Positive margins

I was Gleason 3+4, had RP, and had a positive margin. The prostatectomy provided me with more detailed information of the lesion that resulted in a positive margin. Typically, your PSA can be tested as early as 6 weeks after the prostatectomy and more typically 12 weeks, to give you a first indication of any prostate cancer cells remaining in the prostate bed. If your PSA tests eventually show anything detectable, above 0.01 Ng/ml, your PSA will be monitored to look at the doubling time (amount of time for the value to double) and prior to the PSA reaching the value of 0.2ng/ml (biochemical recurrence) you will have agreed upon a treatment plan that is typically salvage radiation. For a Gleason 3+4, even if you have a biochemical recurrence, it is more likely that any remaining prostate cancer cells are localized in the prostate bed, treatable with salvage radiation, and still curable. There is a lot of good online information at PCF.org and PCRI.org which explains next steps and the questions to ask your doctors.

My Gleason was 4 + 3 in August of 22. My findings were the same as yours. No EPE, no seminal vesicle invasion, 15 lymph nodes removed and were clear. I did have a positive margin. It was 1mm per the pathology. I asked my Urologist/Surgeon about this as soon as I read the report and asked if I should see an Oncologist. He said no as he said it was at the margin and did not extend past the removed prostate. So far my PSA is below 0.1. I did not opt for ultra sensitive PSA tests. At 1 year my Urologist said I could get checked twice annually instead of 4 times but I asked to get my PSA tested 3 times a year instead. I have also seen some studies where the outcome for patients with one micro positive margin (anything under 3mm) that their chances of BCR are no worse than someone with no positive margins. This would be an excellent point of discussion with your Urologist at the first post surgery meeting.

Positive margins with 3-4 are indicative of the possibility of biochemical recurrence. They are more significant if they are multifocal and greater than 3mm of length. Focal marginal invasion is not indicative of possible BCR. Your doctor will give you a fuller description of the marginal invasion. It may be indicative of the need for further treatment--ADT or radiation. I would want and expect (your doctor will as well) close watch on PSA at 2 and 3 months. And a repeat of the evervaluable PSMA/PET later. Marginal invasion is not indicative of future metastasis.
If you haven't had the somatic testing Decipher, Polaris etc. You might request that it me done now.

Thank you for your insights. I am in Canada and actually received the pathology summary online, but have not yet spoken with the urologist who performed the robotic prostatectomy, so I have no clue what he will say, or when. The pathology report does not outline details of the positive margins, so the details you highlight are excellent as questions, so thank you. I have never had a PSMA scan. I had a contrast MRI, followed by a targeted biopsy and the robotic removal. Incontinence is improving, but not ED (low priority for me) but it has only been 4 weeks tomorrow. Best I can tell much reliance will be placed on a 6 week and 3 month PSA screen. Please comment if you feel this is reasonable timing. The availability of advanced screening and targeted radiation approaches in Canada is limited, so I will likely be heading to the US if additional steps need to be taken.

The PSA screen is usually the same here. They like to wait 6 weeks because after surgery some PSA will remain in the blood. Small rises can be anxiety producing. You might ask your md what he is expecting in PSA numbers and what number would be concerning.
The PSMA/PET was approved in Canada last year, but I understand that it is only available through research facilities.
I'm given to understand that 12 to 24 months is an anticipated recover for sexual function. As therapy you can take a 5mg daily dose of a pde5 inhibitor like cialis. The use is to increase blood flow and thereby preserve the nerves by oxygenation. 20 is the general dose. Most men barely notice the 5mg and it is only protective not activating like the 20mg dose.
I wish you the best luck.

Thank you for this. I have no details on the margins as yet, just a comment in the pathology report that (Resection margins positive for malignancy". No measurements. Hopefully it falls into the low number, smaller size you experienced. I will hopefully get those details when I speak with the urologist. I am happy that your experience has been so good, and hoping I get the same prognosis and experience. Thanks again

Thank you for the comments on your experience as well as the references, which i will access. I guess the key is to obtain details on the "Resection margins positive for malignancy" comment in the pathology report. It does not detail size or number of positive margins. Suffice it to say your experience and others who commented on this post at least calm me down a bit while I await a meeting with the urologist. Thanks again.

A year ago I had a robotic radical prostatectomy. Immediately after, while I was still groggy on narcotics, the surgeon told me he found some "sticky" tissue at the margins and scraped some extra material out beyond the prostate because of that. With current medical records transparency, I saw the pathology report before speaking with the surgeon. It noted Gleason 4+3, level 3/5, with positive margins. There were also numerous sections examined described as "fibroadipose, vascular and muscular tissue" from the medial margin and base, which were free of cancer. And about a dozen lymph nodes were removed, free of cancer.

During my first post op visit, he was able to clarify all this. "Sticky" is his vernacular for tissue that looks and acts like cancer. He saw it was at the edges of the prostate, so he scrapped/cut more tissue away from the pelvic sidewall in those areas. I asked if I'd need hormone therapy or radiation, and he said, "Let's wait and see what the PSAs show." Meaning, over time, is there biochemical evidence cancer remained and is growing. So far, a year later, all my PSAs are "undetectable".

I think this is one area where robotic is clearly superior to open RP. The operative field is visualized in greater detail, magnified if you will, and a conscientious surgeon can see better and do more than with the naked eye, or even loupes over their glasses.

Ask your surgeon if they were aware of the margin spots at the time of the RP, and if so, what they did about it.

Thank you for that. I will definitely ask about clarifying the surgical experience and the surgeon’s assessment of the margins.

You're welcome and best of luck with everything.