negative margins?

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montee
Regular Member


Date Joined Mar 2007
Total Posts : 315
   Posted 11/6/2007 11:15 AM (GMT -7)   
I have a friend who had surgery last year at MD Anderson who had negative margins,  his post op psa never went below .5, he went to Mayo and they did radiation sessions, he had his 6 mos post radiation psa and it is .9 and they think it may be in his bones.  How can you have negative margins and may have it in your bones, wouldn't his psa be higher.
 
Thanks
 
Ron
diagnosed sept 06
gleason 3+4=7, right lobe only
psa 4.7
Told not to have surgery at Dana Farber as cancer had already penetrated prostate, in seminal vesicles, would have positive margins. Would only treat with radiation and HT
RP Emory Atlanta December 2006
Path-negative margins, negative lymph nodes
negative seminal vesicles, multifocal perineural invasion, both lobes involved
40% gland involved
gleason 3+4=7
1st psa April 2007-<0.04
 6 Mos PSA <0.04
9 mos PSA still <0.04


Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2249
   Posted 11/6/2007 11:46 AM (GMT -7)   
Did he have negatives in surrounding lymph nodes, seminal vesicles? In my understanding from reading I have done, negative margins means the cancer has not spread anywhere. There are no 100% guarantees, but it seems odd that the cancer has escaped the prostate. Could it be that the pathologist misread the slides made from the margins?

Post-prostatectomy PSA's should be non-detectable, otherwise it means that PSA-producing cells are still lurking in the body somewhere, including the bones.
Age 59 PSA 2.6 (Quadrupled in one year) Gleason 5
Bilateral nerve-sparing RRP 6/21/06
Cancer confined to prostate, post-op PSA's non-detectable


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8122
   Posted 11/6/2007 11:50 AM (GMT -7)   
Hi Ron,
Unfortunately, negative margins is good news, but not difinitive proof that no cancer escaped the prostate. Blood flows through the prostate constantly and it's that is just one way cancerous cells can escape the prostate without positive margins. Positive margins is definitive that cancer has escaped thus the importance of know if you have them or not. Unfortunaly also, PSA is not an exact science either. Some mutations in cancer cells cause the body to produce no or little PSA. Our friend here, Gordy, has no PSA but distant spread of prostate cancer. There simply are no guarentees when fighting cancer. But it works both ways, and that's why I stay hopeful. It is possible to have my grossly abnormal post op pathology, and be a long term survivor.

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!


montee
Regular Member


Date Joined Mar 2007
Total Posts : 315
   Posted 11/6/2007 3:14 PM (GMT -7)   

that's what worries me, even though my post op psa is 0.04, my pre-op was 4.5 and dropped to 3.7 due to low testosterone levels, even though I had 40% tumor volume which is considered large, I worry that the 0.04 is more significant because of the testosterone levels and the fact that I have lost over 30 lbs this year and my pre-op tests at Dana Farber, where they said they felt the tumor outside. Even the surgeon at Emory(Marshall) has been surprised that my numbers have stayed at 0.04  I haven't weighed this since I was in the 11th grade.

 

Ron


diagnosed sept 06
gleason 3+4=7, right lobe only
psa 4.7
Told not to have surgery at Dana Farber as cancer had already penetrated prostate, in seminal vesicles, would have positive margins. Would only treat with radiation and HT
RP Emory Atlanta December 2006
Path-negative margins, negative lymph nodes
negative seminal vesicles, multifocal perineural invasion, both lobes involved
40% gland involved
gleason 3+4=7
1st psa April 2007-<0.04
 6 Mos PSA <0.04
9 mos PSA still <0.04


CaPCa
Regular Member


Date Joined Aug 2007
Total Posts : 118
   Posted 11/6/2007 3:25 PM (GMT -7)   
I, too, have questioned how recurrence can happen if margins are negative. A urologist simply stated that it could be due to a pathology misreading. I question whether cancer cells can enter and spread via the bloodstream since the urological community claims that a biopsy cannot spread cancer. Dr. Walsh says in his book that evidently PCa cells must "learn" to live outside the prostate before metastasis can happen. Therefore, any PCa cells that get disrupted by a biopsy and enter the bloodstream, for example, would not survive the change in their environment.
Age:44
Father diagnosed and cured at age 52.
08/21/07: Diagnosed with T1c cancer
1 of 12 biopsy cores positive; 10% tissue
Gleason score: 3+3=6
PSA level prior to biopsy: 4.3 (velocity < 0.4ng/ml)
10/19/07: da Vinci prostatectomy by Dr. Vipul Patel at OSUMC.
              Difficult surgery due to prostate inflammation.
              Both nerve bundles spared.
              Spongy erections began within 24hrs of surgery!
10/24/07: Catheter out; down to 1 Serenity pad/day next day.
              Final pathology: neg margins, no capsular penetration,
              Gleason 3+3=6, 5% tumor involvement, multi-focal.
 
 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8122
   Posted 11/6/2007 3:27 PM (GMT -7)   
Ron, if you have lost this weight because of your diet and excersize, all the books and studies I read say you are doing it right. I am losing at a much slower pace but I am dropping some weight. Stay positive and think the good things and don't be discouraged by this. You have already shown that you are in much better shape than originally thought. Take good care of yourself and keep up the low numbers.

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!


myman
Veteran Member


Date Joined Feb 2007
Total Posts : 1219
   Posted 11/6/2007 3:57 PM (GMT -7)   
Ron - My husband's post pathology stated negative margins. His first PSA after LRP was 11.8 (as his stats show below). How did that happen? Wish we knew but all agreed it must've escaped the prostate before surgery. When his PSA went to 18.8 Lupron shots were started - the cancer showed in distant lymph nodes - systemic.

I truly say this not to scare you but it happens...not often but it does. Just as Gordy showed no PSA rise, Don's pathology showed negative margins.

BUT...despite that I'd still say to you, try not to dwell on this. If you have been checked out every way possible, if you trust your physicians then go with that. If you have a strong feeling you need further testing then ask for it. Remember you are still in control, just as you had to decide whether or not to have surgery, you can decide your aftercare.

All the best,
Susan
Husband Diagnosed 11/17/05 Age: 63 No Symptoms
PSA: 7.96, Positive DRE
Biopsy Right: 6 of 6 Cores Positive Biopsy Left: 1 of 6 Cores Positive
Gleason: 4+3 = 7 Stage: T2B N0 MX
3 mo. PSA Post LRP Surgery: 11.8, 12.9, 13.9 Bone scan, CT scan, Endorectal MRI, Chest XR - neg.
09/06/06: 6 mo. PSA: 18.8 Distant lymph node involvement Start HT Lupron 3 mo. shots
12/06/06: PSA 0.8
03/07/07: PSA 0.3
06/06/07: PSA 0.1
09/05/07: PSA 0.1

Post Edited (myman) : 11/6/2007 9:11:49 PM (GMT-7)


JCL
Regular Member


Date Joined Jul 2007
Total Posts : 242
   Posted 11/7/2007 6:18 AM (GMT -7)   

Unfortunately, the fallacy remains that if the prostate is removed and the pathology report indicates negative margins, negative capsular penetration, lymph nodes and seminal vesicles, a patient can be considered "cured." As most of us know, although the percentages are favorable for non-recurrence with such a report, that’s not always the case, and there are anomalies. I asked my doctor last month what were the chances that any cancer was left behind and he told me that it’s "not likely given your pathology report, although the only thing you have going against you is your Gleason 7 and there are no guarantees." Not the answer I was looking for, but it’s something we all have to live with regardless of a favorable or unfavorable final pathology report. The only time I think about recurrence is when it comes time to have my PSA taken. Other than that, I don’t think about it much, and thank God for every day I have.


Age: 49
Diagnosed: March 25, 2007
PSA: 3.0
Biopsy: Gleason 6. Five of twelve core samples positive with <5% each. No perineural invasion seen.
DaVinci Surgery: May 21, 2007 at Florida Hospital, Orlando, Florida. Surgery took one hour and 45 minutes. According to my surgeon, everything went textbook and the prostate peeled away nicely.
Post-op Pathology Report: Upgraded to Gleason 7 (3+4), negative margins, negative capsular penetration, negative seminal vesicles, lymph nodes left intact, multifocal perinural invasion, 15% of prosate involving cancer in both lobes.
Continence: Out of the pads at five weeks. Still have some very minor stress incontinence at times but it's not an issue. Still Kegel every day and will continue to do so.
Erections: Yes! With the assistance of Cialis.
1st Post-op PSA: <0.1 2nd Post-op PSA: <0.1
Family history: My Father had his prostate removed at age 67 in 1997 and has had a <0.1 PSA for the past 10 years. I was diagnosed at a much earlier age and had a more agressive cancer than my father. Go figure.
 
 
 


Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2249
   Posted 11/7/2007 9:24 AM (GMT -7)   
In my own case, the positive biopsy slides and subsequent post-op pathology slides were sent to Johns Hopkins, where Jonathan Epstein, a world expert on prostate cancer pathology read them and confirmed the original pathology report.  A second opinion can be useful and reassuring.  
 


Age 59 PSA 2.6 (Quadrupled in one year) Gleason 5
Bilateral nerve-sparing RRP 6/21/06
Cancer confined to prostate, post-op PSA's non-detectable


CaPCa
Regular Member


Date Joined Aug 2007
Total Posts : 118
   Posted 11/7/2007 10:29 AM (GMT -7)   

I am a numbers guy, and like to use available "nomograms" for PCa probabilities. These are based on statistics gathered over hundreds, even thousands, of men who have had prostate cancer. Although nothing is guaranteed with cancer, statements that recurrence "can" or "sometimes" happen need to be taken into context with actual recurrence rates. I have been using the Sloan-Kettering online nomograms at:

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

but others may have even better tools. These tools, based on actual underlying case data, show that reccurence rates can be extremely low with surgery, especially for negative margins and no capsular penetration. Multi-year disease-free survival is often in the very high 90's percentage range.


Age:44
Father diagnosed and cured at age 52.
08/21/07: Diagnosed with T1c cancer
1 of 12 biopsy cores positive; 10% tissue
Gleason score: 3+3=6
PSA level prior to biopsy: 4.3 (velocity < 0.4ng/ml)
10/19/07: da Vinci prostatectomy by Dr. Vipul Patel at OSUMC.
              Difficult surgery due to prostate inflammation.
              Both nerve bundles spared.
              Spongy erections began within 24hrs of surgery!
10/24/07: Catheter out; down to 1 Serenity pad/day next day.
              Final pathology: neg margins, no capsular penetration,
              Gleason 3+3=6, 5% tumor involvement, multi-focal.
 
 


lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 664
   Posted 11/7/2007 8:41 PM (GMT -7)   

I posted earlier in another thread.  Yesterday my urologist informed me that my post surgery psa numbers had climbed in to the positive zone.   It is only .02 which is a number lower than my friends using brachytherapy and radiation consider normal, but it is still a positive number.  I now have to go through the every 90 day psa wait and see syndrome. I am not happy. My doctor will only react if I have two readings over .1 .

CaPca

By all accounts the earlier nomograms predicted  90% -5 and 10 year non reccurence for me.  It is beginning to look like they may be  wrong.  However there is still the chance that this one reading is an anomaly, and will not repeat itself.

I read this article last night which answered some of my questions and provided another nomogram for post surgery psa. The article was titled "What happens if PSA comes back after surgery"?

  http://www.phoenix5.org/Basics/psaPostSurgery.html

 

 



 
Biopsy 10/16/06
T2A,  PSA 4.7
Gleason 4+4=8 right side
adrenocarcinoma of prostate
DaVinci Surgery 01/16/07
Post op report,confirms Gleason4+4=8
no extra extension/invasion identified
age 65
no continence problems
Back on the golf course...
90 day PSA  less than 0.01 (undetectable)
Six Month PSA still undetectable
Dealing with ED problems with Caverject/Viagra
nine month psa slightly elevated + .02
 
 
 

Post Edited (lifeguyd) : 11/7/2007 9:05:42 PM (GMT-7)


CaPCa
Regular Member


Date Joined Aug 2007
Total Posts : 118
   Posted 11/8/2007 10:42 AM (GMT -7)   
I am waiting to do my first post-surgery PSA and am debating whether I should do the ultra-sensitive PSA test. I have a lot of PSA anxiety, rightly so, since this is what led me to surgery in the first place! I may first go with the normal PSA. If I am lucky enough to get "< 0.1 - undetectable" for one or two PSA tests, I feel I can always switch to the ultra-sensitive variety at a later time. I understand your anxiety over this.

Age:44
Father diagnosed and cured at age 52.
08/21/07: Diagnosed with T1c cancer
1 of 12 biopsy cores positive; 10% tissue
Gleason score: 3+3=6
PSA level prior to biopsy: 4.3 (velocity < 0.4ng/ml)
10/19/07: da Vinci prostatectomy by Dr. Vipul Patel at OSUMC.
              Difficult surgery due to prostate inflammation.
              Both nerve bundles spared.
              Spongy erections began within 24hrs of surgery!
10/24/07: Catheter out; down to 1 Serenity pad/day next day.
              Final pathology: neg margins, no capsular penetration,
              Gleason 3+3=6, 5% tumor involvement, multi-focal.
 
 

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