What are positive surgical margins?

Can someone clarify exactly what positive surgical margins are. My pathology report said I had a focal margin of less than 2 mm on my prostate but surrounding fat was negative. Is that considered positive margins?

After they extract your prostate gland, the pathologist covers the surface with a dye, and then dissects it. If cancer is found extending to the dyed margin of the gland, it is a "positive surgical margin." It does not mean that the cancer went beyond the margin into other tissue. In your case the pathologist seems pretty confident that it did not extend beyond the gland, and that the surgeon was able to get it all. Statistically, however, the existence of a PSM means a greater probability of a recurrence. The key now, as Fairwind points out, is to track your PSA regularly.

After reading a few articles on surgical margins (from Harvard and a health website).

I'd say yes, if where they cut has cancerous cells then it is postive surgical margins. It doesn't matter that it is surrounded by fat. The cut had cancer cells so it's positive.

Waiting for TA to correct me if I'm wrong.

A positive surgical margin is 'defined as tumor extending to the inked-surface or margin of the prostate' and is determined by the pathologist. One can think of this situation as removing an orange where the peel is the capsule of the prostate and the fruit is the cancer.

When the prostate is removed, the surgeon also takes a margin of surrounding tissue, often mostly fat, as you report. This margin is often a few to several mm thick. If the cancer is found in this material then the margin is positive. With what you report, I would interpret the margin to be negative as no cancer was found in the fatty tissue that surrounded the prostate, but I am by no means the expert nor have access to the full report.

Some path reports very clearly explain the margin with the terms negative or positive. It appears yours is not that specific and will need the surgeon's interpretation. You do need to rely on the surgeon to explain it to you. He/she is the expert with all the information. The rest of us would only be guessing.

Cd, why don’t you ask to speak with the pathologist? Or ask your surgeons office to contact pathology and ask for more detail?

I asked my surgeon for more detail on my frozen section positive margin including % of grade 4 cells. Their pathology normally does not include that detail, so I had to push, but I was told that he will do it and add it as an addendum to the pathology report.

It might be worth asking him to clarify, and add the clarification.

California Dreamer said...
The pathology report is not specific. It states under margins that focal positive in anterior <0.2 mm but anterior prostate fat negative. It also states prostate surface negative. Very confusing. Guess I will need to wait until 7/26 when I see the surgeon.

(btw, did you mean .2 mm or 2 mm ? -- if it's .2, that's a really small one and would be better news)

Just one more thought for you.

In the following protocols, find the "Genitourinary" section, and select the Prostate Gland current version 2017 PDF:

www.cap.org/web/oracle/webcenter/portalapp/pagehierarchy/cancer_protocol_templates.jspx?_adf.ctrl-state=6a175oqyl_51&_afrLoop=632717397079329#!

Please scroll down to the pg 22, "O. Margins" four diagrams.

The top two diagrams show how a patient can get a PT2+ positive margin from the surgeon cutting down into cancer in the prostate, even though the cancer had not grown through the prostate capsule.

The bottom two diagrams show how a patient can get a PT2+ positive margin from the surgeon cutting into an extraprostatic extension (EPE) where cancer had already grown through the prostate capsule.

In either case, a positive margin exists. But in the top two ("intraprostatic incision"), the prostate "surface" itself was negative, at least until the surgeon nicked into it. This may be what happened in your case and that may be why your path says "prostate surface negative".

It is definitely what happened in mine. Epstein's 2nd path for me states "RIGHT LATERAL MARGIN FOCALLY INVOLVED BY PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3 + 3 = 6 (3 MM, INTRAPROSTATIC INCISION)".

I guess either type of PT2+ is not great to have. If from EPE, then the cancer had already grown through the capsule, which is not good. If from intraprostatic incision, still seems that a small chunk of cancer may be left in the body and some day start producing enough uPSA to become "known" or possibly cause later problems. I think this is what's happening to me. A small bit of prostate tissue, pretty benign gleason 6, that's just going to sit there and do little until I die of something else someday. We will see.

I hope your July meeting and coming PSA tests will clarify things for you. I know, believe me, how difficult it is to get this sorted out. Just when you get done with RALP and some recovery, then you are faced with the "but did it work?" deal.

Robert

It was <2mm.

Pathology report states pT2. Does not state pT2+.

Hello Sister and welcome. I posted your questions on a new thread because you are more likely to get responses that way. I will temporarily lock this old thread so there is no confusion about where to answer.

Jim