No Celebration yet - BAD Path Report !!!

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laswell
New Member


Date Joined Aug 2007
Total Posts : 12
   Posted 10/25/2007 6:12 AM (GMT -7)   
Well day 8 came and catheter removed (a Blessing), but we were not prepared for the bad pathology report. We were devastated :

"Margin-focally involved left anteroapical by adenocarinoma, specifically section F (Gleason 3+3+6) focally contacts the orange inked anterior left apical margin of resection . Extraprosatic Extension - Focally Identified . Seminal Vesicle - Not Identified ".

No Lymph nodes were taken to be evaluated.

The biopsy showed a higher 3=4=7 Gleason on the rt side but was all within the margin. (I couldn't help but notice that the left section of prostate taken was smaller than the rt side -don't know if this indicates a bigger area should have been removed during surgery? Oh well can't change that now.)
I guess we were swayed by all the diff. Dr.s assurances that my biopsy results (3 of 12 samples,3+3=6 gleason and PSA of 3.9 were early stage and high chance of organ containment. It definely took the wind out of our sails!
The surgeon said that only about 20% of patients will have a recurrence. I have learned to hate statictical evidence, since I always seem to fall in the small group! (It's like watching a close football game and hearing the announcer say that the other team's kicker has never made a 53 yd. field goal in his career - of course it insures he makes it to win the game.) The doc said there was nothing to do but wait for the 8 wk PSA test. If it is not 0 he would re-do to confirm and then recommend me to a radiologist.
Physically I seem to have recovered fairly well although I am going through quite a few pads rt now. I got a whoopee cushion for long ride home cause I am still a little tender.
I feel pretty lost as we pack up to return home - (about a 5 hr drive). I just hope surgery still served some purpose even though cancer is still there.
So the journey takes yet another unexpected turn. I'm sure I will be more positive once I've had time to digest it all.
Please share any knowledge, experiences w/ bad margins, and of course any advice, comments in general. Thanks.

I won't be able to reply until we arrive back home this evening.

Laswell

Educator
Regular Member


Date Joined Oct 2007
Total Posts : 37
   Posted 10/25/2007 6:38 AM (GMT -7)   
Laswell,
 
Sorry to hear of the not so good pathology report. I have only just recently been diagnosed. I am still waiting to meet my doctor for initial consultation at Vanderbilt. I wish I was as far along as you are now. Your experience makes me want to beg the doctor doing this surgery to take more than he thinks necessary. That sounds stupid I guess but I would rather them error on the side of to much as to little. Hindsite is always 20/20.
 
It is good that only 20% have a recurrence. Think positive and hope for the non-detectable PSA. I was a high school football coach in Kentucky for 15 years and I would have never tried to kick a field goal with only a 20% chance. You are going to be the winner in this game.
 
My wife and I will keep you in our prayers
 
Educator
 
Diagnosed 10/15/2007
Age 55
PSA 4.2 9/15/2007
PSA 3.9 10/1/2007
TC-1
 
Prostate, Transrectal Needle Biopsy 10/05/2007
 
Results 10/5/2007
 
A-D Right Base, Right Mid, Right Apex, Left Base;
Benign Prostatic Tissue
 
E. Left Mid; Adenocarcinoma, Gleason's Grade 3+3=6, 10% involved
 
F. Left Apex; Adenocarcinoma, Gleason's 3+3=6, Less than 10% involved
 
2 of 12 involved as two samples were taken from each area.
 


kdnole
Regular Member


Date Joined Jun 2007
Total Posts : 152
   Posted 10/25/2007 7:06 AM (GMT -7)   
Laswell, I am in the same boat as you. The waiting game really sucks but there's nothing we can do. I had my initial PSA at 6 weeks which came up goose eggs but the PSA my Dr. will use as the official check will happen Nov. 12. According to him if he see's anything numbers but zero's I'll be off to the Oncologists, so I'm sure that might happen. The one thing I'm wondering is if my PSA is real low (.05) or something like that will the Oncologists take a wait and see approach. I will probably get my PSA checked every 2-3 months anyways. I hate waiting but why expose your body to radiation if you don't have to.
Age 44
PSA 4.8
Gleason 3+3=6
T2
Biopsy - 3 of 12 (2@20% / 1@80%
Da Vinci 7/31/07 @ Duke
2.5 hr. surgery, released from Duke with in 14 hrs.
Saved both nerve bundles. 
Foley out 8/10/08
Positive Pathology Report 
Near left side nerve bundle
New Gleason 7
Oncology visit in the near future for radiation
Back to work 3 weeks following surgery - Sales
 
9/13/07 - 1 Post PSA Undetectable less than 0.1 
 
9/17/07 - Pad Free! 
 
10/11/07 - ED, Trimix injection .2cc Tooo much but it worked.
No luck with viagra or pump. 
 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8122
   Posted 10/25/2007 10:30 AM (GMT -7)   
Hi laswell,
Hang in there. You can still be just fine. And you have to stay on the 80% with positive attitude. I was aware what I may have as a pathology after surgery, but look at my numbers. I understand your disbelief when you heard your doctor speaking. Your trek looks very similar to kdnoles. As you have time to get your PSA down, now is the time to get that second opinion on the pathology slides. You can look into RT and an oncologist without waiting. You don't need to make a decision but rather be ahead of the game. I guess to continue the analogy, that kicker may have made the kick, but you are still in the first half. The game is not decided by any means.

Tony
Age 45 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007
Post-Op Pathology was poor: Gleason 4+3=7, 4 positive margins, Stage pT3b (Stage III)
HT began in May, '07 with Lupron and Casodex 50mg
IMRT radiation for 38 Treatments ending August 3, '07
 
My PSA did drop out after surgery to undetectable.  It has not returned and I will continue HT until January '08.
 
My Life is supported very well by family and friends like you all.
 
STAY POSITIVE!


pasayten
Regular Member


Date Joined Mar 2007
Total Posts : 424
   Posted 10/25/2007 12:50 PM (GMT -7)   
Laswel,
 
Stay POSITIVE!  "Focally involved" is much better than "Locally involved" as it means only a small area.  And the focally involved area was Gleason 3+3 which was less than the overall Gleason 3+4.
 
In my post-op pathology, I had 2 positive margin "focal points" which were explained to me as only a contact area of one or two cells which most likely were also removed in the overall sugical traumas to the tissues.  My initial "no-reoccurrence" numbers for 7 years were 94% then.  Anyway, my first post-op psa at 3 months was < 0.1... which is "zero"...  Note that my doctor does not do a 6 week psa as there may still be some pre-op psa still in my system and he does not like the chance of that occurrence to unneedingly worry patiernts.   Anyway, with that 3 month psa at "zerro", the stats get much better for no re-occurrence.
 
There are also other factors as to which lobe the contacts are in...  You can always ask your doctor for more info or sites to look up this information...  to better define focally and which lobes and what that means...  Beside the doctor's info, I found a lot of additional info on this site and also seaching with google...  Comforted me a lot...
 
One of our members, sorry, forgot which one :-( , has the quote "Cancer feeds on fear...  Starve it!"
 
I have found the more I ask questions and understand this stuff, the better my brain and emotions handle it...  Information lessened fear...  I become more part of the team actively fighting this darn disease!
 
 
God Bless!
 
Ray
 
Age 59 y/o - Last 3-4 years of annual general health checkups - PSA 5-6
3/13/2007 - 12 point biopsy - Left 0/6  Right 1/6 Gleason 3+3 Diagnosed as T1c
4/24/2007 - DaVinci performed at Virginia Mason hospital in Seattle
5/2/2007 - Catheter Out! Final pathology of Gleason 6  T2c Nx Mx,   approx 20% of prostate involved, positive margin, but only at 2 focal points.  
6/28/2007 9 weeks post-op incontinance... Overnite, went from 4-6 soaked pads a day from prev 8 weeks to 2 barely wet pads a day.
7/12/2007 11 weeks post-op  Minimal leakage...  one small pad a day
7/18/2007 First Post-Op PSA...  0.01 !!! 
7/30/2007 ED improved to about 60% erection and "functional". Only using 50mg Viagra generic every 2-3 days.
9/10/2007 Ran out of pads one day and had no dribbles all day...  Now pad free. :-)


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 10/25/2007 1:54 PM (GMT -7)   

Laswell-

First and foremost, I am sorry! We too (my father) had a poor post op pathology report! He had one positive node and one focally positive margin.  The Friday night we got the call was the worst day of my life.  My dad and I were watching a movie and I had taken him to get his hair cut earlier in the day because he was feeling so much better and we were all very optimistic.  I will never forget the look on his face as he heard the news from the doctor.  We took the weekend to be sad and come Monday we regrouped and headed down for the CT and bone scan.  (Both were negative) I told him that we were hoping for a sprint, but got a marathon.  He will begin HT this month and hopefully radiation soon.  I am very hopeful and like Tony stated earlier, this is the first half!  Use half time to do your research, and prepare mentally and physically for the second half! You can win this! We will all be supporting you in this fight!

PS also check out the article link for positive margins on this site! 

Chayna


Father's Information
DX July 15, 2007
Age 62 (now 63)
PSA 5.5
Original Gleason 3+4=7 
Post Surgery Gleason- 4+3=7
DaVinci Surgery Aug 31, 2007
Positive Right Margin
One positive node
Bone Scan/CT Negative (Sept. 10, 2007)
T3a N1 M0
In process of determining follow up therapy
 
 


GreenAcres
Regular Member


Date Joined Jul 2006
Total Posts : 474
   Posted 10/26/2007 11:48 AM (GMT -7)   
Hi, Las - hope you're settled in at home by now. We, too, went in with a biopsy report that said only 5% of one core out of 12 indicated cancer. What a surprise at our followup visit. With such a low percentage, there's really no way to think otherwise going in. You can't look back - a path report is the best way to let you know exactly where you stand with this cancer. Sometimes, you just can't tell - and no doctor can feel - those "nuances" that show up under a microscope.

We know you'll imagine the worst while you wait for that first all-important PSA. As others on this board encouraged us, believe that you'll be in the 80%.
Husband age 66
PSA on 5/1/06: 4.2 (had doubled in 13 mos. and rising monthly)
DaVinci Surgery 8/2/06 - Austin, TX w/Dr. Randy F.A.G.I.N.
T2a (at biopsy)
At pathology - cancer cell leakage into fatty tissue
Post-Surgical PSA on 10/06, 4/07 - undetectable!
Update: 11/1/06 - perhaps bladder neck involvement; 30%-50% chance of recurrence
PSA test "Un-zero-detectable" on 10/16/07.
If it stays that way for 7 years, recurrence rate drops to 9%.
Future: PSA tests twice-yearly for now.
 


hawkfan75
Regular Member


Date Joined Jan 2007
Total Posts : 165
   Posted 10/26/2007 3:56 PM (GMT -7)   

Laswell,

We seem to have a group who have gone through the same thing.  Don't be afraid to think about the fact that you may need adjuvant radiation therapy.  While Dr. Walsh's book states that waiting until a possible reoccurance and then getting RT is just as good as geting it early, a couple of newer studies don't agree.  I always approached this with the mindset that I was going to fight it aggressively.  The first decision was getting the surgery, even when some said that since my biopsy was so small, the seeds could be a better choice.  After receiving the poor pathology report, I too had the "why me?" feelings, but I had to be thankful I took the surgery.  Even when my first PSA was .01, there was discussion of adjuvant therapy, because of my positive margins.  I fought that idea, since it comes with hormone therapy as well - you want to weaken those little B*$#%@s before you zap them.  My second PSA of .08 helped make up my mind.  Thankfully, so far after 4 months the hormones haven't caused any really visible side effects.  I completed my 32 radiation sessions two weeks ago, and also suffered very little.  I feel that keeping physically active is the key.  I still take morning walks, and am officiating high school sports.  In fact, I'm just about to change my clothes and head off to a game.

My advice is to let things settle down for awhile, and realize that there are still many paths you can take.  In the meantime for me, I'm doing all I can - keeping my weight down, exercising, taking selleneum, pomegranate extract, and putting flaxseed on my morning cereal.  All of these things are simple to do, and help me emotionally know that I'm doing everything I can to fight this disease.


PSA 4.7 (up from 3.2 one year ago)
Biopsy November 8, 2006 1 of 10 cores positive 5% LEFT Side Gleason 3+3
Robotic surgery January 19, 2007
Post Surgery Pathology
     Stage T3a, Gleason 3+4, positive margins and
     capsular penetration RIGHT Side
Post Surgery PSA:  March 5:  0.01
5 month PSA, June 13, 2007:  0.08
Adjuvant therapy began June 26 with Zoladex injection
Radiation began August 23
 

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