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snagman
New Member


Date Joined May 2007
Total Posts : 2
   Posted 5/5/2007 5:12 PM (GMT -7)   
Hi everyone, I am 57 years old and just had a RP (Davinci robotic surgery) on 4/30/07. Had a gleason score of 3+3 and a pre-op psa of 5.4 down from 10.1 a month prior to my biopsy. I have been particularly interested in the pathology report questions in this forum. Mine came back and left me a little shaken because It indicated that the PC had penetrated the capsual but the surgeon says he is 100% sure it is gone. I haven't been able to discuss it with him yet but it makes me wonder. All pre op scans were negative. What does "positive margins" mean. I was not told that that was my situation but it sounds like it might be. Nice to be with others slogging through the same swamp. DAN 

stkitt
Forum Moderator


Date Joined Apr 2007
Total Posts : 32602
   Posted 5/5/2007 6:00 PM (GMT -7)   

Hello and Welcome to the  PC forum.  I am Kitt and I am glad to meet you.

  Positive Margins means that there are cancer cells at the edge of tissue that has been removed.    This can only be seen under the microscope, after the surgery.  Positive margins occur about 25-35%  of the time after non-nerve sparing radical prostatectomies and 35-45% of the time in nerve sparing radical prostatectomies.     Positive margins mean the chance of the cancer recurring in the surgical area is significantly greater than if the margins are negative.

  There has been great controversy among urologists as to the treatment of positive margins. It is important to discuss with your urologist how extensive the positive margins are, and what is to be done about them.

I am not a professional so please talk with your physician and get an indepth report on  your pathology findings. 
 
I certainly understand your concerns and I am sure someone with personal experience will come along and give you information so keep posting.
 
Gentle Hugs
 
Respectfully
 
Kitt
RN CCRN, Critical Care and Emergency Department Manager for 26 years.
 
Depression 25 years, Husband Crohns Disease 30 years
My Father and 5 siblings all died of Cancer. It is a subject close to my heart to help people with Cancer.
__________________________________________________ 
"If you doubt you can accomplish something, then you can’t accomplish it. You have to have confidence in your ability, and then be tough enough to follow through.”
Rosalyn Carter
 


pasayten
Regular Member


Date Joined Mar 2007
Total Posts : 424
   Posted 5/5/2007 6:07 PM (GMT -7)   
Dan,

Like you I was looking for negative margins but my pathology report came back with 2 focal positive margins... But the Doctor's explanantion to me was that in my case, focal point meant than only a couple of cells were touching the edge and that maybe only 1 cell or so was "outside". I also read a John Hopkins report (Epstein) about positive margins and how many really do not indicate any need to worry as many times a cell or two outside end up dying anyway just due to the surgical trauma. The overall article and nomogram I got relieved many of my serious concerns.
http://urology.jhu.edu/newsletter/prostate_cancer410.php
My final pathology diagnosis was T2c which suggests "organ confined". The good thing were that it was still a Gleason 3+3 (6) and was not "upgraded", and seminal vesicles and lympth were also OK. The nomogram for my final pathology indicates a 95% chance of no re-occurence for 7 years. Doctor also indicated no further treatment indicated at this time. We will just monitor my PSA like most of us on this board will be doing for the rest of our lives. My signature has most of the statistics of my journey so far.

Read up on pathology reports and margins (I did a lot of googling) before your appoinment for discussion with the doctor and write all your questions down so when you are there, you can go over all your concerns. You can also request a copy of the actual report. With my questions and his answers resolving them, I left the office much more at ease as this overall journey can really spin you up.

Take care and God Bless!

Ray
pasayten
 
Age 59 y/o
Last 3-4 years of annual general health checkups - PSA 5-6 but Free PSA Ratio 21-24%, suggesting "benign" so I did not seek immediate followup urologist referral
3/7/2007 - Went to urologist -No DRE abnormalities but scheduled screening biopsy
3/13/2007 - 12 point biopsy - Left OK  Right Core Gleason 3+3
Consisting of single less than 1mm focus at tip of 1 core. Diagnosed as T1c
4/24/2007 - DaVinci performed at Virginia Mason hospital in Seattle
5/2/2007 - Catheter Out! Got copy of pathology report:
Gleason 6  T2c Nx Mx   approx 20% of prostate involved
Positive margin, but 2 places where a focal point of only 2 cells were touching edge, the right apex and right posterior. Perineural Invasion present. Seminal Vesicle and Lymphatic/Vascular not identified. Doctor was not concerned about that at all and Final Diognosis of T2c "suggests" organ confined.  Stats for no re-occurance are 96% for 5 years and 95% for 7 years. No further treatment other than PSA watch.
 


sween76
Regular Member


Date Joined Feb 2007
Total Posts : 60
   Posted 5/5/2007 6:40 PM (GMT -7)   
Also, make sure you get a detailed copy of your Pathology Report.  Ed

Age: 63
PSA 2.62, Negative DRE
Biopsy: Gleason 3,3
Stage T1c
Prostate 71 grams 
Biopsy: Cancer 5% in one of twelve modules
DaVinci April 16, 2007, Cathter Removed Day 8
Tumor Confined To Prostate,  Gleason 3,3
Surgical Margins and Seminal Vesicles Are Negative for Tumor


jwb187
Regular Member


Date Joined Apr 2007
Total Posts : 101
   Posted 5/6/2007 8:12 AM (GMT -7)   
Hi Dan,

It sounds like you are almost in the same boat that I'm in. I also had davinci surgery (4-24) and received my post op pathology report last week. The report indicated that I had a positive margin and also one of the seminal vesicles involved, the other plus lymph nodes were okay. My surgeon said that I need to get started with radiation asap and made me an appointment with the radiation oncologist for next week. I'm sure that I will have to heal from surgery and become continent first before any treatments are started. My surgical arena has healed good in the last ten days and my continence has improved greatly in just the last couple of days. Down to about 3 pads per day now, did use 7 or 8 for a couple of days. Keep reading this site, I check in daily and always learn something. There are some really great people here. Keep your chin up, and think positive!!! jwb
age: 61
PSA 4.57 - Positive DRE
Biopsy 3-19-07 - Gleason 4+4=8
Negative bone scan 3-20-07
DaVinci 4-24-07
Catheter out 5-01-07
post op pathology:
positive margin left side of prostate
left seminal vesicle involved (both removed)
No lymph node involvement
New gleason score 9
T3B....radiation consult on 5-9-07.


Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 5/6/2007 8:19 AM (GMT -7)   
Snag,

For now you should relax a bit and trust your surgeon. A positive margin may mean absolutely nothing. So, take a deep breath and move forward. You will have to wait this one out and you don't want to wait on pins and needles when you could be eating steak off the grill on such a beautiful Sunday afternoon!

Glad to see you otherwise doing well,

Swim

elpaso
Regular Member


Date Joined Dec 2005
Total Posts : 82
   Posted 5/6/2007 12:43 PM (GMT -7)   
I had laparoscopic surgery in March of 2006 at the Moffitt Cancer Center in Tampa, Florida. PSA was 5.6. Gleason prior to surgery was 6; it was 3 + 4 (7) after surgery. My doctor said I had a cancer cell right on the margin, and my chance of the cancer coming back was increased by 10 percent. Recent PSA was less than .01 ... John Hopkins did a study about positive margins; Here's an excerpt:

"And, even if the surgical margins are positive, this does not necessarily mean that the cancer is left behind. How can this be? "There are several different explanations why, when the margins are positive, the tumor may still be cured," says Hopkins pathologist Jonathan Epstein. "One is that literally you cut across the last few tumor cells" -- that what appears to be remaining cancer is actually a cross-section of the perimeter of the tumor. "And even though it looks like it's a positive margin, there's really nothing left in the patient."

Another explanation is that the act of surgery itself finishes the job, killing any remaining cells. No cut or injury to tissue happens in a vacuum; the area around the cut is affected, too. (Think of lightning striking a tree; the tree dies, but so does a ring of grass around it). "When the surgeon cuts across tissue the blood supply is cut off, there's dead tissue, and that can kill off the last few tumor cells that might have been left behind," Epstein says.

biker90
Veteran Member


Date Joined Nov 2006
Total Posts : 1463
   Posted 5/6/2007 2:41 PM (GMT -7)   
Hey Dan,

Welcome to the "other side" of surgery. Sorry about the less than expected path report. Many things will happen in the next few months, nothing more important than that you heal well. Concentrate on that and keep up the positive attitude..\

Please stay with us...

Jim
Age 72. Diagnosed 11/03/06. PSA 7.05. Stage T2B Gleason 3+3.
RRP 12/7/06. Nerves and nodes okay.
Pathological stage: T2B. Gleason 3+4. Cancer confined to prostate.
PSA on 1/3/07 - 0.04. 
PSA on 4/4/07 - 0.00  T level - 48  Restarted T therapy.
Next PSA on 7/11/07.
 
 "Cancer feeds on fear - starve it to death."


snagman
New Member


Date Joined May 2007
Total Posts : 2
   Posted 5/6/2007 3:10 PM (GMT -7)   
Thank you to all of who replied to my questions. It was very helpful and even comforting. I will keep you informed and will probably have many more questions. Looking forward to further dialogue. God Bless, <I:)~DAN

bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 5/15/2007 5:14 PM (GMT -7)   

Hi ~ Dan *Snagman,

 

Caring Enough to Share….. 

 

   A   “Special”  Warm Welcome  to  You!  yeah

 

This is truly a great forum!!! ~ “You” have joined! You are now part of our forum family ~ a group of wonderful individuals who are so willing to share their journey.  Thank you for joining all of us on this road to HealingWell…..

 

KNOWLEDGE IS POWER... and POWER conquers fear

 

Keeping you Extra Close in our thoughts and prayers.

In New…Friendship ~ Lee & Buddy

 

“God Bless You” 

It's a little prayer  ~  "God Bless You"  ...but it means so much each day,

It means may angels guard you and guide you on your  way

 

(Direct Link ~ just click on the title below and a new window will open!  

Reminder … click on the REFRESH icon once you get there)

Helpful Hints ~ & ~ Direct Links to Important Topic Threads ~ Hope this helps you!! :)


mama bluebird - Lee & Buddy… from North Carolina

J  We invite you to visit our personal thread:  Click Here:  “Our Journey” ~ Sharing is Caring 

April 3, 2006  53 on surgery day

RRP / Radical Retropubic Prostatectomy with "wide excision"

PSA 4.6   Gleason  3+3=6    T2a   Confined to Prostate

2nd PSA 02-06-2007 Less than 0.1 Non-Detectable :)


bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 5/15/2007 5:32 PM (GMT -7)   

Hi ~ Dan,

 

We were away when you first signed on….  But we are back now and you’ll definitely be hearing from us!  And we definitely want to hear from you….. Okay!!   yeah  

 

Stay Close….

This Journey is best traveled with friends at every stepping-stone on our path… 

Welcome New Friend…

 

I think you’ll find some interesting information on the Thread below…

(Direct Link ~ just click on the title below and a new window will open!  

Reminder … click on the REFRESH icon once you get there)

Helpful Hints ~ & ~ Direct Links to Important Topic Threads ~ Hope this helps you!! :)

 

See the 3rd Posting….. There is a thread started by Raheeb….. What about Perineural Invasion?

 

We are here helping each other as we all move forward in our journeys… 

We’re glad you joined us!!!!  Take care for now.  In Friendship ~ Lee & Buddy


mama bluebird - Lee & Buddy… from North Carolina

J  We invite you to visit our personal thread:  Click Here:  “Our Journey” ~ Sharing is Caring 

April 3, 2006  53 on surgery day

RRP / Radical Retropubic Prostatectomy with "wide excision"

PSA 4.6   Gleason  3+3=6    T2a   Confined to Prostate

2nd PSA 02-06-2007 Less than 0.1 Non-Detectable :)

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