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Pathology during RALP procedure?
Hello,
I am undecided between two Urologists to perform my RALP procedure. One of them explained to me that during the procedure he removes a very thin layer of nerve tissue and sends it to the hospital pathology lab, who are standing-by for this, for them to analyze it microscopically, to have them identify if it has any signs of being affected by the cancer tumor or if it is clean. He mentioned that if the lab reports back that they did find that the tissue has been affected, he then removes another layer and sends it again for analysis. He keeps doing this until the lab reports that the tissue is clean, so that he can determine how far he needs to remove the safe margins.
From all the research I have done, I have never found that this is usually done as part of the regular RALP procedure and my thought is that either he is a very good and experienced doctor in order to go through these sophisticated steps, or he is just simply fabricating this to convince me that he is my best option.
Has anyone heard about this practice or do you know if this was actually part of your RALP procedure?
The other Urologist that I met told me that he does not do this and he just determines the safe margins from what he observes during the procedure.
I will appreciate any comments.
Thank you.
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I am the former Director of Clinical and Anatomical Pathology departments in several hospitals during my career. It is customary, and in my view, “good surgical practice” for your urologist to do this. It happens with “many” types of surgeries. They are called “frozen sections”. The tissue is quickly frozen then put in a paraffin block, which is then sectioned on a microtome, mounted on slides and stained as appropriate for the pathologist to examine and quickly report back to the surgeon who is waiting in the surgical suite. It is less common for prostate tissue than say, skin cancer, but my opinion is that you have a concerned urologist who wants the best for you. And…you don’t want to end up like “me” and be one of the unlucky 10-20% of patients who ended up with “surgical margins” in your post-surgical pathology report. My prostate is now gone, but…my urologist left cancerous tissue in me. I will now have to spend the rest of my life wondering “when” and how badly my cancer has returned with PSA values showing it is now active to chemically detected amounts. I would say trust your urologist. Each frozen section takes about 15-20 minutes before the pathologist reports back to the surgical suite as to “clean margins” or not…”keep cutting.”
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8 ReactionsHey rl, that totally sucks that you were someone in the know about these things and still things didn’t go as expected.
I knew my surgeon didn’t do frozen sections so I told him up front at my consult to keep cutting - nerves and all - until he got it all out.
My margins were negative (nerves mostly gone I suspect from my longstanding impotence) and I still suffered BCR 5 yrs later…
I suspect you are preparing for salvage radiation? ADT? Best,
Phil
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4 ReactionsHi, I'm unsure if this happened to my husband when he had his RALP, but his pathology came back as margins negative, so we couldn't understand how it had spread beyond the prostate. Apparently, it's because his extensive extracapsular extension was leading outwards from his lesion (which was on the exterior of his prostate, so no longer internal) like an extended arm in my mind.
This is what Havard have to say:-Clear margins after a prostatectomy indicate that no cancer cells were found at the edges of the removed tissue, even if there was an extended capsular extension, which means the cancer had spread beyond the prostate capsule. This can occur if the surgeon successfully removes all visible cancerous tissue while still ensuring that the surrounding healthy tissue is intact, although it may not guarantee that all cancer cells are eliminated.
Harvard University
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4 ReactionsThank you all again for sharing your experiences. These have been extremely helpful for me to be better prepared when I meet again soon with my two urologists to ask them specifically about “frozen sections” and "Intraoperative Diagnosis".
Based on these discussions that I will have with both of them, I will be making my decision on who I will choose to get my RALP procedure with.
Thank you again for your very kind and helpful comments. I greatly appreciate them.
All my Best,
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