Question about positive surgical margin

New Topic Post Reply Printable Version
50 posts in this thread.
Viewing Page :
 1  2 
[ << Previous Thread | Next Thread >> ]

runner48
Regular Member


Date Joined Mar 2011
Total Posts : 26
   Posted 4/15/2011 4:59 PM (GMT -6)   
Hello All,

I recently underwent robotic prostate surgery. During a Post surgery review of results, my Doctor mentioned that I have a positive margin on the left apex. I don't understand how this can be possible since I had the nerve bundle removed on the left side. Also the pathologist did not mention any nerve bundle samples. Can anyone shed any light on my comments?

Thanks,
J

Post Edited (runner48) : 5/13/2011 3:59:10 PM (GMT-6)


gold horse
Regular Member


Date Joined Nov 2009
Total Posts : 360
   Posted 4/15/2011 5:26 PM (GMT -6)   
Hi JF-58 NO QUESTION IS BORING HERE.THE POSITIVE MARGIN MEANS THE TUMOR
PENETRATED OUT FROM THE PROSTATE.ONE POSITIVE MARGING IS NOT VERY SERIOUS
BUT IF YOU HAVE TWO OR MORE IT IS A CONCERN.
I AM SURE THE OTHER GUYS WILL SHARE MORE LIKE.GOOD LUCK.
DIAGN=46 YEARS
GLEASON=3+3
FATHER HAD PC,THEN I THEN MY BROTHER STILL HAS TWO BROTHER PC FREE.
MARRIED,TWO CHILDREN.AGE 13 AND 8.
LAPROSCOPY SURGERY 6/2005
PATOLOGY REPORT.
GLEASON=3+3
TUMOR VOLUME=5%
LYMPHOVASCULAR INVASION=NEG
PERINEURAL INVASION=POSI
TUMOR MULTICENTRICITY=NEG
EXTRAPROSTATIC INVASION=NEG
SEMINAL VESICLES BOTH=CLEAN
MARGIN ALL=NEG
PT2ANXMX
DEVELOP SCART TISSUE AND NEEDED A SECOND SURGERY BECAUSE COULD NOT URINATE,
PSA 6/05=0.04,0.04,0.04,6/06,0.04,0.04,0.04,6/07,0.04,0.04,0.04,6/08,0.04,0.04,1/09
0.04,10/09,0.04
 

runner48
Regular Member


Date Joined Mar 2011
Total Posts : 26
   Posted 4/15/2011 5:32 PM (GMT -6)   
Thanks Gold Horse. My nerves are on edge right now trying to get my arms around everything. I'll eventually add all my info when I can think straight.

Post Edited (runner48) : 5/13/2011 3:59:49 PM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/15/2011 5:36 PM (GMT -6)   
Welcome, John, to HW, sorry you have a need to be here.

You got to remember, then when your surgeon did the surgery, he wasnt' following a dotted line or the ability to see where cancer cells were located. Even with a wide margin surgery on one or both sides, its possible and not even uncommon to have one or more positive margins. And even with a positive margin, its doesn't ever mean for sure you will have recurrance, often the remaining cancer cells at the cut so to speak, die off and don't cause a problem.

I had one positive margin, and unfortunatley had recurrance within 9 months, then went on to salvage radiation, and that has since failed to.  Certainly doesn't mean it will happen to you.
 
If you post a signature here, it will be easier for the rest of the gang to know what you are dealing with in your particular case.
 
Good luck, and the real test, will be when you start getting your post surgical PSA tests.
 
David in sc

runner48
Regular Member


Date Joined Mar 2011
Total Posts : 26
   Posted 4/15/2011 5:43 PM (GMT -6)   
I appreciate the moral support Purgatory, and am so sorry to hear radiation has failed. What is your next step? Hopefully things turn around for you very soon.

It's tough on here, but sure helps having some support. You have been very helpful..thanks for your response.

Post Edited (runner48) : 5/13/2011 4:00:38 PM (GMT-6)


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4223
   Posted 4/15/2011 5:44 PM (GMT -6)   
John,
Positive margins in the Apex are very common. 51% of all positive margins occurr in the Apex. You may or may not have a clinical reoccurrance as sometimes cells die on their own. Especially if you have G6 as these types of cells have a difficult time matastizing to other areas. Best thing is to get psa tested every 3 months and react if it starts to consistantly rise.
JT
66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/15/2011 5:49 PM (GMT -6)   
JF,

The next logical step for a person in my situation would be hormone therapy (HT) of some flavor. Now that the surgery and radaition has failed so fast, there is no curative card left to play. I have a lot of personal issues of persuing HT, and not sure I will get over them.

My PSA after radiation rose from .06 to 1.24 in sixmonths, then barely 7 weeks later, tripled to 3.81, my next reading is in May, and I am seeking a higher level medical oncologist before seeking any other solution.

David in SC
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06, 2/11 1.24, 4/11 3.81
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

runner48
Regular Member


Date Joined Mar 2011
Total Posts : 26
   Posted 4/15/2011 6:01 PM (GMT -6)   
David, My prayers are with you, I've read quite a bit on this forum and you are always there for everyone else. I'll keep following your story for updates and just wish you all the best.

JT, thanks for your information. My post op Gleason is also a 6 so this does give me more hope. Appreciate it.

Thanks guys

Post Edited (runner48) : 5/13/2011 4:01:03 PM (GMT-6)


logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5815
   Posted 4/15/2011 9:59 PM (GMT -6)   
Jf 58 , read walshes book, section on pos margins, its encouraging, never say never, but to have a Gl 6 on post op pathology is a biggie, even with 1 pos margin. Don't underestimate that pathology report, Alot of people here would love that , Im one of them. Your surgeon obviously was concerned about margins which is why the non-nerve sparing.
Whats the MSK nomagrams, google if unaware, say. Easy to say 18 mos post -op, but try to accent the positive, what was that song from the 40's.
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

brampy
Regular Member


Date Joined Jan 2011
Total Posts : 42
   Posted 4/16/2011 12:06 AM (GMT -6)   
JF-58,
I had positive margins on the left side. Post-surgery pathogy report called it 'extraprostatic extension'. You should have a detailed pathology report which would have the specifics. Since the cancer made its way out, I'm undergoing adjuvant radiation therapy (calypso) to hopefully kill any remaining cancer cells. I have 12 treatments to go. After surgery, my PSA is <0.1 which is a good start. Good luck. <bobr>
__________________________
Age: 54
Routine Physical on 10-20-2010 DRE Normal
PSA 4.3, up from 0.6 5 years prior
PSA 0.6 on 10-25-2005
PSA 0.4 on 7-30-2004
PSA 0.5 on 5-9-2002
Followup with Urologist on 11/10/2010 after elevated PSA; DRE noted slight bump
November 30th, 2010 had prostate biopsy.
December 9th, 2010, Biopsy results 3 of 12 cores positive.
LLB: Gleason's 4+3=7, 11 MM Tumor Length/15MM Core Length (73%)
LLM: Gleason's 4+4=8, 12 MM Tumor Length/15MM Core Length (75%)
LM: 0.1 MM Tumor Length (1%)0.1 MM Tumor Length
RALP Surgery 12/27/2010 Released: 12/30/2010
Thunderbird Banner Hospital, Glendale, AZ
Post-Surgery Pathology: GS 4+5=9
Pathologic Staging: pT3a, N0, MX; location: Left Side; Volume: 10%
Margins: Left posterior inked margin focally involved
Extraprostatic Extension: Observed
Seminal vesicles: Not observed
Lymphatic/Vascular Invasion: Not observed
Catheter: Removed 15-days after surgery
Post-OP Followup on 1/11/2011; Catheter/Staples removed
Adjuvant IMRT 8 Weeks Post-OP.
Radiation Oncologist Initial Consultation on 1/18/2011
Arizona Prostate Cancer Center
Calypso Procedure on 2/17/2011; PSA <0.1; Bone Scan Clear
341 Testosterone
CT Simulation on 2/24/2011.
Calypso IMRT started on 3/8/2011 - 40 Treatments.

runner48
Regular Member


Date Joined Mar 2011
Total Posts : 26
   Posted 4/16/2011 12:53 PM (GMT -6)   
brampy, I do have a copy of the pathologist's report, it shows cancer to the ink margin on the left apex, that's my concern, but right now I'm trying to focus on recovery from surgery, which was 2 weeks ago. Got the catheter out and haven't had any problems with urination as yet, so for that I'm greatly relieved. I hope all goes well for you. How are you tolerating the radiation treatments? I'm happy so far your psa looks good...keep it up... best of luck to you as well.

Thanks for responding,
J

Post Edited (runner48) : 5/13/2011 3:58:37 PM (GMT-6)


brampy
Regular Member


Date Joined Jan 2011
Total Posts : 42
   Posted 4/16/2011 1:47 PM (GMT -6)   
JF-58,
I had to wait 8 weeks after my surgery before I could start radiation. In your case, it sounds like you got a good gleason score going for you and chances are, the cancer would have a hard time living now that your prostate is gone. I feel in my case, even with a post-surg gleason 9, that its gone, but didn't want to chance it - so followup radiation was in the cards. My radiation oncologist even thought I could wait and see, but my chances were better to have adjuvant rather than salvage radiation.

You have some time to examine your options and probably a 6 week PSA. Aren't you glad you got that catheter (ball and chain) out? I had mine in for 15 days - worst part of the overall experience. I've gained most of my continence back (except when I go running). According to my uro, he said that adjuvant radiation is done within an 8 to 12 week post surgery period. Has that even been a discussion with your pathology? So far, I haven't had any major side effects (knock on wood). <bobr>

runner48
Regular Member


Date Joined Mar 2011
Total Posts : 26
   Posted 4/16/2011 2:09 PM (GMT -6)   
brampy,
Yes I did feel like a new man after I got my catheter out..also had it for 13 days. As far as pathology, my doctor said he'll be watching the next 3 psas (first one as you say 6 weeks post op) to determine if radiation is needed. Other than that I'm trying to figure out how to enjoy my life again...lots of ups and downs, as you know.

I hope the adjuvant works out well for you. I don't really understand the different types of radiation. I guess I'll study it down the road if needed, ..hope not.. It's all scary stuff and difficult to process some days. Thanks for sharing your experiences. Good luck to you...

Post Edited (runner48) : 5/13/2011 4:01:39 PM (GMT-6)


logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5815
   Posted 4/16/2011 2:24 PM (GMT -6)   
Adjuvant radiation means getting Radiation as soon as possible after prostectomy, due to disturbing post op pathology and prior to " official reccurence", even with a undetected psa. SRT salvage radiation therapy is done after " reccurence " indicative of a rising psa
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

brampy
Regular Member


Date Joined Jan 2011
Total Posts : 42
   Posted 4/16/2011 2:48 PM (GMT -6)   
logoslidat - yup right on. I see a few salvage guys when I go in for my treatment. Mostly guys with prostates. JF-58...every day gets a little better. I'm 16 weeks post-surgery...other than ED and a slightly leaky faucet while running, everything is normal. I used to have to get up in the night to pee, but thats returned to normal also. The upside is peeing like a teenager. Sometimes, I have a little urgency. Course I'm almost 3/4 thru radiation and side-effects could be from that - who knows.

Sounds like you have alot of positives going for you. The big question will be at your 6 week PSA if you score <0.1 and whether if you need radiation at all. With my gleason 9, there was little questioning.

runner48
Regular Member


Date Joined Mar 2011
Total Posts : 26
   Posted 4/16/2011 3:25 PM (GMT -6)   
logo and brampy.... thanks for the info about radiation. I guess I still don't understand the differences. Is there a difference between the two types in how much radiation you get with each? Also, once you have adjuvant can you get salvage radiation if things continue to show there is cancer present?

Also, what is the best timing for psa testing to begin post- op, and how often is it repeated? My doctor has scheduled my first post-op psa at almost 8 weeks (rather than what I told you previously). I thought it was supposed to be done 6 weeks post op....

Post Edited (runner48) : 5/13/2011 4:02:09 PM (GMT-6)


brampy
Regular Member


Date Joined Jan 2011
Total Posts : 42
   Posted 4/16/2011 3:32 PM (GMT -6)   
My radiation oncologist said no. Once you've done adjuvant...you can't have salvage. It's a one shot deal. I'm getting 40 treatments totalling 72gys. My salvage friend is getting exactly the same treatment. He had a recurrence or BCR as its called. It is exactly as logoslidat defined. My adjuvant is followup...I technically did not have recurrence. My PSA tested <0.1 at 6 weeks. I think that 6 or 8 weeks doesn't make a big difference...minimum is 6 I believe. I'm on a every 3 month PSA for the first year, 6months in the 2nd...and then annually thereafter. <bobr>

runner48
Regular Member


Date Joined Mar 2011
Total Posts : 26
   Posted 4/16/2011 4:00 PM (GMT -6)   
Thanks for all your helpful information. I guess I'll call the doctor's office Monday to doublecheck if that's what he wants. I'd just like to know at 6 weeks but if it doesn't make much difference I won't worry about it.

Good luck with your treatments..hope all goes well from this point on for you.

Post Edited (runner48) : 5/13/2011 4:02:55 PM (GMT-6)


DaSlink
Veteran Member


Date Joined Feb 2011
Total Posts : 713
   Posted 4/16/2011 4:04 PM (GMT -6)   
I really don't have much more to add than good luck and always think positive. Even though some times it's tough and I've already had a few of those days so vent on here if you need to.
Rad Doc is waiting until next PSA in May to see what my numbers are doing before the next step is takin. I had a lousy pre-op PSA so he's just waiting a few more weeks to see if there is any change.
Every minute you fish or ride,adds an hour to your life!

Age 52 Dx age 53 daVinci surgery
prostate volume 32 grams
Biopsy 12 cores with 7 positive
Gleason score of 7
1st PSA 38.7 10/05/2010
2nd PSA 49.9 11/23/2010
CT neg.
BS Negative
RRP on 01/25/2011
PT3a -40% involved
margin involved-Left anterior
lymph nodes -clear
1st post op PSA-0.26-03/16/11

brampy
Regular Member


Date Joined Jan 2011
Total Posts : 42
   Posted 4/16/2011 4:09 PM (GMT -6)   
JF-58,
Your Uro probably can bump up your appt. or you can get your PSA done prior to seeing him at your appt. You might want to visit the nomogram site/tool. It might give you a better feel for your odds:

http://www.mskcc.org/mskcc/html/10088.cfm

The more info you can research, the better off you will be when your options are presented to you. I also found that it was good to have someone (I had my wife) go with you just to take notes. It was helpful for me since I lost my train of thought (when my Uro 'slapped' me in the face with stuff so-to-speak).

runner48
Regular Member


Date Joined Mar 2011
Total Posts : 26
   Posted 4/16/2011 4:31 PM (GMT -6)   
brampy,
yes I do plan to call about the PSA appt on Monday to be sure I get in when I should. I have looked at the nomogram site and the odds are good but in a way I don't trust anything right now. I know I need to stay positive but that positive surgical margin does bother me.... hoping to avoid further treatments, but only time and PSA tests will tell.

My wife has gone with me to most doctor appts. She's right there with me through all of this. She's very informed up to this point, but not sure either what will take place if PSAa are too high.

Thanks again.......

Post Edited (runner48) : 5/13/2011 4:03:38 PM (GMT-6)


brampy
Regular Member


Date Joined Jan 2011
Total Posts : 42
   Posted 4/17/2011 12:43 AM (GMT -6)   
JF-58,
When and shortly after my robotic surgery, I was so sure and overly confident that I would have been free of this ugly cancer. When I got my pathology results, I was surprised that I had positive margins...why? It was the same feeling I had when I got my biopsy results which I was not ready for also. It is like somebody slapping you in the face when you don't expect it. Much like you, I only had 10% cancer...so why did it decide to go out of the prostate instead of inbound. I can truly understand your trust factor...this crap is humbling. Good luck to you...and beat the crap out of it.

runner48
Regular Member


Date Joined Mar 2011
Total Posts : 26
   Posted 4/17/2011 6:13 AM (GMT -6)   
Hope 1,
It's just a location point on the prostate, at the bottom. It's also the most common place for a positive surgical margin.

Post Edited (runner48) : 5/13/2011 4:04:02 PM (GMT-6)


Ken S
Regular Member


Date Joined Nov 2006
Total Posts : 120
   Posted 4/17/2011 9:17 AM (GMT -6)   
JF,

You may not get your old life back as you knew it, but it'll be pretty darn close. You'll adapt and have a new normal life.

Other than you having nerves removed, I had exactly the same pathology report you did and I chose to have adjuvant radiation when my PSA showed an ever so slight trend upward.

In my case I was continent for only a couple of weeks before starting radiation, so a few weeks in I had to bring out the pads again. Four years later I still have stress incontinence and wear one pad a day. The rad doctor told me that whatever my continence and erectile functions were before radiation that's what they would be like after and that's been an accurate prediction.

Hope1 - The prostate gland is "upside down", the base is on top abutting the bladder and the apex is on the bottom closer to the penis. The way it's been described to me is at the apex the prostate, soft tissue, and the urethra kind of blend in a little and the doctor is trying to save as much of the urethra and nerves as possible. Also the apex is deeper into our bodies and less accessible. I assume that's why there's a high percent of positive margins in that area.

Ken
Age 54 (2006) PSA: 2005 - 3.2, 2006 - 3.7
Biopsy 8/06, Gleason 6 (3+3), T1c
RRP 11/3/06 Post-Op Biopsy, Gleason 6 (3+3), T2c, right apical margin positive
IMRT (37 Treatments) 4/23/07 - 6/14/07
PSA: 7/10 - 0.02

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 4/17/2011 9:25 AM (GMT -6)   
JF, as Ken said, there are excellent chances your life will be very close to what it is now. There are plenty of people who have had surgery and/or radiatin who have managed to regain most if not all of their functions after treatment. Just pick the best help available to you.

It's a process, but you'll come out of it. In my experience, the process itself seems far more daunting before starting it. Once in it's a battle that you'll know how to handle. And as weird as this sounds, there is something unique about that battle and how it changes us and frankly, there are aspects of it I miss now that I'm on the other side of it ( for now at least ).
New Topic Post Reply Printable Version
50 posts in this thread.
Viewing Page :
 1  2 
Forum Information
Currently it is Monday, June 18, 2018 7:12 PM (GMT -6)
There are a total of 2,973,011 posts in 326,050 threads.
View Active Threads


Who's Online
This forum has 160874 registered members. Please welcome our newest member, glennisglennis.
423 Guest(s), 6 Registered Member(s) are currently online.  Details
Christine1946, CaliGirl81, opugirl, Boston221, magoo2, Mark FW