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4 mts Post prostectomy

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User
Posted 20 Jul 2020 at 11:43

Hi,

had my prostate removed on the 7th of March 20.

no complications to report and feel well. was very incontinent but seems to be settling down now and only using pads when I'm out and about.

my histology came back showing a 3mm surgical margin and a Gleason 4+4 (5) so Gleason 8 or 9. So, not the best!

My PSA now is 0.03 (3mts post surgery)

so, my concerns are:

1. is 0.03 low enough or should it be <0.03

2. if PSA starts to rise would RT be beneficial for me (gleason 8or9)

if anyone has anyone got any views on this so, would like to hear it :)

 

 

 

User
Posted 20 Jul 2020 at 17:52

hello lexie26,

thank you.

tell him not to worry too much about the op its just one of those things that just got to be done and not that scary.

after that i hope your husband will get the news he is hoping for.

he will have 3 days of pain but paracetamol will help a lot. short walks are recommended because of DVT and also a swift way to get movement back to normal.

please, let us know of his progress.

wishing you all the luck

User
Posted 23 Jul 2020 at 07:05

Good morning Chris,

Well I’ve been told that it is a probability and that if psa starts to rise I will need rt to the prostate bed.
yes, I too came across an article where it’s down playing ‘positive margins’.

still I feel very uncomfortable especially since I did not achieve the < in front of my 0.03.

wait and see, I suppose.

wishing you a good day:)

 

 

 

 

User
Posted 25 Jul 2020 at 18:31

Originally Posted by: Online Community Member
Surely extraprostatic is another way of saying positive margins and intraprostatic is negative margins?

Someone may know more, but I'd say they are simply assuming (or shall we say using educated guesswork) that if the cancer is through to an edge of the prostate then it has likely spread beyond, and if it hasn't then that is considerably less likely. They can be wrong.

 

No - extraprostatic means that there was cancer outside the gland; positive margin means that there was cancer up to the edge of the wax that they wrap the gland in before slicing it to inspect (and therefore a possibility that some cancer smells have been left in the prostate bed); a negative margin means that there was no cancer within 5mm of the wax; intraprostatic extension means that some of the prostate gland was accidentally left behind; and intraprostatic extension with positive margin means that there was cancer at the wax edge of where the prostate hasn't been cut cleanly and there may therefore be some cancer cells left in the prostate bed. 

The possibility of cancer cells left behind (a positive margin) increases the chance of needing adjuvant or salvage treatment, but it is not a certainty. 

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 25 Jul 2020 at 19:42

Originally Posted by: Online Community Member
Surely extraprostatic is another way of saying positive margins and intraprostatic is negative margins?

Someone may know more, but I'd say they are simply assuming (or shall we say using educated guesswork) that if the cancer is through to an edge of the prostate then it has likely spread beyond, and if it hasn't then that is considerably less likely. They can be wrong.

Intraprostatic margin was mentioned in another thread last night and I did a little digging. There's a couple of articles out there. 

Quote:
Intraprostatic margin involvement or capsular incision (CI) occurs when the urologist inadvertently develops the resection margin within the plane of the prostate rather than outside the capsule. CI with a positive surgical margin is diagnosed when malignant glands are cut across adjacent to benign prostatic glands.56 In these cases, the edge of the prostate in this region is left in the patient.

https://www.rcpa.edu.au/Library/Practising-Pathology/Structured-Pathology-Reporting-of-Cancer/Docs/P23_G3_07#:~:text=CG3.07b%20Intraprostatic%20margin%20involvement,than%20outside%20the%20capsule. 

 

Another one here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4312547/

Seems like you want a surgeon with >250 prostatectomies under their belt to reduce the chances of this. (Although, it seems this learned paper has labelled the graphs atrociously).

Edited by member 25 Jul 2020 at 19:43  | Reason: Not specified

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

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User
Posted 20 Jul 2020 at 12:37

I wouldn’t worry too much at this stage. So long as it’s below 0.1 the docs see the values as noise. Just keep an eye on any upward trending. Apparently 0.2 is when the next treatment steps need to be planned. Easier said than done as I always have nerves on 3 month PSAs. Wish it was practical to have a PCR Analyser at home so I could do my own tests 🤷🏼‍♂️

User
Posted 20 Jul 2020 at 12:42

thank you.

the waiting!!!!

 

User
Posted 20 Jul 2020 at 17:39

My husband’s op is a week today for a G8. Hope you continue to do well.

User
Posted 20 Jul 2020 at 17:52

hello lexie26,

thank you.

tell him not to worry too much about the op its just one of those things that just got to be done and not that scary.

after that i hope your husband will get the news he is hoping for.

he will have 3 days of pain but paracetamol will help a lot. short walks are recommended because of DVT and also a swift way to get movement back to normal.

please, let us know of his progress.

wishing you all the luck

User
Posted 22 Jul 2020 at 15:59

Jay

Make sure you do not miss your future PSA tests. Your PSA may still drop slightly. My post op PSA and histology has some similarities to yours and mine did not work out as  well as I had hoped. <0.03 would be better than 0.03 and my follow up treatment was SRT.

I have a philosophy , can I do anything about the situation, if yes, then get on and do it, if no, don't spend time worrying about something you can't change.

Hope your recovery goes well.

Thanks Chris

User
Posted 22 Jul 2020 at 16:16
Hi Chris,

Thank you.

Your philosophy makes sense! Hard not to think though but yes one has to get on with living.

How did your srt go?

J

User
Posted 22 Jul 2020 at 17:25

Jay

Unfortunately also failed,I am waiting for the PSA to rise before having one of the tracer type scans. Stay positive, we are all different and you may be well on the way to remission.

Thanks Chris

User
Posted 22 Jul 2020 at 19:00

Chris,

I am very, very sorry to read that.
Hope you will get the breakthrough you need soon.

 

User
Posted 22 Jul 2020 at 19:33

Hi Jay,  If I may throw in my thoughts. 

The first thing that struck me was the margin of 3mm.  That sounds a lot on a prostate and if so it should be a positive point.  I recall the doctor told me he had good news and bad news, although I wish he hadn't said that.  The good news was a negative margin.   I asked him how big the margin was.  Knowing that with my skin cancer they took a 4mm margin.   He said with prostate they don't cut a margin as the margin is the edge of the prostate and it's very thin, not something they cut or measure. It's a pathological judgement.   I must admit I was a bit sceptical as any gap between the edge and the lesion could be classed as a margin.

The second thing that struck me was although the hospital use the <0.03 if you went to a GP they have a tendency not to mention the < as their system comes from the time of the Ark.   It would be interesting to confirm what the sensitivity of the psa analyser is.    As another thought, the surgeon could have left some prostate behind which would generate psa.   All that's a bit optimistic, the next psa test will give more indication.   In the early days it's worrying isn't it.  We all go through it.

As to whether RT will be beneficial.  I can't really say but in my humble opinion I'd be very interested in having it if the next psa rises and not want to wait until it reaches 0.2.   If they're on the ball they'll agree, in my opinion.  There is one person on here whose oncologist gave him RT at a very low level because they saw it was only going one way and I've read that early intervention is better than waiting.

By the way my bad news was Gleason upgraded to 4+4 from 4+3 but because of the margin I've had more hope than otherwise might have been the case.

All the best, Peter

 

 

 

 

 

Edited by member 22 Jul 2020 at 19:35  | Reason: Not specified

User
Posted 22 Jul 2020 at 20:09

Peter

Your consistent PSA results have surely got to be a good sign and I wouldn't be rushing into SRT without good reason. Remember SRT to the Prostate bed without any detailed scans is based on an educated guess. 

Thanks Chris

User
Posted 22 Jul 2020 at 22:04

Hi peter and thank you for your thoughts.

firstly, I think I am using the wrong terminology. My 3mm is surly not good news as this is ‘tumor seen for 3mm at insition’ so positive margin and some cancer has been left behind.

psa 0.03 is 0.03 cos I’ve asked about this and it remained so even @ 4.5 months. Hoping it might come down a bit at 6 months.

yes, I’ve read that early rt is beneficial especially if psa start to rise. Hope my urologist will agree with this too. Not that I’m looking forward to it!

what I’m doing is psa’s every 6 weeks so if there is a change I know about it sooner rather then later.

other then that not much else to do I suppose:(

 

User
Posted 22 Jul 2020 at 23:10

Jay

Have you been told that there were cancer cells left behind. I looked into positive margins when it was reported to me by my consultant. I came across articles that implied positive margins did not always mean that cancer cells had been left behind. 

Thanks Chris

Edited by member 22 Jul 2020 at 23:11  | Reason: Not specified

User
Posted 23 Jul 2020 at 07:05

Good morning Chris,

Well I’ve been told that it is a probability and that if psa starts to rise I will need rt to the prostate bed.
yes, I too came across an article where it’s down playing ‘positive margins’.

still I feel very uncomfortable especially since I did not achieve the < in front of my 0.03.

wait and see, I suppose.

wishing you a good day:)

 

 

 

 

User
Posted 25 Jul 2020 at 18:10
Surely extraprostatic is another way of saying positive margins and intraprostatic is negative margins?

Someone may know more, but I'd say they are simply assuming (or shall we say using educated guesswork) that if the cancer is through to an edge of the prostate then it has likely spread beyond, and if it hasn't then that is considerably less likely. They can be wrong.

User
Posted 25 Jul 2020 at 18:31

Originally Posted by: Online Community Member
Surely extraprostatic is another way of saying positive margins and intraprostatic is negative margins?

Someone may know more, but I'd say they are simply assuming (or shall we say using educated guesswork) that if the cancer is through to an edge of the prostate then it has likely spread beyond, and if it hasn't then that is considerably less likely. They can be wrong.

 

No - extraprostatic means that there was cancer outside the gland; positive margin means that there was cancer up to the edge of the wax that they wrap the gland in before slicing it to inspect (and therefore a possibility that some cancer smells have been left in the prostate bed); a negative margin means that there was no cancer within 5mm of the wax; intraprostatic extension means that some of the prostate gland was accidentally left behind; and intraprostatic extension with positive margin means that there was cancer at the wax edge of where the prostate hasn't been cut cleanly and there may therefore be some cancer cells left in the prostate bed. 

The possibility of cancer cells left behind (a positive margin) increases the chance of needing adjuvant or salvage treatment, but it is not a certainty. 

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 25 Jul 2020 at 19:42

Originally Posted by: Online Community Member
Surely extraprostatic is another way of saying positive margins and intraprostatic is negative margins?

Someone may know more, but I'd say they are simply assuming (or shall we say using educated guesswork) that if the cancer is through to an edge of the prostate then it has likely spread beyond, and if it hasn't then that is considerably less likely. They can be wrong.

Intraprostatic margin was mentioned in another thread last night and I did a little digging. There's a couple of articles out there. 

Quote:
Intraprostatic margin involvement or capsular incision (CI) occurs when the urologist inadvertently develops the resection margin within the plane of the prostate rather than outside the capsule. CI with a positive surgical margin is diagnosed when malignant glands are cut across adjacent to benign prostatic glands.56 In these cases, the edge of the prostate in this region is left in the patient.

https://www.rcpa.edu.au/Library/Practising-Pathology/Structured-Pathology-Reporting-of-Cancer/Docs/P23_G3_07#:~:text=CG3.07b%20Intraprostatic%20margin%20involvement,than%20outside%20the%20capsule. 

 

Another one here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4312547/

Seems like you want a surgeon with >250 prostatectomies under their belt to reduce the chances of this. (Although, it seems this learned paper has labelled the graphs atrociously).

Edited by member 25 Jul 2020 at 19:43  | Reason: Not specified

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

User
Posted 25 Jul 2020 at 20:25
Positive margins and a PSA of 0.03 means you need to watch your PSA like a hawk especially with that tertiary 5. Check out Ulstermans profile.
User
Posted 28 Jul 2020 at 16:04
extract from my pathology (Histology) report:

Gland confined: Yes

Extraprostatic extension: No

Seminal vesicles involvement: Yes (tumour focally infiltrates into extra-prostatic SV muscle coat)

LVI: Yes

Apical margin involvement: No

Basal margin involvement: No

Circumferential margin involvement: Yes (tumour is seen at a gland incision for 3mm at left side

HISTOLOGICAL DIAGNOSIS: Robotic radical prostatectomy: Tumour: Acinar adenocarcinoma

Gleason score: G4+3 with focal Gleason 5 (<5%) overall

Grade group: 3 with minor high grade component

Tumour volume: 9.0ml Stage: pT3b pNX

Margin status: Tumour is seen at a gland incision for 3mm at left side

User
Posted 28 Jul 2020 at 23:26
Okay, so not the best pathology ever reported but it is confined and the tertiary 5 area is very, very small which is why they have kept your Gleason at G4+3. All in all, with a post-op PSA of 0.03 it is still the case that they may have got it all out - all you can do is monitor the PSA levels over time. If you are interested in discussing adjuvant RT without waiting to see what the PSA does, ask for a referral to oncology - it is not your urologist's decision.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 29 Jul 2020 at 08:25

hello LynEyre,

thank you.

No, not the best but it is what it is.

So, keeping an eye on the PSA is the current plan. Thinking of booking a consultation with an oncologist to get his view. Not keen on RT but i suspect i'm going to go there sooner or later.

 My MDT Outcome  4+4 (5). pT3b pNx. PSA surveillance.  So, G8 but my surgeon is saying its a G9 hight grade and high risk. So, concerned that way.

 

User
Posted 29 Jul 2020 at 11:47
John was in denial and waited as long as possible before accepting that he needed salvage treatment; his op was in Jan 2010 and he finally agreed to start HT in May 2012 for RT that July / August. It helped that the two years gave him the opportunity to completely recover from the op and have some normality before getting back on the side effects mill. He stopped taking the hormones early, he hated them so much. All these years later, his PSA happily Bob's along at around 0.1 and, apart from at PSA test time, the whole debacle seems like a distant memory now.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 29 Jul 2020 at 11:48
PS your pathology report says 3+4 so worth clarifying with the surgeon why he is saying different.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

 
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