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@jeffmarc How can non focal extraprostatic extension and ‘negative margins’ be consistent? They seem almost contradictory in nature.
I had negative margins and a ‘tiny break’ (my urologist’s words) in my capsule and even then I thought it was odd to put the two on the same page.
I wonder what the limit is on how much tissue surrounding the capsule can really be removed in order to get negative margins…?
I get the sense from some posters that they feel ‘positive margins’ is the fault of the surgeon not being diligent; however, I think anatomical considerations (bladder, eg) limit how much a surgeon can excise without causing additional damage.
I think the best policy would be for surgeons to be forthright and say ‘I wasn’t able to get it all’ rather than soft peddling the fact that cancer is still inside your body. JMO,
Phil
Replies to "@jeffmarc How can non focal extraprostatic extension and ‘negative margins’ be consistent? They seem almost contradictory..."
Negative margin means : no cancerous cells seen beyond line of cutting - it is actually cauterization that they use, not scissors or scalpels. (at least it was case in our surgery)
They cut away from the gland, as much as they can, so - when you look at the slide you see the whole section of a gland (gland is sliced like using egg mandolin on an egg) - one whole horizontal slice at a time. I was lucky in a sense that surgeon arranged us having a zoom call with pathologist and we went over slides together.
Since I am biologist and worked with microscope extensively it was easy for me to follow but my hubby saw things clearly also because pathologist was very patient and very good at showing and explaining findings.
We had one single EPE, that kind of EPE is called unifocal (one focus/ spot). They actually measure EPE size - it's width and also how much it is peeking out of the gland. BEYOND that EPE is a tissue (usually fat tissue) and than there is line - that is line of cutting. Line of cutting is dyed very clearly and in different ways and colors so they can know what is up, left, right, down.
To make the story short - it is very visible where that line passes AROUND the specimen. If it cuts too close to the gland or nicks a gland - it is positive, if the whole gland is intact and than some other tissue is BEFORE the line - it is negative. Negative means - no glandular or cancerous tissue is beyond the excision line.
They do not cut out only the gland, they cut out some fatty tissue around it for examination and also sometimes some nodes.
So - can you have EPE and negative margins - absolutely !!!
It means that line of excision is above and beyond visible EPE. Since we are talking about MICROSCOPIC examination, idea is that even microscopic bad cells would be seen if they are beyond EPE , but of course, one can not 100% examine every single cell in a gland ! That is why EPE is a red flag, no matter if margin is negative. BUT, if it is inside margin, it is a small red flag. If it is unifocal, it is even smaller red flag, if it is 3+3 EPE it is the tiniest "flaglet", etc.
And this goes for every single finding !!! Determination of how adverse situation really is depends of margins, size, gleason , and extent of every adverse feature present.
@heavyphil
“Negative margins” is obviously good but not definitive. The pathologist cannot look at ever tiny bit of capsule for extensions but looks at a lot of representative sections. Mine said “clear margins” but then said”tumor within 0.1mm (!) of the posterior capsule”. Had that been his prostate, I bet he would have. Looked a lot more and not called it clear. Also things like tumor along nerves and vessels (perivascular and perineural) and tumor in seminal vesicles and, of course, tumor in lymph nodes are all worrisome findings (and the surgeon can’t take out ALL the lymph nodes but only the ones available close by for sampling. All in all, there are a lot of factors other than the path report, mainly follow up for persistence or recurrence of tumor.
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@heavyphil
That’s why I thought that he should talk to his doctor about that EPE issue. It sure seems that the way it was described in the biopsy, it had spread a lot. You could be right that they Really can’t completely remove something like EPE If it is spread as much as the biopsy reports.
The positive margins people get can be the fault of the doctor not having a pathologist available to check the margins as surgery is going on. Then again it could be because it was not possible to get clean margins without damaging other important tissue.
It’s a difficult situation when having surgery is already difficult.
You have pointed out a real conundrum.