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Posted 8/19/2009 6:27 PM (GMT -5)
Could some explain to me in laymens terms?

Can't seem to find much about it.

Thanks,

 

Posted 8/19/2009 7:11 PM (GMT -5)
A positive margin means that when the prostate gland or one of the attachments were removed surgically and examined by the pathologist, there were cancer cells seen at the cut margin or edge of the organ or attachment. Usually this implies that there was still cancer cells left on the other or body side of the incision made to remove the organ or attachment. It could be microscopic scattered cells, or it could be more evident. This is something that will probably be explained when you meet with the urologist to review the path report.
Posted 8/19/2009 8:12 PM (GMT -5)
Dr. Walsh says there are several reasons for having positive margins even though no cancer is left behind. He estimates about 40% of positive margins are in this category. Reasons include damage to the specimen while handling it prior to pathology, the prostate surface "glued" to surrounding tissues gets torn out during surgery exposing the cancer, but leaving nothing behind and more that I don't remember. I also remember a discussion that even if some cells are left behind, the disturbance of the blood supply and tissue damage due to surgery will kill them.
Posted 8/19/2009 8:51 PM (GMT -5)
Geebra said it well, wait to talk to your doctor
Posted 8/19/2009 9:26 PM (GMT -5)
From the AJCC (2007) for staging manual for prostate cancer, a positive margin (PM) is defined as cancer extending to the edge of the dissection cut of the surgery. It is possible to have a postive margin and no residual disease but the odds are small for that. Also note that cancer can be outside the prostate capsule and there not be a positive margin. This is termed as Extra Prostatic Extension (EPE). Commonly EPE extends beyond the cut of the dissection.

Unfortunately, I had to do my homework on this one. I had both to go along with bilatteral seminal vesicle invasion (SVI)...

Tony
Posted 8/20/2009 7:20 AM (GMT -5)
Thanks all. At least I can get answers here faster then via the Dr.
On Monday I get the cath pulled, hoping for the best.
On Aug. 31 I am talking to my local Urologist about the Positive Margins.
Then on Oct. 12th (I think that is the date) Back up To Vanderbilt to Talk to my Doctor there about his take on the Positive Margins and to get my first Post surgery PSA.
Posted 8/20/2009 8:24 AM (GMT -5)
For the effect of positive margins on the prognosis/risk of recurrence, see Figure 2 in jco.ascopubs.org/cgi/reprint/23/28/7005.pdf. I believe that the nomogram in the article has been cooked into the Sloan Kettering online tool at www.mskcc.org/applications/nomograms/Prostate/PostRadicalProstatectomy.aspx. See also the Han tables at urology.jhu.edu/prostate/hanTables.php. There's tons more, but those should give you a feel for the impact.
Posted 8/20/2009 9:40 AM (GMT -5)
Larry,
The PDF is outdated and uses AJCC1997 tables which can confuse a stage 3 guy. The major change in AJCC2002 was the rolling of Stages 3A and 3B into simply 3A. Stage 3C has been deleted and is now 3B (SVI positive). The MSK nomagram is the best. If you want to look up probabilities then look at the MSK nomagram. Make sure if you use any nomagram what AJCC table was used in the pathology ~ 1992, 1997, 2002, or the current 2007.

Lew, you are going to look at them we all do. You will see your prognosis is good. But the bottom end numbers can scare you a bit. Remember that these are probabilities and they take in account of where we were with treatment many years ago in order to show 10 year probability. We have come a long way in recent years and these numbers will drop in time. My biggest line here at HW I thought valuable enough to put in my signature ~ Stay Positive.

Lew one more thing. If you can, have your slides went to Johns Hopkins for a second opin on the margins and Gleason. Jon Epstein is considered one of the best PCa pathologists, and he will review anything prostate cancer when sent to JHU...

Tony
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