Layman response: Lymph nodes are sampled, if possible, for evidence of PCa. If the PSMA pet scan was clear, then there was no scan evidence of PCa in the lymph nodes and if your recent hernia repair was an issue, then a choice had to be made at surgery to sample or not.

EPE can be microscopic cells, I believe, and I don't think that the surgeon can "chase" what cannot be seen. And the broader the margins cut, the more there will be a risk of damage to other functions, such as continence and erectile function.

My preop PSMA scan was equivocal/ suspicious for lymph node involvement and postop pathology raised my preop Gleason score and confirmed G 9 w/ EPE. Margins were reported as clear and the 4 lymph nodes excised and seminal vesicules were clear.

Your 1st postop 60 or 90 day PSA will tell the story. Less than .1 is the standard.

Nevertheless, my postop PSA was a "persistent " .19 , which sent me " down the hall" to the Radiation Oncologist and Salvage Radiation Treatment.

Salvage Treatment radiated the whole pelvic floor region and the pelvic lymph nodes. I also received 4 mos of ADT (Orgovyx).

My PSA has been undetectable for about 1 yr since salvage treatment and of course I am hopeful that continues for an extended period of time.

G 9 and EPE are harbingers of persistent postop PSA and /or future recurrence. And unfortunately, salvage treatment is needed in a significant percentage of cases postop.

All of my tx has been at Johns Hopkins.

Hopefully, your postop course will be better than mine. However my G 9 is driving the train.