Positive margins - Now what?

I'm sorry to hear that your margins weren't clean. Fortunately you still have plenty of options ahead of you for ongoing treatment to fix those spots. And now you KNOW what is going on, no guesswork, having the RARP allowed the professionals to see the entire picture and it will help determine the future options offered to you.

You are 9 years my junior, so you are strong and can most certainly beat this thing. Your margins are small, the treatment hopefully will be direct and kill this thing for good so you can get on getting on. I suspect, but don't know, that they may want you to start hormone therapy to stop the growth until your next treatment since they can't do much else for a couple months post surgery. I seem to remember that you were getting your surgery near the same as mine, at yesterday was my 6 week mark - but if you are just getting the pathology then it sounds like you are pretty recently post-op.

Your results look pretty good. Other than the positive margins there really isn’t anything else that seems to be worrisome. At this point, they probably want to consider doing salvage radiation to radiate the whole prostate bed, which would then hit those spots that are positive. In order to make sure that it doesn’t come back they’ll probably want to use ADT for a while, But not too long since you are a Gleason 3+4 seven.

At least you heard of some possibilities and can be prepared when you speak to your doctor on Monday.

That could very well take care of the problem permanently. You aren’t high risk.

Unfortunately your health insurance may be a limiting factor on what you opt to do.

A Decipher test of the tissue removed will give you some insight as to the aggressiveness of the cancer.

You might opt for adjuvant / early radiation now and this treatment is more effective than waiting. Again, insurance may not cover this.

You may also be advised to wait vs shooting radiation with no identified target.

Get second opinions.

I agree with the Jeff Marc post. Your results look pretty good. Because of the Perineural invasion and small positive margins your medical team may advise salvation radiation to the pelvic area to kill anything that remains. Your surgeon should have surgical notes on the Perineural Invasion and positive margins in addition to pathology report you may want to ask about. In any case radiation isn't given for several months after surgery to allow your body to heal so you have time to have all your questions answered.

As others have discussed, with positive margins may come adjuvant therapy -potentially radiation to the prostate bed and short term ADT, say six months.

You can plug your clinical data in these nomograms to get some numerical idea of possibilities - https://www.mskcc.org/nomograms/prostate

You can also read through the NCCN Guidelines - https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1459

Kevin

Sir , your Pathology looks not too bad at all really . The only concern I would have are those small margins . You got operation just in time it appears ! Good for you! I had 3+4 Gleason and a small 2mm margin . What happen to me is 4 years ago I had operation. The PSA slowly went down , but then started to rise very slowly . Very slowly indicates this is likely normal prostate cells or maybe type 3 at best ( Gleason cells don't change categories as some believe). So , after 1.5 year and PSA went up to 0.14 , I got 22 sessions of Pelvic floor radiation ( no ADT ) . After that it was a waiting game . Over the 1.5 years I have had 5 progressively lower PSA blood tests . Now at 0.036 . I have another one in a week - hoping for even lower . I feel fine and have no real deficits. Keep us informed of what you doctors says . I am here to help you - God Bless ! You will make out fine , from what I see here. James on Vancouver Island .

I should also mention that I have a Decipher score from when I had my biopsy. It’s low at 0.15. I know it’s not the only factor to consider, but it’s at least a tiny bit comforting. Does anyone know if any of the other tests (Prolaris or Oncotype) are beneficial in assessing future risk? My doctor only sent for Decipher.

I agree with other posts that path looks good except for the positive margin. I doubt your doctors will do anything initially except for monitor your PSA. As long as your PSA doesn't rise above a certain level (depending on the physician 0.1-0.2) they will continue to get PSA tests every 3 months. Once (or if) your PSA rises above 0.1-0.2 they will likely offer salvage radiation with or without short course of ADT. My guess anyway.

Your Gleason score is so low and with the very low decipher results, surgery plus radiation will probably give you permanent remission. I would be real interested in hearing what your doctors recommend.

Only 20% to 30% of the prostate cancer patients have reoccurrences.

Your reply indicates, to me anyway, that the majority of doctors (and/or Oncologists) will recommend salvage vs. adjuvant radiation treatment for @mayolink. What other circumstances would tip in favor of adjuvant? Would it be pN1 or margins with higher GS, or SVI?