Postive Surgical Margins....

User

Posted 04 Dec 2024 at 12:46

Hi all

I posted this (below) in another thread. Ive had the horrors a bit about the PSM and thought it sensible to post again in a new thread and ask for help from anyone who has had a postive outcome after a PSM. Many thanks in advance.

'Had my RARP surgery on Thursday afternoon last week.

Surgery went ok but had a PSM of 10mm at the right-side base after the Neurosafe frozen section procedure, which was a bit of a blow. The prof went back in and took 50% of my right side NVB as a precaution to ensure disease control. The left side had a clear NSM, so all is not lost, but that knocked me a bit tbh, I was not really thinking about not curing the cancer as I was 3+4, T2c, last PSA 4.7 with no sign of EPE. Every prof, consultant, and oncologist I had seen told me it was contained within the prostate but now I have been catastrophising a bit about reoccurrence after such a large PSM.
Post op not feeling too bad. The catheter, though not something you would ever choose is manageable, 9 days to go and counting. Feeling tired in the afternoons, but again nothing unmanageable. The single incision looks to be healing nicely.
I have asked the prof for a follow up call as I cannot really recall much of the conversation we had on the Friday morning after surgery, it was generally positive I think even with the resection after the PSM, but after a little reassurance as it’s a few weeks until the final pathology report and longer again for the first PSA.

If this can help anyone or if anyone has any questions I can try and help with let me know.

Cheers

Gus'

User

Posted 04 Dec 2024 at 16:30

A PSM identified by neurosafe, followed by the surgeon removing more tissue and NVB, I presume means that by the end of the surgery all your surgical margins were negative.

A shame to have lost some right side nerves, but I don't think you have much to worry about going forward.

Dave

User

Posted 04 Dec 2024 at 19:44

Hi Gus,

While a positive margin can seem disappointing, Neurosafe has been used as intended, to check margins and take more tissue if necessary, while you're still on the operating table.

I had surgery with Neurosafe five years ago and had a positive margin, the surgeon described to me how he applied heat to the area affected. I had SRT a couple of years ago but that doesn't mean that you will, although it's always a possibility even with negative margins. My latest PSA is <0.010 undetectable which is definitely a good outcome for me.

Good luck.

Kev.

User

Posted 05 Dec 2024 at 08:26

I suppose the Neurosafe did its intended job. It found a positive margin and allowed the surgeon to go back in and correct things. That’s good news. My husband had a shaved positive margin post surgery which involved a small tumour that was missed by the MRI and biopsy. The surgeon did not even know there was tumour there. In fact he had three small tumours that were not identified on MPMRI or by targeted and systematic biopsy. I think you have done everything possible to minimise your risks, there are no guarantees but I am sure you have put yourself in the most favourable position possible by having Neurosafe procedure.

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User

Posted 04 Dec 2024 at 16:30

A PSM identified by neurosafe, followed by the surgeon removing more tissue and NVB, I presume means that by the end of the surgery all your surgical margins were negative.

A shame to have lost some right side nerves, but I don't think you have much to worry about going forward.

Dave

User

Posted 04 Dec 2024 at 19:44

Hi Gus,

While a positive margin can seem disappointing, Neurosafe has been used as intended, to check margins and take more tissue if necessary, while you're still on the operating table.

Good luck.

Kev.

User

Posted 05 Dec 2024 at 08:26

User

Posted 05 Dec 2024 at 13:43

Ive seen the final Histology now and there is a clear NSM where the previosu PSM was, so fingers crossed it'll be ok. That did bump my final stageing up from T2c to pT3a, which is not ideal but I think due to the final NSM hopefully its gone.

I think I was fortunate to have had the option of neuroSAFE, I am sure the PSM would have been missed if not as no one thought it was there. Another surgeon I spoke to suggested that neuroSAFE was a little hit and miss as it may over or under diagnose. I put that to the surgeon I used and he disagreed totally, its all about the quality of the pathlogist he said which makes sense. There has been quite a lot of contradiction during my journey, and I am pleased I eventually found the people I did to help. I am not sure if there is another way of doing things but choosing a path for PCa does feel a little like every man for himself...

User

Posted 05 Dec 2024 at 13:59

Completely agree with you there, Gus. Every consultant I spoke with was addressing the issue with the hammer they held and all saw a different nail (to stretch the saying a little). At the same time it’s left up to you to decide. There’s the NICE guidelines, of course, but I can’t help think that funding is going to play a part in what’s actually made available for those going the NHS route too. Add onto that the complexities of each and every individual diagnosis. It’s an absolute minefield! Thank goodness for this forum - it’s been a godsend to me.

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