I'm interested in conversations about and I want to talk about
Know exactly what you want?
Show search

Notification

Error

Positive margin worry.

Email this conversation Print this conversation
User
Posted 21 Oct 2014 at 13:30

Had my histology report last Friday.

Gleason 4+3, Stage T2c classification remain unchanged.

Seminal vesicles, Vasa Deferentia and pre-prostatic fat free of tumour. No lymph nodes seen (presumably taken out!)

Now the disappointing bit: report read 'Apical inked limit shows tumour for 1mm'. I was hoping and, indeed, expecting complete eradication of my cancer! I interpreted that finding as one positive margin with 1mm size tumour at the apex of the prostate where most PM occur. Interestingly, neither the  consultant pathologist  (in his report) nor the consultants (including my surgeon) I saw used the term 'negative or positive margins'. They said I'll be fine and expect my PSA to be undetectable. My head was buzzing with all sort of thoughts and it was difficult to focus on information presented to me at the time of my appointment.

It was bothering me (all weekend) as evidence suggests that PM carry double the risk of biochemical recurrence within 5-10 years.

I emailed my concern and wondered whether adjuvent RT regardless of whether PSA undetectable would be clinically appropriate. He kindly called me back the same day. Bottom line : he did not think the margin to be significant due to size and location. Unfortunately, I am among his 7% patients who has PM. He is a high volume surgeon. As for extra therapy he thinks it'll be overtreatment plus associated complications.

Any thought/comment/critique most welcome!

Thanks for looking in.

Regards,

Jacey 

 

User
Posted 21 Oct 2014 at 18:55

Hi Jacey, always a worrying time when we don't hear the results we want. Having said that I think your consultant is giving good advice. Why have RT when you may never need it.

The Radicals trial is trying to determine the best way forward for high risk men but the jury is still out.

The interesting thing is that they have classified it as t2c which I understand to mean no breakout, yet your consultant refers to a PM. Perhaps there was a focal breach but it was clear in the surrounding tissue that was taken with the prostate.

I would wait to see what your PSA test is and then subsequent tests.

All the best

Bri

User
Posted 22 Oct 2014 at 11:26

Hi Jacey

 

I am in a fairly similar position.  Pathology following RALP confirmed the MRI scan that there was a small "breakout", although margins were clear.  The consultant urologist, who did the surgery, said this increased the risk of recurrence of the cancer by about 20%.  I have had two 6 week PSA tests since the op which showed PSA undetectable.  Next PSA test booked for December.

 

I saw the consultant oncologist this morning to discuss the option of radiotherapy as an adjunct.  She went over the options and possible side effects of RT and explained there was no way of knowing if RT now or if PSA rises was the best option.  For me, the only remaining side effects are ED (which is gradually improving) and very occasional small leaks of urine and I am leading a normal life with no restrictions on what I do.  As there is no certainty that RT now will give 100% reassurance of no recurrence and with the risk of side effects I have decided to wait and see what happens.  The oncologist was perfectly happy with my decision, as was the urologist.

 

User
Posted 22 Oct 2014 at 12:56

Jacey

 

My stats were very similar to yours. I had 2mm positive margins and 20 -30 per cent chance of recurrence. 6 months post op PSA 0.003 classed as undetectable. Positive margins are not always what they seem, I looked into it when I was told I had PM and found that there can be a number of reasons for them. They do not always mean that you still have cancer cells left.  Stay optimistic until you get your results.

 

Thanks Chris

User
Posted 22 Oct 2014 at 17:14

Hi Jacey. My history is very similar to yours, diagnosed June 2013, pre op PSA 18, biopsy 1 of 10 positive, Gleeson 7 (4+3). RP mid July 2013, Post op declared to be a T2c NO R1 Gleeson 8 (4+4) with a positive margin. PSA tests carried out at 6 weeks then two four week intervals results 0.03, 0.043, 0.083.

Although these PSA were very small due to the rising trend I was referred for RT which took place Jan/Feb 2014. No further testing of PSA until October. A very long agonising wait; but yesterday given good news PSA now 0.01 and I am now on six monthly reviews.

Bri is right, wait for your further PSA tests only then will you have a clearer picture, the hard bit is definitely the wait and not knowing but sadly there are no quick fixes. If needed RT is a good backup to the RP.

Regards

John

User
Posted 23 Oct 2014 at 09:03
Hi JC,

I'm glad you've been back for your histology. I feel guilty as I'm not well versed with some of the medical terminology but I would agree with what others have said , your results sound pretty good to me and I wouldn't worry until you've had further PSA tests, easier said than done I know😉

Just concentrate now on getting stronger and moving forward.

Best Wishes,

Jane

User
Posted 23 Oct 2014 at 13:44

Thank you, Jane, for your comforting words and continued support.

I am the one who should be feeling guilty for using terminology that some layperson may not understand! 👎

I guess my health background has something to do with it.

I do feel optimistic and even more resolved to adhere to my philosophy of 'Carpe Diem' (live for the day).

 

Best Regards,

JC

Show Most Thanked Posts
User
Posted 21 Oct 2014 at 18:55

Hi Jacey, always a worrying time when we don't hear the results we want. Having said that I think your consultant is giving good advice. Why have RT when you may never need it.

The Radicals trial is trying to determine the best way forward for high risk men but the jury is still out.

The interesting thing is that they have classified it as t2c which I understand to mean no breakout, yet your consultant refers to a PM. Perhaps there was a focal breach but it was clear in the surrounding tissue that was taken with the prostate.

I would wait to see what your PSA test is and then subsequent tests.

All the best

Bri

User
Posted 22 Oct 2014 at 00:47

Hi Brian,

Thanks for your input.

You are absolutely right, on reflection, about the non urgency or need for RT. I may, indeed, never need it!

I am a little puzzled as you are about my PM. My multi parametric MRI and template-guided biopsy reports clearly stated 'no extracapsular extension or bulge, bilateral tumours confined to organ, Gleason 4+3, T2c, etc. My final pathology stated 'carcinoma gland-confined circumferentially (Stage T2c), one PM at apex'. In terms of recurrence risk mine would be medium.

It's likely there might have been a focal breach. E.Genega, a professor of pathology at Harvard med school thus explains: "What’s referred to as the prostate capsule is a band of fibrous tissue and smooth muscle. But it’s not a true capsule because it does not completely envelop the prostate gland, and its components intermingle with the tissue that forms the framework of the prostate. It is somewhat better delineated around the posterior and lateral surfaces of the prostate, but as you move around toward the apex and anterior prostate — well, it’s generally accepted that there is no capsule at those two locations. So although we use the term capsule, it’s not a well-defined, complete structure."

Bear in mind also, not all pathologists use the same method to assess and interpret margins. Therefore,there would always be the potential for margin (pardon the pun!) of error.

I would concur with your advice about waiting for my first post-op PSA and subsequent ones. Thanks.

Regards,

Jacey

Edited by member 22 Oct 2014 at 00:55  | Reason: Not specified

User
Posted 22 Oct 2014 at 11:26

Hi Jacey

 

I am in a fairly similar position.  Pathology following RALP confirmed the MRI scan that there was a small "breakout", although margins were clear.  The consultant urologist, who did the surgery, said this increased the risk of recurrence of the cancer by about 20%.  I have had two 6 week PSA tests since the op which showed PSA undetectable.  Next PSA test booked for December.

 

I saw the consultant oncologist this morning to discuss the option of radiotherapy as an adjunct.  She went over the options and possible side effects of RT and explained there was no way of knowing if RT now or if PSA rises was the best option.  For me, the only remaining side effects are ED (which is gradually improving) and very occasional small leaks of urine and I am leading a normal life with no restrictions on what I do.  As there is no certainty that RT now will give 100% reassurance of no recurrence and with the risk of side effects I have decided to wait and see what happens.  The oncologist was perfectly happy with my decision, as was the urologist.

 

User
Posted 22 Oct 2014 at 12:56

Jacey

 

My stats were very similar to yours. I had 2mm positive margins and 20 -30 per cent chance of recurrence. 6 months post op PSA 0.003 classed as undetectable. Positive margins are not always what they seem, I looked into it when I was told I had PM and found that there can be a number of reasons for them. They do not always mean that you still have cancer cells left.  Stay optimistic until you get your results.

 

Thanks Chris

User
Posted 22 Oct 2014 at 13:14

Hi Rod,

Thank you for sharing your thoughts.

The arguments you've outlined make perfect sense to me.

Like you, I've decided to adopt a 'watchful waiting' approach in the hope that my December PSA will be 'undetectable'. This is a word I hope I'll grow to love!! 😊

 

Regards,

Jacey

User
Posted 22 Oct 2014 at 13:26

Hi Chris,

It was very comforting to read your and others comments about the issue of PM.

You're right, there can be several factors not necessarily negative associated to that.

For sure, I won't be holding a Damocles sword over my head until proved otherwise! 😜

 

Cheers,

Jacey

User
Posted 22 Oct 2014 at 17:14

Hi Jacey. My history is very similar to yours, diagnosed June 2013, pre op PSA 18, biopsy 1 of 10 positive, Gleeson 7 (4+3). RP mid July 2013, Post op declared to be a T2c NO R1 Gleeson 8 (4+4) with a positive margin. PSA tests carried out at 6 weeks then two four week intervals results 0.03, 0.043, 0.083.

Although these PSA were very small due to the rising trend I was referred for RT which took place Jan/Feb 2014. No further testing of PSA until October. A very long agonising wait; but yesterday given good news PSA now 0.01 and I am now on six monthly reviews.

Bri is right, wait for your further PSA tests only then will you have a clearer picture, the hard bit is definitely the wait and not knowing but sadly there are no quick fixes. If needed RT is a good backup to the RP.

Regards

John

User
Posted 22 Oct 2014 at 18:14

Hi John,

Thank you for sharing that information which I found very useful and your wise advice.

Am definitely not pushing for or demanding adjuvent therapy as, I agree, it's far too premature.

Although some uro-oncologists (particularly in the US) would recommend a more aggressive approach!

 

Regards,

Jacey

User
Posted 23 Oct 2014 at 09:03
Hi JC,

I'm glad you've been back for your histology. I feel guilty as I'm not well versed with some of the medical terminology but I would agree with what others have said , your results sound pretty good to me and I wouldn't worry until you've had further PSA tests, easier said than done I know😉

Just concentrate now on getting stronger and moving forward.

Best Wishes,

Jane

User
Posted 23 Oct 2014 at 13:44

Thank you, Jane, for your comforting words and continued support.

I am the one who should be feeling guilty for using terminology that some layperson may not understand! 👎

I guess my health background has something to do with it.

I do feel optimistic and even more resolved to adhere to my philosophy of 'Carpe Diem' (live for the day).

 

Best Regards,

JC

 
Forum Jump  
Email this conversation Print this conversation

Join the online community now.

Click through to become a member and gain access to support, information and real time replies.




MenuTop ▲
©2024 Prostate Cancer UK