, "Although longer followup and validation studies are necessary for confirmation, patients with a positive margin less than 1 mm appear to have similar recurrence rates as those with negative margins." (Yours, I've noted, was 0.5mm.)

The paper link is here: http://www.ncbi.nlm.nih.gov/pubmed/19450829?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=1

You might want to do your own pubmed search...probably better technical info than from a chat room environment on the internet. To find the paper above, I used these search terms: "prostate cancer" location "positive margin"

It looked to me that there were other papers with relevant info...the quote I extracted was from the very first paper that popped up. I didn't look further.
Posted 2/10/2010 8:52 AM (GMT -7)
Tumor location only has value prior to surgery. The surgeon wants to know where it is at in order to make a wide as possible margin around the tumor growth in an effort to remove the cancer. Sometimes the location near the apex and the base can be a bit tricky, so the surgeon needs to know to avoid any surprises.

Tumor location after surgery generally is meaningless for prognostic value.

As others have already stated, the positive margin in your case is very small and should be viewed in the same light as a negative margin at this point.
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 

Posted 2/10/2010 10:06 AM (GMT -7)
When I interviewed surgeons before my surgery, a common theme they discussed was that a minimal protrusion beyond the margin was regarded as basically contained from a future prognosis point of view. Yours sounds like the equivalent of contained if I had to guess. The good news which you get from surgery is that you know exactly where the tumor was located and your future psa blood tests will tell the rest of your story.
Age 54
PSA 8/2009 5.6 Gleason 8
DaVinci surgery 11/2009
Pathology - totally contained in margins -one bundle spared
PSA now undetectable at < .05
Continance: Night and morning fine and improving
Doing 3 P's and now using trimix

Posted 2/10/2010 10:21 AM (GMT -7)
Les is right on, but I would expand it futher to the fact that tumor location is importantant in eliminating surgery as the best option.
If a tumor is in the peripheral zone and shows extra capsular extension, surgery may not be the best option.
Also transition zone tumors have a very high probability of being contained, but are problamatic for surgeons.
Tumors next to the seminal vesciles are also problematic.
I also understand that tumors in the Apex have a high degree of positive margins.
Dr Bahn considers tumor location one of the most important elements in clinical staging and in many cases will dictate the treatment option.
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

Posted 2/10/2010 10:37 AM (GMT -7)
John & Les, you guys are both correct regarding knowledge of tumor location going into surgery...but Mel has already had surgery, and so I interperted his question to be having to do with the implications of tumor location after surgery.

With regard to the paper I referenced above ("Zonal location of prostate cancer: significance for disease-free survival after radical prostatectomy?"), I agree with Les's comments that location was not determined to be a statistical independent variable (in predicting BCR). Rather, the independent variables for BCR reported here were lymph node involvement and Gleason score. One would say that it "just happened to turn out" that most tumors were located in the TZ when there was BCR.

The follow-up comment & report on size of margin is the more important factor on BCR.

Post Edited (Casey59) : 2/10/2010 10:46:14 AM (GMT-7)

Posted 2/10/2010 4:51 PM (GMT -7)
Mel, mine was right at the edge but did not escape. My guys exact words were " I dont think further treatment will be necessary" Don`t get freaked out brother, Tim
Dx at 50 in 12/09 Merry Christmas its cancer....

3 of 12 positive, right side only, psa at dx 2.6 free%14

gleason 3+3=6

routine physical, no symptoms

Da Vinci performed Feb 2k10 by Dr Marc Milsten [hes got mad skills]

99% continent from cath out, we`ll see about mr happy

path showed same gleeson with no other blips other than one slight margin, organ confined 20% right, 5%left, 34grams

 

Posted 2/10/2010 5:09 PM (GMT -7)
Tim,

One thing I think we have to learn in this game ( or at least I have ), is that doctors sometimes say the darndest things. Fact of the matter, there is a lot they don't know. That is why we politely say thanks, and then examine the pathology, the surgical report, the follow up PSA's and any other thing we can to insure that they indeed did get it all, or if they didn't, what our next step is.

I hear too many times on this forum where the doctor said this or that , and he/she was wrong, misinformed, or confusing us with one of his other 20 patients of the week. We must insist on 3 month followup PSA's, (ultrasenisitive in my opinion), and be ready to act when we start to signs of reoccurence.
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

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