Ertra prostetic extension

[Channelhomec]

Is extra prosthetic extension the same as a positive margin on a pathology report or extra prosthetic soft tisue

[Hidden]

No it is not the same but both are considered negative findings on a pathology report. A positive margin means the surgeon was unable to cut around all of the cancer and left some behind (theoretically). An epe indicates the mass was effectively “sticking out” of the prostate to some degree.

[spinosa]

Yes, sszyszkiewicz is correct. I had ece at the time of surgery, but, results after that are....unpredictable. For example, I was undetectable for 12 years, then, my PSA moved past .04 and yo-yo'ed between .06 and .18 for 3 years. At the end of 3 years, my PSA hit .2, and I elected for "salvage" radiation - that was 3 years ago, and my PSA has been less than .09. However, despite the luck, I know I'm only as good as my next test - for me, this July. Fingers crossed for us all.

[AlanMeyer]

I have no expertise in this area but, from my reading of articles available on the Internet, my impression of these two conditions (positive surgical margins vs. extra prostatic extensions) is as follows:

Positive margins are tumor cells on the margins of the prostate tissue that was removed during surgery.. The cause can be difficulties in the surgery that made it hard for the surgeon to excise all of the prostate tissue. Upon post operative examination of the removed tissue, the presence of tumor cells on the surface of the removed prostate indicate that there may be tumor cells that were outside that surface and didn't get removed. Some of what got left behind may contain tumor cells. The amount and the status of those cells may be unknown, though the surgeon and the pathologist may be able to make some good guesses.

Extra prostatic extensions (EPE) are tumors that have grown outside the prostate by pushing through the prostate wall. I presume that they are mostly discovered by MRI or other scanning done before the surgery, though I imagine that they will also leave positive margins.

I was treated with HDR brachytherapy plus ADT and external beam radiation in 2003/4. The docs did an MRI before the procedure and showed me an image they made of the prostate that contained an EPE. It looked to me a little like a part of a thumb sticking out of a closed hand. They told me that they were going to put one or more of the brachytherapy seeds into the EPE, and they also used external beam radiation on all of the tissue up to one centimeter around the outside of the prostate, which would have included the EPE. It must have worked because, so far, I have had no recurrence of the cancer (crossing my fingers here.)

Tall_Allen or a good doctor can give you better advice than I can, but I think you should at least ask your surgeon what, if anything, he thinks should be done about whatever it is that you have. A second opinion from the best radiation oncologist you can find might also be desirable. It also seems to my inexpert mind that getting frequent PSA tests (every 3 months?) is a good idea in order to find out early if something nasty is developing.

Best of luck.

Alan

[Channelhomec in reply to AlanMeyer]

Thanks good infomation

[Cooolone]

ECE, Extra Capsular Extension means the presence of the PCa is at the edge of the gland. But this diagnosis is usually from scans, etc. A pathology report of observance of tissue samples taken from surgery would show positively if the PCa had escaped the capsule.

Positive margins indicate the cut the surgeon made was not clean, that the cut had went through cancerous tissue, therefore leaving some behind. The cut the surgeon make, are usually just beyond the capsule of the prostate and surrounding tissue, including whatever tissue may be suspect, ie, Nerves, Seminal Vesicles, etc.

They are two different things... Similar, but different.

[MateoBeach]

The implications of either is that some cancer remains in the prostate bed. Also shows that it is aggressive. If your scans are negative for distant metastasis then it calls for prompt salvage radiation treatment of prostate bed and to the extended pelvic lymph node fields. This combined with adjuvant ADT for at least 18-24 months. Go for the possible cure. I would not wait to see BCR of PSA. Have a discussion about adding an advanced AR drug and possibly docetaxel to the ADT per the PEACE1 results.