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Read A Primer on Prostate Cancer, The Empowered Patient's Guide
G’day purelife52,
You say you are getting paranoid – I’d say you’ve passed that landmark:-)
Jokes aside, I do think you are trying too hard to put certainty where there is none, but….I’ll try, from my non-medical point of view to give you my understanding of the structure of the peach/prostate. But you should get hold of what I think is the best book for laypeople (and most of the doctors who don’t have much a clue about prostate cancer) that book is A Primer on Prostate Cancer, The Empowered Patient's Guide", There is an enormous amount of detail and plenty of drawing, pictures etc.
But back to the peach:
1. OK lets say that the pit in the middle of the peach is the prostate gland, the entire peach sits below the bladder (correct me if I'm wrong). OK so far
2. The pit would be in 2 pieces surrounded by the nerve bundles and main vessels from the bladder leading towards the out spout and toilet. Not quite. The pit (the gland itself) is in one piece, although there are subdivisions within the piece – like your heart – and the urethra runs right through the middle of the pit/gland from the bladder to the penis. So when you remove the gland you have to cut out a piece of the urethra and re-join both cut ends – that’s were the leaks can occur. Think joining a hose pipe. The nerves are buried just under the skin of the gland which is why it is so difficult to ‘save them’ – one surgeon described the procedure as trying to pick up tissues off a wet sidewalk, in one piece
3. So far in my "idiot" peach analogy we have the pit... {prostate} sourrounded by the flesh of the peach, {the wet stuff under the skin}and finally the skin of the peach. You refer to the prostate as being the pit, but it is only the gland itself that is the pit. I think by using the peach analogy, that the thickness of the flesh may give you a wrong idea, because surrounding the gland itself there is what is commonly referred to as the capsule, but this is not a thick layer of flesh, simply an outer layer protecting the gland itself or, in the words you quoted a protective sheath of tough fibrous tissue.. The gland, within the capsule, sits in what is referred to as the prostate bed.
4. OK S.V.I. I don't have it so far but I read about it often. I would guess that they go through the flesh of the peach, thru, under and often wrap around the
"pit" of the peach and usually get cancer in them from the pit/prostate. I assume by S.V.I. you mean seminal vesicle invasion or involvement? This being so, you need to know the seminal vesicles are external to the entire prostate/peach set up and are joined to the gland by the ejaculatory duct. The tumour will often spread from the gland/pit to the seminal vesicles by following the duct.
5. Before I forget the needle biopsy's we all know and love only take samples of the PIT/prostate correct? That is correct - only the gland
6. Perineural invasion is what to my peach? within your pit/the gland itself is a network of nerves. Perineural invasion refers to the tumour getting into these nerves. One pathologist said that the tumour sometimes followed the nerves like tree roots up at water pipe and escaped the capsule in that way. The subject has been fully discussed on this Forum – put perineural invasion into the search engine at the top of the page.
7. Extracapsular invasion is what to my peach? There is evidence that the disease has penetrated the capsule into the prostate bed.
8. pt3a means the pit/prostate has done, or is likely to do what? Pathology stage T3 means – see #7 above and T3a means the tumor has spread through the capsule on one or both sides
9. Right side margin of the "peach" is the flesh or the skin of my peach? The margins refer to the margin between gland and capsule – pit and flesh.
10. Oh..the entire peach is sitting in my pelvis? Well, not any more – but it was before you had it out.
11. SO...where is the margin drawn? A "dent" in the fibrous tissue is considered a + Margin? The margin is where the gland is excised – see #9 above. So positive margins show that in the removed gland there is evidence of cutting through tumour cells and the implication is that the tumour will have left the gland either into the peach flesh/capsule or beyond the capsule.
12. And where in this picture is The Extracapsular invasion? {invasion into the Fiberous Tissue} I presume. No, through the fibrous tissue/peach flesh into the prostate bed but, because you have not been staged T3b, there is no evidence that it has spread beyond the capsule into the seminal vesicles, or T4 which would indicate spread into nearby structures.
13. Thanks in advance! Well, I hope I have helped – and that what I have said is accurate enough. Now I’m off for my evening meal and closing down.
Re: Read A Primer on Prostate Cancer, The Empowered Patient's Guide
Thanks Terry, and I hope that you enjoyed you supper. You have (with my peach} proved once again that even an idiot{me} can be educated to some degree! I'm grateful for your hard work and incite to make the trip back down to my 5th grade level! lol...Do you get the tv show "are you smarter than a fifth grader"? in your part of the world? It's a great show. I'm not....but you sure are!
I must confess that using the peach was a brilliant plan on my end as well. I knew that you would answer it and elaborate brilliantly, and you did, but I also knew that I'm probably not the only one fishing with a "brain Cloud" problem...lol...and it would help me now and other "idiots" in the future. So when I'm pushing up daiseys/pomagranates in a few years be sure our/your peach stays available to future "idiots".... Yes it helped....Proving once again "that the peach is mightier than the surgeons/robots sword!"
Re: Read A Primer on Prostate Cancer, The Empowered Patient's Guide
Yes indeed I had an excellent meal. Now I have had a good walk with my three 'boys' and am about to have breakfast!
There are no 'idiotic' questions, as far as I am concerned - the only really stupid question is the one not asked. This is a complex disease we are dealing with and the more we individually understand it the better it is for us - and for those who come behind us, because we can help them.
12. And where in this picture is The Extracapsular invasion? {invasion into the Fiberous Tissue} I presume. No, through the fibrous tissue/peach flesh into the prostate bed but, because you have not been staged T3b, there is no evidence that it has spread beyond the capsule into the seminal vesicles, or T4 which would indicate spread into nearby structures.
This # 12 explanation has me wondering if it's possible or likely that the Cancer {this based on your saying THROUGH the fibrous tissue} started away from the pit/prostate gland? I'm reasonably certain the robotic arm went THROUGH the fibrous tissue on its way to GRAB the PIT/prostate, so the robots arm either put the cancer onto the tissue on the way in or on the way out. Perhaps your gonna say that it was already there. No hurry for an answer here, enjoy your weekend. I guess it's the end of winter or early spring where you are, enjoy.
Perhaps (if you have the patience) it might be worthwhile watching the whole of an actual robotic prostate removal procedure. You will certainly get a better idea of what and how it was done. It is pretty interesting if you have the stomach to watch such surgery. http://www.or-live.com/jeffersonhospital/1285/event/rnh.cfm
Bill
1. Why is the disease we share called PROSTATE cancer? Why, because it starts in the prostate gland!!! Not outside it.
2. Since the biopsy needles only sample the prostate gland, is it possible that the disease identified as PROSTATE cancer could have developed elsewhere and have been imported into the gland by a procedure done AFTER the biopsy that discovered the disease? Err.....probably not!
Have you ordered your copy of the Prostate Primer yet? Have you read Donna Pogliano's draft yet?
Personally I found "A Guide to Surviving Prostate Cancer" by Dr Patrick Walsh to be very good. I found it a very understandable read. Keep in mind that Dr Walsh is an "open guy" and tends speak well of this procedure.
