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Re: Have positive margin to Perineural Nerve on post RP......adjunctive treatment
Thanks Tarhoosier
More info.
I am 48 and had a PSA of 4.4 in April 09 up from 3.2 in Sept 08. It fell to 2.6 (following antibiotics) in Dec 08 and as such my Doctor said to wait. By chance I followed up in April and here I am.
I had a Laparoscopic RP on the 10th June. My surgeon told me on Wed that there were good negative margins except for microscopic (can it be anything else) positive margins to the Perineural nerve. I dont have details but will get next week.
One strange thing my surgeon said he would remove lymph nodes but did not as he said they looked fine. MRI was clear as was bone scan. But can he tell from looking at? I suspect not.
So yes I can help feeling there was better ways of treating the bed with radiation. Proton may be better. Who has better machines? Or I noticed that Prostrcision use seed implant with accelerator radiation (is this different). I also saw Tomotherapy. Are these better or worse? Can similar be done in Australia?
Re: Have positive margin to Perineural Nerve on post RP......adjunctive treatment
Paul:
Your Gleason is not mentioned and it is often almighty in determining treatment decisions. Regarding your specific questions, yes a bulky tumor can be seen in surgery and sometimes is in areas a surgeon cannot remove such as colon and bladder. Thus microscopic margins are not unique. Diseased lymph nodes are sometimes visible. Even those removed and examined microscopically and found clean are sometimes determined later to have harbored residual disease. There is little certain in our disease.
It sounds as if your surgeon used his best judgment and experience in your case. I leave regret for the ladies' novels and I move forward.
How does your recovery proceed?
Re: Have positive margin to Perineural Nerve on post RP......adjunctive treatment
Paul. Take a breath. It's not clear from your posts exactly what your pre and post operative path reports showed.
Perineural invasion is often not even mentioned anymore on path reports because it is so common. There is a difference between pre-operative biopsy evidence of PNI and post operative. When it is discovered at biopsy stage it MAY indicate that the cancer has found an escape route out of the capsule. But when the pathologist has the entire prostate under the glass, after removal, they can see that if the margins are clear then although the nerve was attacked (so to speak)the cancer went no further.
I am not a doctor but I think you need to allow yourself to recover, have your pathology rechecked and see what your PSA does over time. Combine this with more scans if necessary and then discuss what - if any - further treatment you may need.
Best wishes - and do go through all the mentor reports here. There is a huge wealth of experience on this site.
Re: Have positive margin to Perineural Nerve on post RP......adjunctive treatment
Paul,
If you put perineural into the search box at the head of this Forum, you will find a number of discussions on the subject which may help you. Similarly, if you go to the SEARCH ENGINE on the main site and do the same thing there, you'll find dozens of references to places on the site where you can get more information.
I believe that there is no need to make an early decision on what to do next, unless you have a very high Gleason Score, and I assume you don't because if this was the case, surgery would not have been the first option.
Re: Have positive margin to Perineural Nerve on post RP......adjunctive treatment
Many thanks all.
I keep thinking that I had mentioned it but my pre op biopsy showed a 7 (4+3) but I don't know post op. I will detail during week. The surgeon was confident that we would get it all so a bit shocked at the news so did not really take in everything too well.
I am 10 days after op and 3 days post catheter. I have a new found respect for the bladder. I seem OK when lying and sitting mostly but walking and standing is a lottery. It seems if my bladder is full and I have the erg to go it seems easier to stop at least for the walk from couch to toilet. When I do empty it I then have trouble stopping the dribbling until I lie down.
The wounds are healing fine and are of little consequence.
Also want to think about the erectile piece but one step at a time I guess. He did save part of one nerve and he said it would take at least a year before it would come back.
I have a wonderful wife and two beautiful boys 5 and 7.
Again thanks all I will post more info when I get the report this week.
