Meeting Notice Thursday February 18th

The meeting notices went out with an error. They stated our meeting will be held on Thursday February 19th. Of course the meeting is on this Thursday the 18th. I guess we'll see how many people notice the error.

This months meeting will be an open house for both the guys and the gals. We will be handing out a questionnaire to gather information for our club database in hopes of better aligning new comers to those with similar experience. We also hope to gather information about books our members have read, information they gathered and how to share it. Additionally, our chapter leader, Tony Crispino, will be speaking on his experience with the Internet and prostate cancer.

The plan is to develop a sharing mechanism for all of our members...Please come and share what you did when you found about your diagnosis. Spouses and partners are welcome as well...

Significance of Positive Margins

Positive Margins ~ To worry or not to worry... That is the question.

The following study is from the Mayo Clinic from 1990 to 2006. 11,729 patients, pretty solid information. Usually I don't like single center studies, there are a few centers that have such great data it's hard to be interested in these results. Mike Scott has done us a favor and broken it out well...from the "New" Prostate Cancer Infolink...

prostatecancerinfolink.net/2010/02/06/what-does-a-positive-surgical-margin-actually-predict-after-surgery

Mike finishes the article as follows:
The authors note that their data show a distinct reduction in the frequency of positive surgical margins (at least in their series) over the past 20 years. They conclude that the presence of a positive margin after radical prostatectomy does increase the probability of biochemical recurrence, local recurrence, and the delivery of salvage therapy. However, it does not reliably predict risk for systemic progression, cancer-specific death, or overall mortality.

A critical question does remain unresolved, however. What is the standard of care for a man with a positive surgical margin after radical prostatectomy? At present it seems to us that the precise care needs to take account not only of the size and number of the positive margins but also other risk factors, most particularly including the preoperative and postoperative PSA level, the pathological Gleason score, and the pathological stage of the patient’s disease. A 55-year-old patient with a PSA level > 10 ng/ml, a Gleason score of 8, and a positive surgical margin is presumably at greater risk for clinically significant (as opposed to just biochemical) recurrence than a 55-year-old with a PSA of < 10 ng/ml, a Gleason score of 6, and a positive surgical margin.

My own commentary:
While I know I fell into the very high risk category, I see a lot to be hopeful for. Many of our guys here should also. Positive margins should not automatically be construed as a failed surgery. As Mike points out well...

Positive Margins are not a significant predictor of:
1> Systemic Progression
2> Cancer specific death
3> Overall mortality

We tend to view positive margins as a huge negative, and they certainly are not a positive in spite of their designation, but positive margins are useful information. They are not a death sentence, nor a failed surgery. What you do once you have them identified remains controversial.

One other point...
Mayo Clinic reports this interesting tidbit...
From 1990 to 1995 Forty-One (41.1%) percent of surgeries had positive margins...
From 1996 to 2000 Thirty-Two (32.0%) percent of had positive margins...
From 2001 to 2005 only Nineteen (19.6%) percent had positive margins...

The Mayo Clinic started as one of the pioneering centers using the Da Vinci robotic system in 2001...While they still do open procedures as well, it would appear that adding the RALP has not at all negatively impacted the number of cases with positive margins...