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Herophilus
Veteran Member


Date Joined Sep 2009
Total Posts : 664
   Posted 3/12/2010 10:16 PM (GMT -6)   

Good Evening

Regardless of what type of surgical intervention (open, lap, robotic) how many of you asked your surgeon what his/her positive surgical margin rate was?

Hero


Age 51, PSA 08/31/2009= 6.8, DRE Neg.
Biopsy 9/24/09 =10 of 12 positive. Gleason 6. involving up to 75%
da Vinci at Wash U, Barnes on 11/02/09
Modified Pathology, Gleason 4 + 3 = 7. Gleason 7 present throughout Prostate.  Negative surgical margins
4 of 4 periprostatic Lymph Nodes Negative, 10 of 10 pelvic Lymph Nodes Negative. Seminal Vesicles tumor free. No prostate extension
Post-op PSA 12/10/2009, Undetectable
12/12/2009, Pad Free and Started jogging.


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 3/12/2010 10:26 PM (GMT -6)   
Honestly, I didn't know what a margin was. I did ask his success rates, and how many surgeries he had done.
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


Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4119
   Posted 3/12/2010 10:34 PM (GMT -6)   
Like Goodlife. Did not know what a margin was. I wish I had known what I know now..I would have had many more questions.

Cajun Jeff
AGE:58, 57dx. PSA 5.4
Biopsy: 9/08 Gleason 3+4=7
open RP: 10?08 Nerve sparing. Path Report : GS 3+3=6 Stg pt2c margins clear
Cath for 10 day. Dry day after removal of Cath
PSA @ 3 months <0.1
6 months <0.1
9 months <0.1
12 months <0.1
16 months <0.1

ED Started VED at 3 months, pills followed VCL none did much, tried MUSE at 9 months (YUCK) Hated it. 15 months out injections Caveject (succecc)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 3/12/2010 11:11 PM (GMT -6)   
Having had cancer surgery 3x before, that was one of my original questions with my surgeon, along with a long list of others.
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, no problem post SRT
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, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, Caths #13 & #14 same time, 3/6 Cath #13 out - 4 days


deer hunter
Regular Member


Date Joined Jan 2010
Total Posts : 250
   Posted 3/13/2010 6:57 AM (GMT -6)   
Hopefullly this forum will help the newcomers that have yet to do either. I wish i had know what to ask but was in shock and in total areea about what to do in the situation .Iwish i would have ask more guestion!!!!!!!!!!!!!!
DEERHUNTER
dx age 57 01/06 open RP 4/06 psa in 01/06 8.1  surgery path report Gleason 3+4=7 poorly differentiated  tumor was 90%involved in both lobes surgical margins postive. in the right apex and right radial margins tumor grade G3  perineural invasion present high grade of PIN found  T2c NX MX PSA 0706  .01 10/06 .02 01/07 .03 04/07 .04  06/07 .05  07/07 .08 07/07 bone scans pelvic ct neg. 08/07 proscintic scan neg.9/07 psa.10 net with rad onc. wanted to do SRT but i did not do it 10/07  saw a new dr at Emory University [my old dr urg. suggested second opinion ]  bone scans negs ct scans pelvics neg. biopies of the bladder and adrinal glands neg.another proscintic scan neg.12/07 Psa .11 clinial trial Emory injected with protons to try and find the cancer cells no luck 3/08 psa .17 06/08 psa .23 psa 09/08 psa .32 12/08 psa .39 3/09 psa .39 6/09 psa .43  meet with medical onc. he said  i might have waited to long to start SRT 7/09 psa .50  another bone scan ct scan all neg.MRI neg. meet rad. onc. 7/09 started casdex 50mg 1 day for 30 days 2 shots of lupron started rad treament 10/09 40 treatments 75 gm 12 shots each time all aroud pelvic finished 12/09  psa .07 and psa 01/10.05 next dr visit 03/10 wait and see!!!!!!


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 3/13/2010 8:01 AM (GMT -6)   
This why guys like me post QUESTION EVERYTHING and get a real education, get past the biases. Also, do you think your doc is going to tell you about his unsuccesses or errors?? So, he is naturally going to tell you a sugar coated version of how perfect he/she is, do more checking, consider their words carefully.
We as patients are gullible, naive and under educated and therefore easily persuaded in most instances. How many of your docs advised you please seek other opinions then come back and see me????? Maybe heard 1-2% of the time is my guess. I had been lied to more than once and fortunately made different plans that were to my best interests, your case may be different of course, but it can be a jungle is the message.
Youth is wasted on the Young-(W.C. Fields)


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3741
   Posted 3/13/2010 8:36 AM (GMT -6)   
I didn't. But here's a question for you. If I had, how would I know the number he gave was true? We were alone in a room with nothing being written down. What is to stop him from inflating results? (I like my Uro by the way.)
I'd like to see that information on a verifiable public site like Better Business Bureau statistics on stores and services or an Angie's List for Uros. I know the data is "confusing" and "difficult" but we'll figure it out.
Jeff - the leaking one
Married 34 years, DX Age 56. First routine PSA test on April 8, 09: 17.8. Start 2 weeks of Cipro to rule out protatitis. May '09 PSA: 22.6, 3 weeks later: PSA: 23.2.
Biopsy 6/10/09: 7/12 scores positive, 20%-70%, Gleason 6=3+3. Bone and C/T scans neg.
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.
Extraprostatic extension present; Perineural invasion: present, extensive.
No Malignancy in Seminal Vesicle, vasa deferentia, lymph nodes 0/13
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. No effect with 20 mg of Cialis or 100 mg of Viagra. Shots next See Uro 1/22/10 Trimix #1. Try 0.08- 25%, 0.12-25%, 2/26/10 try 0.16 First Success! 90%.
Incontinence - 8/20 4 full pads per day
.. 9/7 3-4 full pads per day (Try cutting down on fluids. Bad idea. I know.)
12/11 5 months: Still 3 pads per day. 400-450ml/day
2/26/10 7 months: Still 3 pads but leak is now 320 ml (5 day avg.)
Post Surgery PSA - 9/3 6 weeks - 0.05; 10/13 3 months - 0.04, 1/14 6 months - 0.05.


60Michael
Veteran Member


Date Joined Jan 2009
Total Posts : 2243
   Posted 3/13/2010 8:38 AM (GMT -6)   
You are all right, sorry but I didnt think about a margin, and I am convinced my surgeon would have pulled his answer out of the air. But hopefully this will help others and I think you have to ask others about different Dr.'s to get a true idea of their craft and success.
Michael
Dx with PCA 12/08 2 out of 12 cores positive 4.5 psa
59 yo when diagnosed
Robotic surgery 5/09 Atlanta, Ga
Catheter out after 10 days
Gleason upgraded to 3+5, volume less than 10%
Margin slightly involved
2 pads per day, 1 depends but getting better,
8/5 1 depend at night only, now none
 started ED tx 7/17, slow go
Post op dx of neuropathy
3 months psa.01, 6 month psa.4, 6 1/2 month psa.5
Starting IMRT on 1/18/10
Great family and friends
Michael


Herophilus
Veteran Member


Date Joined Sep 2009
Total Posts : 664
   Posted 3/13/2010 9:07 AM (GMT -6)   

I didn’t ask… however my younger brother (turned 47 in December) has a 3mm positive margin. In researching hours on the subject of biochemical failure in individuals with positive surgical margins, I have come to believe that asking the following 2 questions supersedes all other questions…or at least it would if I had to do it over again.

1. What is your rate for surgical margins. To be asked in the positive or negative, it is up to you. As an example if your having an open procedure I’d ask…What is the overall rate of negative surgical margins as a percentage of all same surgeries?

2. What is the percentage of biochemical failure as a percentage of all same surgeries?

Hero


Age 51, PSA 08/31/2009= 6.8, DRE Neg.
Biopsy 9/24/09 =10 of 12 positive. Gleason 6. involving up to 75%
da Vinci at Wash U, Barnes on 11/02/09
Modified Pathology, Gleason 4 + 3 = 7. Gleason 7 present throughout Prostate.  Negative surgical margins
4 of 4 periprostatic Lymph Nodes Negative, 10 of 10 pelvic Lymph Nodes Negative. Seminal Vesicles tumor free. No prostate extension
Post-op PSA 12/10/2009, Undetectable
12/12/2009, Pad Free and Started jogging.


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3741
   Posted 3/13/2010 9:15 AM (GMT -6)   
How would we know the numbers were true? Would you ask for a written copy? Do you think you'd get it?
Just askin'

The answers need to come from an independent outside source.

Herophilus
Veteran Member


Date Joined Sep 2009
Total Posts : 664
   Posted 3/13/2010 9:27 AM (GMT -6)   

I believe that the answer would be covered under the medical legal concept of informed consent. I also believe most surgeons would realize that the true numbers would be easily discoverable. So yes I believe that you would be given an accurate answer reflective of the expected outcome.

Hero


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 3/13/2010 9:40 AM (GMT -6)   
Like to see some more input an answer to your question. Can't believe I would have been only surgery guy that did ask. Perhaps it just doesn't come to mind if you have never dealt with a cancer surgery or perhaps any surgery in general.

With my previous cancers, it was due to poor surgical margins, that I had to deal with recurrance not once, but twice. A sloppy small town surgeon bungled the first one. The second one, a more qualified and different surgeon admitted after the recurrance happened, that he must not have cut quite enough By the 3rd surgery, I was with a major surgeon, and he did a good job, but by then, it had spread enough to where it involved a lot of comlplex plastic surgery on the top of my head, long recovery time.

With any kind of cancer, even a "simple" skin cancer, that is an important question.

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, no problem post SRT
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, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, Caths #13 & #14 same time, 3/6 Cath #13 out - 4 days


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 3/13/2010 9:58 AM (GMT -6)   
I didn't ask, as I didn't really know that much about the details of being an informed, questioning patient at the time. However, his answer could be anything, and still not be accurate or true.
James C. Age 62
Co-Moderator- Prostate Cancer Forum
Gonna Make Myself A Better Man: www.youtube.com/watch?v=a6cX61oNsRQ&feature=channel
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
32 mts: PSA's: .04 each test since surgery, ED Continues-Bimix .3ml PRN or Trimix .15ml PRN


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 3/13/2010 12:25 PM (GMT -6)   
I will admit I had never heard of that term when I was preparing for surgery. I did not question my surgeon at all nor his experience. I just wanted to get it done and move on. WOuld I have done things different now that I am equipped with more knowledge?? The answer is no, I feel like I made the best decision for me.
thanks for the question

peace to you
dale
My PSA at diagnosis was 16.3
age 47 (current)

http://www.caringbridge.org/visit/dalechildress

My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11

PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
PSA July 28th 2009 is .01
PSA OCt 15th 2009 is .11
PSA Jan 15th 2010 is .13

Testosterone keeps rising, the current number is 156, up from 57 in May

T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 3/13/2010 3:11 PM (GMT -6)   
The question is, is there an implication that positive margins are the fault of surgeon ? According to what I understand, a surgeon can obviously cause a positive margin, and there is a correlation between number of surgeries or experience and positive margins.

But, there is also just facts. If the cancer has spread beyond the capsule, and to the point where it cannot be trimmed around, it is hard to fault the surgeon.

We have men on here who have had highly experienced surgeons who have had positive margins. Did he/she have a bad day at the office ? Or was it just too late for it too be cut out cleanly.

Now who is at fault ? Not having regular PSA screenings ? Not taking rising PSA seriously ? Or a bad surgeon ? What percent of the time is it the state of the cancer and what percent is surgeon error ?

That is the problem with some of these questions. Who can say with certainty ?

I guess I have just had to resolve myself to the old cliche we say around here, it is what it is .
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


kuls
Regular Member


Date Joined Mar 2010
Total Posts : 57
   Posted 3/13/2010 3:15 PM (GMT -6)   
We have yet to make a treatment decision, ( considering surgery, Brachy, Active Surveillance) but will be having consults with a local urologist who performs open RPs, and one in Edmonton who performs robotic RPs.

Some of the questions we will be asking will be:

-What is your rate of positive post - op margins for surgery on men with a similar Stage/Gleason Score/ tumor volume?

-Does that positive margin incidence increase with bilateral nerve sparing? (i.e. is there a higher rate of local recurrence)?

-Do repeat biopsies make it more difficult (scar tissue) to acheive nerve-sparing and negative margins

Also, we'll be asking for other information as far as the number of procedures he's done, as well as whether or not he performs them consistently, or if he "blocks" them.
-Husband's 1st PSA done (age 45) at routine physical  PSA 3.8
-DRE at physical indicated no abnormality other than slightly enlarged
-Consult with urologist Jan. 2010---DRE negative, PSA 3.89
-Biopsy Feb. 10, 2010:  T1c, Gleason 3 + 3, 2/10 cores pos. (5% in one core, <5% on other core) 1% of core volume positive, gland size     38.84


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 3/13/2010 3:35 PM (GMT -6)   
goodlife, the various scenarios you present are all correct possibilities, and there would be no 100% postive way to know for sure. some people are "blame" people, and some people are "solution" people. the "blame" game is one reaason there are so many silly lawsuits flying around all over the place.

you are correct too, we have brothers that had some of the nations best surgeons at some of the best hospitals in the country, and still had poor results, as they use to say in my day, "Shi* happens".

mind you, there are bad surgeons, that try to cover up their mistakes, and there are very inexperienced surgeons, that just don't have their learning curve done yet, thus we always preach about finding very experienced surgeons, whether it be robotic or open. But as we know by example, even that doesn't guarantee anything.

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, no problem post SRT
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, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, Caths #13 & #14 same time, 3/6 Cath #13 out - 4 days


Carlos
Regular Member


Date Joined Nov 2009
Total Posts : 486
   Posted 3/13/2010 3:44 PM (GMT -6)   
I chose my surgeon because of his track record with margins and continence.  He also used intra-op pathology because he felt it improved the odds for negative margins.  He has presented his data at uro conferences so I presume it is reasonably honest.   My current uro says the statics are just numbers and are meaningless from an individual standpoint.  If the surgeon has a 95% sucess rate but you are in the 5% failure group, it has been a bad day.
 
Carlos

Diagnosed 2/2008 at age 71, Gleason score 5+3=8, stage T1c, PSA 9.1. 
Robotic surgery 5/2008, nerves spared, All margins, SV and lymph nodes negative. 
Staged pT2c, Gleason score 5+3=8.  PSA <0.1 at 20 months, Jan. 4, 2010.


Herophilus
Veteran Member


Date Joined Sep 2009
Total Posts : 664
   Posted 3/13/2010 4:56 PM (GMT -6)   

As related to the question of positive margins…To be sure I usually like my data set to be scrubbed of all dirt and noise. However that is not the case with this situation. You want the number (which will be alarming high) for all like surgeries. That is to say include the old, and the young, include the Gleason 8 and the Gleason 6, nerve sparing, and non-nerve sparing. The theory for the most part would hold that you are just one in the overall data set (you actually are) Your Gleason 6 may actually be a Gleason 8, you may or may not request nerve sparing procedure. This number, regardless of how much noise it contains, is a significant number. Two excellent studies just published are excellent reads as to positive margins. One common theme is that while all surgeons have positive surgical margins, the fact remains that “margin status is unique that it is the only variable that can be affected by surgical technique…” From Lake, Chang, Wood…”Focal Positive Surgical Margins Decrease Disease-Free Survival after Radical Prostatectomy Even in Organ-confined Disease". The other real good publish this month is from the March 2010 Urologic Oncology “Margin control in open radical prostatectomy: what are the real outcomes?” They are rather long and have a bunch of technical stuff (Multivariate cox regression analysis, Kruskal-Wallis analysis, Kaplan-Meier methods) but they are full of important points.

Hero


Timm
Regular Member


Date Joined Feb 2010
Total Posts : 83
   Posted 3/14/2010 2:17 AM (GMT -6)   
Can someone give me a basic definition of positive margins? As I understand it, it's the margin between good and bad tissue removed.

Tim


58yrs.
PSA. 6.74
8 of 12 cores pos.
gleason 3+4+ 7
Robotic, April 14

brainsurgeon
Regular Member


Date Joined Jul 2009
Total Posts : 137
   Posted 3/14/2010 2:55 AM (GMT -6)   
To me, a margin is the edge of the specimen, positive or not. It is a microscopic term, not a gross thing that one can see (hopefully).

So here I am, the surgeon, and there you are, the patient. I am purposing an operation and in giving your informed consent, you must know the risks. I say that there are really only three bad things that can happen, paralysis, coma, and death. Fair enough? That is exactly what I used to tell my patients. I also wrote it in the chart and did it with a nurse witness at hand. You would be shocked at how few patients asked about the odds of those things happening. If they did ask, then I could honestly say that in today's world, the odds were minuscule, but as we all know 100% of minuscule is a 100%. When I sat down to speak with my doctor and watch his diagrams, I asked him to tell me things that could go wrong. There were no surprises. My surgery was a b*tch, but only for him.

These sessions ended with, "are there any questions"? I heard this at least a half dozen times. Nobody ever mentioned the word "cure".
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


rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1132
   Posted 3/14/2010 8:49 AM (GMT -6)   
Hero, good question. I did not ask. Someone said I should have asked the doctor how many patients he lost of the table. I didn't because there would be way too many possibilties. Also, I think most folks was pc asked me to ask about nerve sparing and continent issues. Thanks for othe post. I will ask this to the do's to quesitons for new members to ask.
 
Age 49
occupation accountant
PSA increased from 2.6 to 3.5 in one year
biopsy march 2008 - cancer present gleason 7
Robotic Surgery May 9, 2008 - houston, tx
Pathology report -gleason 8, clear margins
20 month  PSA <.04 (low as the machine will go)
continent at 10 weeks (no pads!)
ED is still an issue but getting better


Herophilus
Veteran Member


Date Joined Sep 2009
Total Posts : 664
   Posted 3/14/2010 2:13 PM (GMT -6)   

Timm,

A margin in terms of cancer surgery is just as you described. A Positive margin would indicate that cancer cells/glands are microscopically identified along that boundary. (this could be a bad margin, if you will) A Negative margin would not contain any cancerous cells/glands, along that boundary (this would be good). From what I have been reading, the oncology and pathology disciplines further define this positive margin as FOCAL or EXTENSIVE. A focal margin is equal to or less than 3 mm. Extensive margin is greater than 3 mm. The importance is that studies are quite convincing that even a positive focal margin conveys a greater risk of biochemical reoccurrence of prostate disease (PSA). Then the BIG question is what in the heck do you do?

Hero


Age 51, PSA 08/31/2009= 6.8, DRE Neg.
Biopsy 9/24/09 =10 of 12 positive. Gleason 6. involving up to 75%
da Vinci at Wash U, Barnes on 11/02/09
Modified Pathology, Gleason 4 + 3 = 7. Gleason 7 present throughout Prostate.  Negative surgical margins
4 of 4 periprostatic Lymph Nodes Negative, 10 of 10 pelvic Lymph Nodes Negative. Seminal Vesicles tumor free. No prostate extension
Post-op PSA 12/10/2009, Undetectable
12/12/2009, Pad Free and Started jogging.


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2460
   Posted 3/14/2010 7:22 PM (GMT -6)   
I didn't ask about margins but I did ask how many robotic surgeries he has performed. I also told him to be aggressive in removing nerve bundles and tissues if there was any doubt.
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


Timm
Regular Member


Date Joined Feb 2010
Total Posts : 83
   Posted 3/15/2010 11:32 AM (GMT -6)   
Thanks Guys
 
             Tim
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