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Extracapsular Extension at Posterior Left Apex

ScottCPA
Posts: 3
Joined: Oct 2013

Hi Everyone

I am new to this forum.  I have been reading many of the threads, and I find it very informative.

I recently has RP, and the post-op pathology report came back.  Most of the bullet points were good, except for one:  Extraprostatic extension is present at posterial left apex.  The doctor explained that the cancer poached the capsule.  However, the report also said that ALL margins are negative.  The doctor emphasized that although it broke the capsule in that one spot, it didn't extend to the actual margin.  Therefore, I should be good.

I won't have my first post-op PSA until about a month from now.  My pathologic stage is pT3a (m) N0MXR0.  Gs is (4+3).

Did anyone else have extracapsular extension, but still have no positive margins overall?  If so, what were the subsequent outcomes in terms of PSA levels?, additional treatments?

I am hoping that having no positive margins will greatly diminish the need for future treatment, but the extracapsular extension does annoy somewhat.

Any feedback would be greatly appreciated,

Scott

 

 

 

 

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

Hi Scott and welcome to our forum. But of course we all are saddened for the reasons that you had to find our corner of the web.

I am by no means a doctor nor am I in the medical field. I would agree that not having the positive margins is indeed a good sign. So try not to worry and heal.

You didn't mention when your surgery was so hoping you are well on the road to recovery. As the doctor may have explained to you when they remove your prostate during surgery they ink it and then send to the lab. The lab doesn't want to see any cancer cells in the inked area. If they find that it is considered a positive margin.

I had my surgery 4 years ago and was also a Gleason 7. I did have a positive margin. I just recently started IMRT radiation due to my PSA slowly starting to rise. I'm just over the half way point in the radiation.

Follow your Doctors advice and get those PSA checks. Its a bother but it is best to find out as early as possible if the PSA does start to rise. Then you can follow up.

Of course the Gleason 7 is borderline aggressive but I think you will do fine.

Keep us posted with any further questions and your PSA

lewvino (larry)

 

ScottCPA
Posts: 3
Joined: Oct 2013

Thanks, Larry

My surgery was only last week, so I won't get my first post-op PSA test until later this month.  I was not aware that the prostate is inked before it is sent to the lab.  I will look into that further, just for my own edification.

The best of luck with your radiation therapy.

Scott

 

 

 

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

I was not real familiar with the extracapsular extension so did a little reserach and found the following:

Extracapsular tumor extension means that tumor cells are seen growing in the tissue surrounding the prostate. It is possible to have extracapsular extension with negative (clear) margins if a rim of additional tissue is removed with the prostate gland. However, it is also possible to have extracapsular extension with positive (cancerous) surgical margins.

In either case, the risk for tumor recurrence is higher than if the cancer were completely contained within the prostate gland, but the risk is higher when there are both extracapsular extension and positive surgical margins.

So you are in a slightlyl higher risk group but not as high as having the positive surgical margin.

Keep up with the PSA's now. They will most likely check you every 3-6 months and then let you go to a yearly check.

larry

 

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

Have you had the cath removed yet? If so how is it going? I was lucky and had no problems with urinary continenance.

A good book that is easy to understand is Dr. Patrick Walsh's guide to surviving prostate cancer if you haven't read it.

Very informative book.

larry

ScottCPA
Posts: 3
Joined: Oct 2013

Next Monday it will be removed.

That's great you had no incontinence.  I hope I am the same way.

Did you do anything in particular to get this result?  I read Kegel exercises are important after the catheter is removed.  Did you do any of that, either before or after your surgery?

Prior to my surgery I did read all the relevant chapters of Dr. Walsh's book.  Definitely on the recommended list.  I would imagine every public library has a copy.  I am sure it is checked out often.

Scott

 

 

 

 

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

Yes I did the kegels before surgery and after cath removal. Sometimes I still do a handful a day figuring it can not hurt!

A coupld tips for when the cath comes out:

Avoid alcholol and avoid lemonaide. I don't drink but have heard from others that lemonaide will make you drip and I know that lemonade made me drip! Every now and then depending on position I'm in I might get a small drop or two of urine. Like if you are setting on the floor or some other not normal position and you get up. Just small drops like if you don't shake enough after going to the bathroom.

I had bought a box of pads for the time after the cath came out and took one with me to the urologist office as they recommended. That is the only pad I used but didn't even need it.

It doesn't hurt to have the cath out, just a different sensation. Wishing you a smooth time on Monday.

larry

kozykitty
Posts: 15
Joined: Jul 2013

Hi scott.  Had my prostrate out about 2 years ago and everythig was ok , no spread of cancer so no radation, kemo or anything, thank you.  It was nice to have the cath out but I do have constant leakage, in fact I just had an "ams800" artifical urinary sphnitor" installed on sept 6 and am waiting to get it activated, should happen on the 17th, can't wait to et rid of the4 -6 pads a day use. good luck and remenber everyone is different, I was really concerned with the recovery after the installation of the AUS from what I read on this and other forums,  May-be I just have a higher pain tolerancebut I didn't have the swelling that seemed to be a complaine of everyone.  Anyway, do what you have to do and good luck with everything,  George

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