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I did. All clear, no invasion of other aneas or lymph nodes, however 3 positive margins 4,4 and 5 mm. Not small, but surgeon seems fine with it. I am not so sure as they seem larger than others I have read about. As a result I am awaiting 1st PSA (6 weeks next week) to be see if it is undetectable as the surgeon as expects. If not, his view is to await 3 month PSA before considering additional work. My strategy will possibly be different. Others have recommended a PSMA PET scan to assess whether adjunct radiation of the remaining cancer makes sense. I would appreciate other’s views on strategy. My Gleason on pathology remained 3+4 so urologist is less concerned.
Replies to "I did. All clear, no invasion of other aneas or lymph nodes, however 3 positive margins..."
I believe any sort of radiation is not recommended to be given until 3 months after surgery to allow for complete healing of area. If PSA is below 0.1 it's doubtful a PSMA test will detect anything. This disease confronts us with a lot of decisions to be made which aren't clear cut. Overall, it seems like a good pathology report.
Like you, my path report showed several areas of positive margin, "linear length 3-4 mm". 60-70% Gleason grade 4, 34-40% grade 3. Like you, my surgeon "seemed fine with it", and wanted to wait for 6 week PSA before talking about further diagostic or treatment steps. I'm now 13 months out with all PSAs "undetectable" (< 0.02).
I am wary of getting Too Much Information. My opinion/feeling is that, until the PSA begins to rise, there is no reason for getting any other test. The PSA is molecular. Imaging studies are not as sensitive or precise.
"When keeping an open mind, be sure your brains don't fall out."
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I had two positive surgical margins after my RARP in December 2018: 4mm at distal apical margin and 1mm at bladder neck margin. The former was in an area of Gleason pattern 4, which for me was cribriform architecture, and the latter had been cauterized. At that time, there was the option to wait to see if salvage radiation would be indicated by a future PSA rise or to elect to have immediate adjuvant RT (ART). Given that my Decipher Biopsy score was 0.94 and that cribriform PCA cells tend to be prolific, I chose ART to my prostatic bed (I think that they recommend some lymph nodes now). Perhaps having a Decipher test of your surgically removed prostate would give you more information for decision making?
I believe that current protocols would lean towards PSA monitoring to two digits after the decimal point and then to have early salvage RT (eSRT) to prostate bed and some local lymph nodes. That's what a friend was recommended and had last year. Probably delays experiencing side effects while still being effective -- quality of life factored in. Your surgeon should have more information and be able to offer options, and you can always seek a second opinion.
FWIW, I ended up with BCR about 2.5 years after the end of ART, but had a great 2.5 years where I ran a marathon and did a century ride on a recumbent road bike.