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Location of Positive Core(s)

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Prostate Cancer
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Posted 7/15/2013 1:21 PM (GMT -5)
One Doctor mentioned to be that the location of the positive cores should factor into a decision on what course to take (such as active surveillance)... For example, if the positive core is closer to the edge vs the center...

Has this come up in anyone else's conversations? (If it matters, this Dr also believes strongly in PCA-III tests). Thanks
Posted 7/15/2013 2:44 PM (GMT -5)
My doc(s) didn't mention it.
Posted 7/15/2013 2:57 PM (GMT -5)
My husband's urologist mentioned it to us. One of the two positive cores was right on the outer edge of the prostate. My husband had surgery and was glad that he did: the surgical path report showed that the cancer had broken through the prostate and was invading the capsule. Fortunately, the doctor knew this going in and cut a wider-than-necessary around that area to ensure a clean margin.
Posted 7/15/2013 3:04 PM (GMT -5)
Another difference it can make is that cancer in the apex somewhat increases the possibility of impotence and incontinence after surgery. At the apex the surgeon has less room to cut wide and still spare the nerves and the area around the urinary sphincter. As I recall the difference isn't huge but it has been measured and is significant.
Posted 7/15/2013 4:17 PM (GMT -5)
The location is critical. If it is near the margin, in the apex or in the seminal vesicles the probability of a surgical failure increases significantly.
Posted 7/15/2013 4:31 PM (GMT -5)
So, from what I am reading, it sounds like, if **all other things are equal**, someone with a positive core(s) on the outer edge of the prostate should be less inclined to do "active surveillance".....

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For some reason my sig has never come through; here it is:
BD: 1959
PSA .49 11/2012 (no symptoms)
Biopsy 12/2012 Negative
PSA .59 05/2013 (still no symptoms)
Biopsy 06/2013 3+4 (thank goodness for PSA tests)
1 core positive (upper left), 1 suspicious (lower left) out of 12
DRE: bump on the right side
T1c
PCA-III Score 20 (normal)
Da Vinci Robotic Surgery scheduled 7/18/2013
Posted 7/15/2013 7:08 PM (GMT -5)
My main tumor was on the right side, positive with dre, but was located well away from the wall and organ confined. I'm close to 4 years, gleason 8 [surgeon} gleason 9{pathologist}, <.1 with one treatment., that, a negative node firewall, no rad in future{negative margin} belief in HT later than sooner, for me any way, positive attitude, faith, fitness and aloha. A guy who will say yes, I am healed. You know the guy who when it recurs, we can't help, but feel a little glee,then feel guilty, maybe, and oh you know…….. Yes placement of tumor is important for prognosis
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