Negative margins

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Regular Member

Date Joined May 2010
Total Posts : 84
   Posted 7/30/2010 9:29 AM (GMT -6)   
I got the call from Dr Catalona last night with the final pathology report from my RRP. In short, the cancer was aggressive, it was extensive, and it was penetrating out of the capsule in multiple directions, BUT the margins were clear.
Final GS was 4+3 with a tertiary (less than 5%) showing a 5. Tumor was 30-40% of total sample, with involvement on both sides. Seminal vesicles were involved. Lymph nodes were clear, but there is one line that says lymphovascular invasion identified. The tumor was rated pT3b and the nodes were pM0.
In short, it looks like we nailed it in the nick of time but the outlook at this point is pretty good.

Veteran Member

Date Joined May 2009
Total Posts : 2692
   Posted 7/30/2010 10:18 AM (GMT -6)   
I would say kiss the surgeon next time you see him. He/she did a great job.

The seminal vesical involvement can be as bad as a posotive margin. The LV invasion is fairly common, and it draws mixed reaction from doctors. It is however, another potential conduit to the outside.

Certainly you will be on 3 month interval PSA's for a couple of years, so you will need to watch it carefully. Some radiation guys would probably still recommend adjuvant radiation with the pt3b.

Glad to hear it went well, and good luck on your journey.
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
1 year psa (364 days) .01
15 month PSA <.01

Veteran Member

Date Joined Nov 2009
Total Posts : 1100
   Posted 7/30/2010 1:21 PM (GMT -6)   
You certainly had one of the nation's (world's?) leading surgeons. Given the path report, I would at least discuss with Dr. Catalona and also with a radiation oncologist the use of adjuvant radiation. I am not saying I would go that route -- I don't know -- but I would at least have the conversations.
Age 46.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5, 1.5

Regular Member

Date Joined May 2010
Total Posts : 84
   Posted 7/30/2010 2:39 PM (GMT -6)   
We did broach the need for RT in our conversation. He stated that most people in my situation would take a watchful approach and see what the PSA tests show. He thought that was valid approach for me in this situation.

Veteran Member

Date Joined Nov 2009
Total Posts : 7270
   Posted 7/30/2010 2:56 PM (GMT -6)   
My report was a little worse than yours (same GS, but one positive margin, ecp, and pni, but no seminal vessicle involvement) but very similar.
My doctors did point out that adj. radiation can be advocated for, but it's a close call and they too recommended that we carefully follow my PSA in 3-month intervals.
From my reading, SRT should be started fairly soon upon BCR, so if I hit .20, I will have to get on it for sure (maybe sooner).
Let me know if any of the abbreviations are confusing

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 was about 75 (way above the 35 threshold). That led to:

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.  (Second opinion from Jon Epstein at Hopkins confirmed these results)

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry, was  using 1 pad at night for security, but pretty much dispensed with that most nights. Update: no pads at night. No pads while at home, but still very uncomfortable. Use 1 pad for out-of-house activities. Suddenly got MUCH better on 3/10/10, almost overnight. Still some urgency but no pads about 90% of the time.  As of 3/12/10--completely continent! Uh...OH. As of about 3/16/10 problems with constant urgency although no pads needed--feels like an infection but none showing in urine.

Update: since late March all is well in that area. I would say 99.9% continent (a spurt here and there, maybe 5 spurts per week). As of 6/22/10, I would say I am 100% continent, but I do have (controllable) significant urgency.

First post-op PSA on 3/10/10--DRUM ROLL: 0.01 Next PSA in mid-June.

Second post-op PSA on 6/21/10--0.02--Not too bad!

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