Capsular penetration

Philomene writes:

> In the meantime, there are 3 terms that I'd like some explanation of and

> can't seem to find. Since I work for a university, I am able to do an

> electronic library search which automatically sends me the relevant

> articles on my topic every week. One of my search topics is (not

> surprisingly) long term progression-free rates after RP. Many of these

> studies break down long-term prognosis based on focal capsular

penetration

> (better), established capsular penetration (less good), and postive

> (surgical) margins (worst). What exactly is the difference between these

> three? If I were a pathologist, what would I be seeing?

Focal capsular penetration occurs when only one or two microscopic glands

have penetrated through the spo-called capsule. Established penetration

occurs when three or more glands penetrate (the definition is that of Jon

Epstein at Hopkins, other institutions just divide things into organ

confined and not-organ confined. Dr Epstein found that there is prognostic

significance to the "focal" category.). Positive surgical margins means

that tumor can be seen at the cut surface of the specimen. This implies

that there is still tumor left in the patient, but a decent men with a

small amount of positive margins do not recur. Apparently, the body's

immune response can destroy a little bit of cancer that may be left behind.

JR Oppenheimer,

Prostate Pathologist

Oppenheimer Urologic Reference Laboratory