Anyone had positive margins after prostate removed ?

[Lisa7739]

Positive margin after prostate removed, five months out from surgery psa still 0.00 should i still proceed with radiation or only if bcr

[Petertanner]

I would go for the radiation. If there are positive margins, then the disease is still there and there is a possibility that radiation may kill it or at least delay resurgence.

[SammyNUFC]

I had positive margins Lisa 7739 - PSA 0.006 after bladder/prostate removed, then 6 months later 0.email another 6 months 0,7, then 4 months later 1,8, 2 months later 2,68 - oncologist said I have biological recurrence, but put me on active survellence until reaches 20 (bone and CT scans showed nothing), 3 months on PSA is 4.8

[Hidden in reply to SammyNUFC]

In the UK PSA is measured in ng/ml i.e. nanograms per milliliter. The most sensitive tests available, I believe, cannot detect anything less than 0.01 ng/ml, 0.2 ng/ml after prostatectomy is judged to be a chemical recurrence at which point radiation therapy is advised. I'm not sure what units you refer to as 0.006? Mathematically speaking, 0.2 is 20 times 0.01, so if your PSA was 0.006 then 20 times that is 0.012, whereas 0.7 would be 117 times greater!

Additionally, I believe the "doubling time" is important, i.e. how long does it take for the PSA level to double. I see yours went from 0.7 to 1.8 in 4 months, i.e. it more than doubled in 4 months. I believe the rule is that if it doubles in less than 10 months, it ls a recurrence.

Furthermore, if your margins were positive then cancer cells were left in and will be growing and advancing "locally". CT scan may not pick them up as yet whereas some types of MRI scan might. Until they reach local lymph nodes they won't possibly spread to bone.

I think you need to find out what units you're being given, what's the value for indicating a recurrence and what's the doubling time. get an MRI scan and basically.

why are you waiting???

[MelbourneDavid]

I think it depends on the Gleason score. For Gleason 8 or higher, salvage radiation is recommended for positive margins because the are so aggressive. For Gleason 6 or 7 (especially 3+4) people often wait to see if there is a rising PSA because the is a fair chance that a small positive margin will not result is recurrence (typically around 50-50)

[Dr_WHO]

I would be aggressive with it and go for the radiation. The problem with prostate cancer is that it is always mutating, turning into forms that are harder to treat.

[Burnett1948]

Burnett1948Lisa7739.I had 6mm at the right apex missed in 2005. I had 32 shots of Radiation in 2009 (the Dose was 64 Gy) when my PSA reached .4. It was my decision to have the radiation with the support of my General Doctor. I have since found out I should have had the Radiation when my PSA reached .2. I didn't see my 2005 pathology until 2012 when I saw a new Urologist. It will be good when PET scans can pin-point the exact location of the recurrent new tumors so the Radiologist knows where to aim. As I understood my Radiologist just aimed generally in the area where the prostate was. My PSA reduced to .08 after the radiation treatment. Now my PSA is 2.5. My doubling is 18 mts and I don't know when my recurrent prostate cancer will start to metastate. One other point; I believe now my prostate would be shrunk by hormones before surgery because the one thing my surgeon told me in 2005 was that my prostate was large. I hope this helps.

[Paulo1968]

Hi Lisa, would you say by now if you decided to do any further treatment?

I had 1 mm positive surgical margin in right apex and all the rest was clean, included 18 lymph nodes. Tumor was PT2. Gleason 8.

I will do my psa test next week.

Thanks, Paulo

[Lisa7739 in reply to Paulo1968]

Decided to simply go with active surveillance. PSA has been 0.00 since i had RP at end of September 2017. I must admit i suffer from PSA anxiety each time I go for my test! I have been going at 3 month intervals. Decided not to got with radiation as perhaps the positive margin was false. No way of knowing for sure of course.

[Paulo1968 in reply to Lisa7739]

Thanks, I will do psa tests every 3 months too.

[MichaelDD]

Diagnosed Marxh 2016 . PSA 12 Gleason 8. 4+4.

I had DaVinci robotic June 2016. After first PSA .024.

3 months later .042 (Oct 2016)

October to Dec 2016 -39 sessions of radiation.

Jan 2017 almost doubled after radiation to .080.

April 2018 it's .720 . Doubling every 4.5 months or so.

July blood work next Monday. Doing blood work every 3 months.Expected PSA to be 1.2 to 1.7.

Chemo and HT next .....