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Patholgy Report

lewvino's picture
lewvino
Posts: 1007
Joined: May 2009

Dr. Office just called. Today is one week post surgery.
Final report showed 20% of the prostate was involved with Cancer.
Overall Gleason score given of 3+4 (7)
POSITIVE SURGICAL MARGIN noted on the right apex.

Does anyone know if this means that I have to now start radiation or will they just do PSA tests for awhile To see what happens?

Very depressed right now.

Larry

NM
Posts: 214
Joined: Jul 2009

Larry sorry to hear about the positive margin. Wish I could offer some advice. Just wanted you to know I am praying it turns out ok. you have helped many here myself included so maybe my thanks will help a little ......Nick

ld34
Posts: 24
Joined: Jun 2009

Sorry to hear about the bad final report.

I was in the same situation in 1997 but my post surgery gleason was 9 ( prior to going into surgery my gleason was 7).

My surgeon ( famous guy .. 8 to 10 surgeries per week ) suggested radiation asap

My surgery was on Feb 6 1997.. the 33 radiation treatments were started in May 1997.

My psa remained <.1 for nine years .

Now it is slowly creeping up.

As a result, I am now looking at a hormone therapy.

Hopefully ,a long time from now.

I wish you well.

saoco
Posts: 43
Joined: Aug 2009

Hi levino,many people with one positive marging have a very good chance to get cure.
the 20% and the gleason of 3+4 I think your Dr will send you for radiation to make sure
everything is right.if the gleason was 4+3 then maybe you will not need radiation,but that
is my humble opinion.you will do ok I will pray for you and family just hang in there ok.

novaguy
Posts: 76
Joined: Jul 2009

Larry, sorry to hear about your positive margins. For what it's worth, this is something I really worried about, and as it turned out, my margins were negative. But I remember my urologist telling me that I was worrying about the wrong thing. He said positive margins by themselves don't mean that much, because the cells they find along the margin may be sliced in half, or any that remained behind will probably die off. He said extracapsular extension is more important, and from what I recall he said the rate of extracapsular extension is only half of the rate of positive margins.

The other thing, if you go into the sloan kettering calculators and play around with post surgery numbers, you can put in positive margins and for your gleason and psa I think you will still find that you have a very high probability of nonrecorrence. You have to make up the length of time before psa comes up because you need that for the calculator, but just put in say 12 months or something. Just to show you that positive margins are not that big a deal for recurrence, if everything else is clean.

Good luck!

Watch.repair.man's picture
Watch.repair.man
Posts: 49
Joined: May 2009

Larry I am sorry for the report. I really don't know what that means. I will keep you in my prayers. The doctor will do what needs to be done to kill the cancer.
Keep your head up.
Your doing so good in the other areas, keep on going.
God Bless.
Keven

gator880
Posts: 21
Joined: Aug 2009

My husband's urologist/surgeon recommended radiation and hormone treatments after his surgery left positive margins. He had 36 radiation treatments(after healing from surgery), kept working and had relatively few side effects. While on hormones for a year after surgery, his PSA stayed nearly undetectable. Together, those therapies definitely kept the cancer at bay.
It's okay to be depressed, angry, etc. Tomorrow, start making a plan to fight back! Keep us informed--we care.

novaguy
Posts: 76
Joined: Jul 2009

Just found this report from an Australian group that lists guidelines for radiation after surgery, see link below. They say that positive margins is an indication for radiation, so you might want to read through this and discuss it with your doctor. Even if the positive margin is not a big deal (as my urologist seemed to thing), if it were me I would go with this radiation. I've read that it's best to wait until the surgery is healed because radiation freezes the healing process at whatever point it is.

I know it's tough to think you still have a hill to climb, but radiation will be a whole lot easier than the surgery we've been through. I was playing golf with a guy a month ago who was going through radiation treatments for prostate cancer, and it didn't seem to affect him. He beat me pretty badly. Good luck!

http://www.ncbi.nlm.nih.gov/pubmed/18514340

Toyoungforthis
Posts: 10
Joined: Aug 2009

Hang in there friend we are praying for you.

Lindorf
Posts: 11
Joined: Apr 2009

Larry:

I had a very similar experience. My post op pathology was 4+3 with a tertiary of 5 T3a and 1 focally positive margin everything else clean. My pre op PSA was 24. Hearing the report was a shock, perhaps even bigger that the initial report that I had cancer. It was quite depressing initially, but we were able to manage it to get on with the treatment choices. Part of your choice will be based on whether your PSA drops to undetectable. Mine did at my 1 month follow up and my surgeon offered me the choice of waiting and watching closely, having a PSA every 3 months and doing salvage if it started to rise or doing adjuvant Radiation Therapy. I have chosen the adjuvant Rt because of the statistical advantage to the ART and the adverse pathology. I was offered hormone therapy with the RT, which several doctors supported and several did not. I have declined the Hormones because there is no real proof that they are effective in this treatment as of now. I chose to meet with Radiation and medical oncologists prior to the 1 month follow up so I would be ready to decide what was best in good time. As was noted above, Rt does not start for 3 months so that you can fully heal, and I had advice that you have up to two years after the surgery to still keep a strong statistical advantage with ART. Unfortunately, as with other aspects of PC treatment there is not an obvious and simple answer. For certain the values in your one month PSA may clear this up a bit.

I wish you the best,

Harry

lewvino's picture
lewvino
Posts: 1007
Joined: May 2009

Harry,
Thanks for sharing your experience. When we checked out of the Hospital the discharge nurse told us not to worry if there was a positive margin that the 'Gold standard' is the PSA Testing which I won't have until Early October. I'm staying more positive after the initial shock. Was going to talk to my local urologist about it but just going to wait until I go back up in October to Vanderbilt and get there take on things first. I don't think I would really gain much right now from my local urologist since there is no PSA test yet.

Larry

txbarton's picture
txbarton
Posts: 85
Joined: Aug 2009

I am amazed at the leap to the negative.

Larry 100% had cancer a week ago. The post surgery pathology shows that all the cancer MAY not have been removed. Much better odds than he had last week.

Keep your head up, Larry, we're gonna beat this!

VB

hopeful and opt...
Posts: 1363
Joined: Apr 2009

To be honest, I don't know what's going on...........but, my thoughts are with you for the best..........Ira

mjweis
Posts: 11
Joined: Jan 2009

Do your research! I am in a very similar situation - 4 months out of surgery, post-op 3 + 4 = 7, 5% involvement, Single positive margin in apex and am leaning toward radiation. There is a SWOG study out there that makes a pretty good case for adjuvant radiation. There are debates as to the best time to begin treatment (right away, after healing, once PSA starts to rise) so read as much as you can about the treatment and side effects and try to apply it to your personal situation.

lewvino's picture
lewvino
Posts: 1007
Joined: May 2009

Have you decided yet what you will do?

mjweis
Posts: 11
Joined: Jan 2009

I am 95% certain I will undergo radiation - it's just a question of when to start. My surgeon would like to see me wait 2 months (start at 6 months post op) while the radiation oncologist thinks I am healed enough to begin treatment now. The two doctors are in contact and I have not yet heard back - I am inclined to wait, all other things being equal.

lewvino's picture
lewvino
Posts: 1007
Joined: May 2009

Would you mind sending me your email address to lewvino@yahoo.com ? I have a few more questions I would like to ask you offline.

Larry

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