Prostate contained cancer but one positive margin

bdhilton said:

I am 55 and we all have
I am 55 and we all have different perspectives based on our final outcomes on our post surgery pathology…The fact and from my perspective you downgraded to a Gleason 6 from a 7 in your pathology is the best news (less aggressive) and cause for celebration…the positive margin is anyone’s guess and what I have come to believe is that reoccurrence or not is just luck (destiny or what ever you chose to call it) …

My surgeon and oncologist both wanted me to have adjunct radiation after surgery and after doing my own research I talked to my oncologist and he agreed that he would do the same thing I am doing and wait to see it I get a PSA rise (to date I am having Zeros) then have salvage radiation… The trade off for me is a PSA test every 90 days but I believe the longer I go without radiation (or just get lucky on the side of statistics) the better off I am..

After my oncologist reviewed my pathology report with me he told me to start living my live and enjoy…so my advise is enjoy the journey and take the positives where you can-

Peace

Exam Date and Time: 3/3/2010 12:00 PM Results Date and Time: 3/8/2010 8:18 PM
Final Diagnosis
A. Lymph Node, Right Pelvic, Excision:
-One Lymph Node, Negative for Metastatic Carcinoma
B. Lymph Node, Left Pelvic, Excision:
-One Lymph Node, Negative for Metastatic Carcinoma
C. Prostate and Seminal Vesicles, Radical Prostatectomy:
-Prostate Adenocarcinoma with Focal Ductal Differentiation, Gleason’s Score 4+3=7, involving both the Right and Left Prostate Lobes
-A tertiary Gleason’s Pattern 5 Component is Present
-Extensive Extra Prostatic Extension is Identified Involving the Right Apex, The Right and Left Mid, And The Right Base
-The Adenocarcinoma Focally Extends To The Inked Margin In The Right mid Prostate (Slides C8 and C9)
-The Adenocarcinoma Invades Into The Right Seminal Vesicle
-The Left Seminal Vesicle Is Free Of Tumor
-The Remaining Surgical Margins Are Free Of Tumor
-Intraductal Spread of Adenocarcinoma is Present (See Notes).
-Extensive Perineural Invasion is Present
No lymph vascular Space is Present
-The Dominant Tumor Nodule is Present in The Right Prostatic Base and Measures 2.2 CM in the Greatest Dimension.
-Additional Tumor Nodules Are Present In The Left Apex, Right Apex, Right and Left Mid Prostates, and The Left base. The Adenocarcinoma is Present In 24 of 34 Submitted Slides And Involves Approximately 18% of the Prostatic Volume.

-High Grade Prostatic Intraepithelial Neoplasia.
Note: The positive surgical margins are in an area of extra prostatice extension. The ductal differentiation is best appreciated in slides C33 and is focal in nature (less than 5% of the total tumor). A PIN4 immunohistochomical stains perform on block C23 supports the diagnosis of intrductal spread of carcinoma. Dr; Ximing Yang has reviewed selected slides for this case and agrees with the above interpretation of margin status and seminal vesicle invasion.

This test was developed and its performance characteristics were determined by the Northwestern Memorial Hospital Immujnohistochemistry Laboratory. It has not been cleared or approved by the U.S. Food and Drug Administration. The FDA has determined that such clearance or approval is not necessary. This tst is used for clinical purposes. It should not be regarded as investigational or for research. This laboratory is certified under the Clinical Laboratory Improvement Amendments of 1900 (CLIA-00) as qualified to perform high complexity clinical laboratory testing.

The positive Control demonstrates appropriate positive staining. The known tissue negative controls were negative. The non-immune serum control was non-reactive.

Prostatic Cancer Staging Summary:

Tumor Type: Acinar with Focal Ductal Differentiation

Gleason Score
Primary + Secondary: 4+3=7
Tertiary: Pattern 5

Location Main Tumor: Prostatic Base
Location Additional Tumor Nodules: Left Apex, Right Apex, Right Mid, Left Mid, and Left Base

Extraprostatic Extension
Focal (<2 Microscopic FOCI): N/A
Established (Extensive): Present and Extensive

Margins
Apical Margin: Free of Tumor
Bladder and Urethral: Free of Tumor
Other Surgical Margins: Positive, right mid Prostate

Seminal Vesicles: Positive for Carcinoma
Location, If Involved: Right Seminal Vesicles

Perineural Invasion: Present

Lymphatic/Vascular Invasion: Not Identified

Total Lymph Nodes: 2
Number positive: 0
Tumor Volume Approximately 18%
Tumor (T): pT3b
Metastasis (M): pMX
Nodes (N): pN0</p>

thor123 said:

Thank you
VGama, thank you for your very encouraging and generous comments.

A question: I can't anywhere on the Web find a definition of a successful RP, such as you note at .06. Having reached 0.02, does that constitute the nadir that I've reached and indicate success, even it if goes up to 0.03 or a little higher? Could you refer me to research on this subject?

Also, does "successful" in this context pretty much indicate a cure.

Thanks again.

Thor

prostateman said:

Thor, success is measured on
Thor, success is measured with a non measurable PSA reading after surgery. If you have a measured PSA then you more than likely have a recurrence and should consult with your oncologist. NO one here should be giving you any different advice than seeking professional advice. I wish you the best and please consult with your oncologist.

prostateman said:

Giving professional advice?
Giving professional advice? Having had a RP I believe I have a vested interest in understanding the risk and things to watch out for during my journey. Any measured PSA reading after a RP is a major red flag. The “cure” from a RP is based on no PSA reading. This is not my opinion this is a medical fact. If you would like I could provide some links or copy and paste some articles but you could just Google the same.

I do not know why you are challenging such basic information that any urologist or oncologist would inform their patient. From what I have read from you have had some form of radiation with no side effects to date and I am truly happy for you and your treatment choice. I am new to this group and perhaps I am reading you wrong but you seem a bit combative and controlling of this board.

Kongo said:

Success, failure, and BCR
Prostateman,

If you have a link to a study, report, or professional finding from a major medical association that suggests that a successful RP is defined as having “no measurable” PSA I would be grateful if you would post the link. As I suggested in my first response to Thor’s question about “success,” my personal (non professional) opinion is that a successful surgical (or any other treatment) outcome is in the eye of the beholder. Biochemical recurrence (BCR), on the other hand, is a technical definition related to PSA with widely varying definitions and interpretations. So perhaps our differing views of this subject are only a matter of semantics.

In one study I read recently, the authors used as many as ten different definitions of BCR to analyze data in an attempt to reach some sort of scientific consensus as to what the best definition of BCR might be. You may be interested to read this report from the Journal of Clinical Oncology which can be found at: http://jco.ascopubs.org/content/24/24/3973.short. This paper specifically addresses the issues we are discussing here. As Vasco describes in his comprehensive post, different institutions use different levels of PSA readings to set thresholds for when intervention would be recommended or not, since the presence of a detectable PSA does not always mean that prostate cancer will progress.

Given the advent of the ultra sensitive PSA tests available today, most men who have an RP have some detectable level of PSA following surgery. If we used the definition you suggest is common in the field to describe “success”, then all of these RPs (including Thor’s) would be “failures” and I do not believe that is the case. In fact, I believe that since most men do not progress to a technical definition of BCR then most surgeries could be considered successful, even though there is a detectable level of PSA. Many posters here have described an initial PSA score after surgery that rapidly dropped within several weeks and then stayed that way for years. Even though most of the prostate is removed at surgery, it’s not like unbolting a carburetor from a car engine. Depending on the surgeon and technique, prostate tissue is always left behind and is capable of generating some amount of PSA after surgery.

I agree that a rising PSA for anyone (even those who have had radiation treatment) might be a cause of concern but more important than the actual number itself is the rate of rise or PSA velocity. Many urologists have different views as to what constitutes a tripwire for further intervention and the significance of the PSA readings. Some do not recommend the ultra sensitive PSA tests. Others recommend treatment at the earliest sign of PSA rise while others take a “wait and see” approach. I think it is important for men to understand the logic behind their doctor’s reasoning and be aware of alternate views that might prompt them to seek a second opinion.

I certainly don’t mean to be combative or controlling (eerily reminiscent terms often used by one of my favorite posters who “took a break” about the same time you arrived) but it seems to me that the more each of us learns about prostate cancer in our individual journeys the less we understand about the extremely complex mechanisms going on within our bodies and the plethora of factors that affect the growth or remission of our cancers. I have learned the hard way to be suspicious of too simple explanations of what causes what to happen with respect to prostate cancer. I think that if we put forth an opinion on this board, we ought to be prepared to explain our logic and back it up with references where appropriate so readers can make an informed decision about whether or not to buy in to it or even if it applies to their own individual case. I am fully aware that some might not always agree with me or agree with me even a little. There is a wide degree of controversy among professionals, surgeons and radiologists alike, about prostate cancer treatments so it's not surprising there are differing opinions on this forum as well. Understandably there are sometimes emotional or heated exchanges. After all, we’re betting our lives on our decisions so we ought to have strong opinions about these things. I think most would agree that a spirited exchange of views is healthy and productive and I look forward to continued exchanges with you in the future.

I hope you will feel free to share more about your background so we can better understand the perspective of your posts.

Best

How are you doing