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Positive Margin - Possible damage to prostrate.

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User
Posted 01 Dec 2022 at 22:24

Finally got to the post operative review today. 


Despite being T2a N0 Mx with no external extrusions, it turns out that the pathology showed up a 3mm positive margin. 


The surgeon said we was very surprised to see this and went on to make a number of points which I am sure are well versed...


One thing he did say was that it's possible the prostate was 'nicked' which exposed the cancer on removal. The pathologist then will see this as being on the surface with the inevitable 'positive' report. He went on to say that some times the surgeons will sew these up.


Read Lynn's excellent explanation of PM in a previous post but did not note the above. I did find an article which did mention false positives caused by handling.


Clearly feeling a bit jittery today and I guess very disappointed.


 

Edited by member 02 Dec 2022 at 17:45  | Reason: Not specified

User
Posted 02 Dec 2022 at 20:37
I think the surgeon is using smoke and mirrors a little bit - "it is possible the prostate was nicked" is another way of saying "I left a tiny bit behind." False positives is also a misnomer - if the pathologist sees a positive margin, he sees a positive margin. I think that what the surgeon means is that some positive margins don't mean that some cancer was left behind and it appears that he believes you are in this group ... that is a good place to be as an internal positive margin <3mm is no more likely to lead to a recurrence than a negative margin is.

Also worth considering that even if you had been given an amazing path report today, you would have ridden into the sunset and then realised in 3 months' time that the sunset is a mirage. Even with a brilliant path report and undetectable PSA, you would always be looking at the next PSA test with a bit of trepidation.

On the up side, John's salvage RT was 11 years ago and his PSA remains at 0.1
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 02 Dec 2022 at 08:45
Sounds like your surgeon is a bit full of himself. + margins usually occur because the surgeon fucked up that is why it is a measure of the quality of their work.

Good news is you are undetectable. Focus on that and getting better... If you want to asses your chances of a recurrence check out the nomogram here:

https://www.mskcc.org/nomograms/prostate/post_op

You can even compare them to negative margins and see the difference in risk (it won't be much).


User
Posted 02 Dec 2022 at 16:05

Yeah... in that boat.


2x positive margins. T2c, Gl.7(4+3)+Tertiary5.


Three undetectables on the bounce, then a couple at 0.04 and yesterday a 0.08. All at three-monthly intervals, now at 18m post-op. Still not at a level for next steps but disconcerting all the same. Don't need to be a rocket scientist to see a rising trend and I expect to be having radiation before middle of next year assuming the NHS still exists.


Won't let it ruin xmas though!

User
Posted 02 Dec 2022 at 20:02
Frustrating for you Jim.

To be fair, surgeons have an impossible job with nerve-sparing. The all important nerves to the penis are so small as to be essentially invisible, the challenge for the surgeon is to leave the outside layer of the prostate (containing those nerves) intact while removing he prostate below in its entirety. They would find it easy to maintain negative margins if they didn't try to leave that very thin layer.

I have been in the same situation, worried about the small positive margin while happy that I had at least some remaining nerves. Crossing fingers wasn't enough, and eventually PSA reappeared and got above the 0.2 threshold - and I had salvage RT this summer. Now it's a matter of crossing fingers again!

(But to be fair, I have been making the most of life all along, other than when treatment stopped me, And I plan to keep doing the same as long as I can).
User
Posted 02 Dec 2022 at 23:01

Sorry to hear about the positive margin Jim, I guess we all just want to hear the best post histology report.


Really encouraging post by Lyn though, and yes I think regardless we all worry about 3 monthly PSA tests. I always thought we worried more, as although negative margins rob had cancer in his lymph node which was removed…..but most feel the same as us.


We’re always expecting a rise from undetectable, but still very much getting on with and enjoying life to the full in between tests.


Wishing you all the very best.

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User
Posted 02 Dec 2022 at 08:45
Sounds like your surgeon is a bit full of himself. + margins usually occur because the surgeon fucked up that is why it is a measure of the quality of their work.

Good news is you are undetectable. Focus on that and getting better... If you want to asses your chances of a recurrence check out the nomogram here:

https://www.mskcc.org/nomograms/prostate/post_op

You can even compare them to negative margins and see the difference in risk (it won't be much).


User
Posted 02 Dec 2022 at 10:46

Seen too many posts on here where post surgery PSA is undetectable but soon climbs thereafter so I don't feel overly reassured.


Thanks for the link ran the numbers.

Edited by member 02 Dec 2022 at 17:40  | Reason: Not specified

User
Posted 02 Dec 2022 at 16:05

Yeah... in that boat.


2x positive margins. T2c, Gl.7(4+3)+Tertiary5.


Three undetectables on the bounce, then a couple at 0.04 and yesterday a 0.08. All at three-monthly intervals, now at 18m post-op. Still not at a level for next steps but disconcerting all the same. Don't need to be a rocket scientist to see a rising trend and I expect to be having radiation before middle of next year assuming the NHS still exists.


Won't let it ruin xmas though!

User
Posted 02 Dec 2022 at 20:02
Frustrating for you Jim.

To be fair, surgeons have an impossible job with nerve-sparing. The all important nerves to the penis are so small as to be essentially invisible, the challenge for the surgeon is to leave the outside layer of the prostate (containing those nerves) intact while removing he prostate below in its entirety. They would find it easy to maintain negative margins if they didn't try to leave that very thin layer.

I have been in the same situation, worried about the small positive margin while happy that I had at least some remaining nerves. Crossing fingers wasn't enough, and eventually PSA reappeared and got above the 0.2 threshold - and I had salvage RT this summer. Now it's a matter of crossing fingers again!

(But to be fair, I have been making the most of life all along, other than when treatment stopped me, And I plan to keep doing the same as long as I can).
User
Posted 02 Dec 2022 at 20:22

Absolutely no criticism of the surgeon at all. They have to make a judgement call at the time and they do what is a very high pressure and highly skill job to the very best of their ability.


I guess I was hoping that I could get this done and ride off into the sunset. But that's me working on projects all the time start, finish move on... With the occasional blood test in-between. I am going to have learn to live with this.


Really my curiosity was sparked by the potential for false positives and his comments around damage to the prostrate through removal. 

User
Posted 02 Dec 2022 at 20:37
I think the surgeon is using smoke and mirrors a little bit - "it is possible the prostate was nicked" is another way of saying "I left a tiny bit behind." False positives is also a misnomer - if the pathologist sees a positive margin, he sees a positive margin. I think that what the surgeon means is that some positive margins don't mean that some cancer was left behind and it appears that he believes you are in this group ... that is a good place to be as an internal positive margin <3mm is no more likely to lead to a recurrence than a negative margin is.

Also worth considering that even if you had been given an amazing path report today, you would have ridden into the sunset and then realised in 3 months' time that the sunset is a mirage. Even with a brilliant path report and undetectable PSA, you would always be looking at the next PSA test with a bit of trepidation.

On the up side, John's salvage RT was 11 years ago and his PSA remains at 0.1
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 02 Dec 2022 at 23:01

Sorry to hear about the positive margin Jim, I guess we all just want to hear the best post histology report.


Really encouraging post by Lyn though, and yes I think regardless we all worry about 3 monthly PSA tests. I always thought we worried more, as although negative margins rob had cancer in his lymph node which was removed…..but most feel the same as us.


We’re always expecting a rise from undetectable, but still very much getting on with and enjoying life to the full in between tests.


Wishing you all the very best.

 
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