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Cancer: Prostate Message Board
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Old 11-02-2010, 07:31 AM   #1
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For those contemplating a prostectomy

One of the main issues with prostatectomies is the potential for positive surgical margins. When the cancer is found to have extended to the edge of the removed prostate, it is presumed that some cancer tissue was left in the body. Studies have shown that when this happens, the recurrence rate goes up nearly 400%. If your cancer is in the apex of the prostate, you chances of having positive surgical margins is quite high.

Currently there is some intensive research to find ways to avoid positive margins, and several centers are reporting great success using new surgical techniques. An interesting article from the University of California, Irvine, discusses the issue and some of the new techniques: http://www.urology.uci.edu/prostate/Margins.html.

As you can see, before you sign on the dotted line for your surgery, you should first ask about the risk for positive margins, and if they exist, whether your surgeon is up on the latest techniques. Or perhaps even go straight to one of the centers that specialize in the techniques for your surgery.

Sure wish I had.

Best wishes,
Tom

 
Old 11-02-2010, 10:51 AM   #2
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Re: For those contemplating a prostectomy

Hi Tom,

I had surgery in 2005 ( radical prostectomy) for a Gleason 8 cancer. I had no postive margins and no indication that it had spread to the lymph nodes. It looked like I might have had a cure. However, in 2008 it returned, much to the surprise of my urologist and of course, with news like that, I didn't know what to think.

Since that time, I have done a bit of research on Gleason 8-10 cancers and from what I've read, the prognosis is not good. It seems that in that category, whether you have positive margins or not, the cancer seems to recur in most cases. I've had radiation since my recurrence and so far, the cancer is being held at bay. I fully expect though, that it will return at some time in the future and then hormone therapy is the choice for me.

I can only hope for the best for myself and of course, fellow victims like yourself. Miracles do happen, but I'm not about to hold my breath waiting for one.

Take care and have a great day...Lionel

 
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Old 11-02-2010, 11:21 AM   #3
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Re: For those contemplating a prostectomy

Hi Lionel,

Sorry to hear about your recurrence. As you say, Gleason 8-10 cancers seem to be a different beast. They are rich in cancer stem cells to spread beyond the prostate and start a new life -- whether through the lymph system, via the neural network, or from surgical splash, not to mention positive margins.

I ran a Sloan-Kettering nomogram for my stats (Gleason 9 (5/4), positive margins, PSA of 20, age of 58, no treatments as of yet), and came up with the following results:

Progression Free Probability After Surgery:
2 Year 89%
5 Year 79%
7 Year 74%
10 Year 67%

Probability of Prostate Cancer Mortality after Surgery:
10 Year 1%
15 Year 2%

These aren't bad numbers. But then I've seen other places that suggest a greater percentage for recurrence, especially with positive margins.

Like you, I expect the cancer will recur at some point. Right now my PSA is not measurable. I'm hoping to avoid treatment until my PSA rises, as the studies I've seen say that, so long as treatment starts soon after the rise starts, the effectiveness is not less than if it were started immediately. I have a consultation with Dr. Scholz tomorrow to see if this is possible.

Best of luck with your cancer. I hope the radiation knocked it out.

Tom

 
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