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Positive margins - Now what?

Prostate Cancer | Last Active: Mar 20, 2025 | Replies (19)

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I have not had hereditary genetic testing done, but my maternal grandfather had prostate cancer and one uncle also had it. I appreciate your input Jeff; I've read a lot of your comments here and you've obviously "been around the block" with this. Any insight regarding perineural invasion you might be able to offer would be appreciated. Thanks.

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Replies to "I have not had hereditary genetic testing done, but my maternal grandfather had prostate cancer and..."

While perennial invasion makes the cancer more aggressive most of the time it is caught before it leaves the prostate and a prostatectomy removes it. I must admit, I missed the fact that your margins do show an issue.

With cancer showing up in the margins, they may want to do salvage radiation sooner rather than later. That should take care of the problem long-term. In some cases, I know they wait to see if the PSA rises after surgery to confirm that there is a problem due to margins.

Perineural invasion is a frequent finding; it used to be thought that it indicated a more aggressive tumor - similar to cribriform/intra-ductal findings.
However, research has shown that it simply quantifies the spread of malignant cells laterally toward the nerves. I had it in almost every core in my biopsy. I did wind up with salvage radiation 5 yrs after surgery but not all men do.
What’s strange to me is how low your tumor volume is - yet it shows PNI and positive margins. The tumor formed in just the right place (wrong, actually) to put you in a possible salvage radiation situation.
It would be helpful to know your Decipher - or similar - Score to give you an idea of what path you should take.
But it’s also been shown that men who have radiation years after surgery (provided they’ve been closely monitored) have the same outcomes as those radiated right after surgery.
So you DO have plenty of time to heal, relax and monitor PSA’s going forward before you really need to do anything. Best,
Phil