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Surgical margins, negative or positive are always the opening made by the surgeon to enter thru the fibrous tissue that surrounds the prostate while in the process of taking out the prostate. Assuming that I have that correct, I read a surgeons "results" after over 1000 mixed grade robotic surgery's. PT3a + PT3b patients have a much higher rate of positive margins. I've also seen pt3a + pt3b rated patients with negative margins. It was noted that historically it's rare that a pt2 surgery results in positive margins, but fairly common and most often not the surgeons fault when pt3 or pt4 cancer is involved. This sound reasonable?
The pathologist examines tissue removed from the patient after surgery. The tissue at the edge of the sample is the Margin. The pathologist cannot examine tissue still in the body which is the other side of the margin. Margin status is determined by microscopic examination of this tissue from surgery and those men who are determined to be CLINICAL T3 are more likely to have positive margins after surgery since they are diagnosed with likely spread before surgery. Such men are more likely to be referred to radiology rather than surgery at diagnosis. Those men who are PATHOLOGICAL T3 have margin status determined by examination by pathologist as mentioned before. It is indeed possible to be pT2 and still have diagnosed spread from examination of tissue not in direct contact with the prostate. Thus, for example, some (few) men may be pT2x N+: Negative margins, Node positive. Also, if the surgeon does not remove all of the prostate gland itself there may be positive margins because the remaining tissue left in the body is the remnant of the cancerous prostate itself, and not a sign of spread outside of this organ, to the best of the ability of the pathologist to determine: pT2, + margin. Fortunately this is also quite unusual.
We've been through what 'margins' means at some length. They are NOT the entry points for a laparoscopic prostatectomy. Please go back and read the responses to your previous questions.
Also please note that there is a difference between clinical and pathological staging (I'm pretty sure we've covered that subject too.)
It is not possible for a pathological T3 staging to have negative margins, since the definition a pathological staging T3 is "the tumor has spread through the prostatic capsule (if it is only part-way through, it is still T2)
* T3a: the tumor has spread through the capsule on one or both sides
* T3b: the tumor has invaded one or both seminal vesicles"
Of course a clinical T3 staging could turn out to be a pathological T2 staging
