RARP shows 2 positive margins

They did find intraductal, which is pretty aggressive even with a 3+4. I would want to get a decipher test since that Gleason is so low, but between the margin problems and the intraductal you want to know more about your reoccurrence chance.

The Following are some notes about issues found in your biopsy after the prostatectomy.

Extraprostatic extension (EPE) is the spread of prostate cancer beyond the gland's capsule into surrounding fat, classified as pT3a stage. It is a significant adverse prognostic factor, increasing the risk of biochemical recurrence (rising PSA) after surgery. EPE management often involves wider surgical margins, adjuvant radiation, or hormonal therapy.

Intraductal carcinoma of the prostate (IDC-P) is an aggressive form of prostate cancer where malignant cells spread within the prostate ducts, often associated with high-grade invasive cancer. It is characterized by poor prognosis, high recurrence rates, and increased, rapid metastasis. Treatment usually requires immediate, intensive intervention like radical prostatectomy or radiation.

Invasive carcinoma at the prostate margin (positive surgical margin) means cancer cells are touching the inked edge of the removed tissue, indicating a higher risk of remaining cancer cells. This finding, occurring in roughly 20% of surgeries, often prompts consideration of follow-up treatments like radiation therapy to manage potential biochemical recurrence. NIH

The pT2 Doesn’t sound good, but there is a lot of spread which appears to be outside the prostate.. I would ask the doctor how come it is not a pT3a Since EPE and margins were not clear.

Definitely get a second opinion of all this and Mayo Jacksonville would be a great place to start.

They did find intraductal, which is pretty aggressive even with a 3+4. I would want to get a decipher test since that Gleason is so low, but between the margin problems and the intraductal you want to know more about your reoccurrence chance.

The Following are some notes about issues found in your biopsy after the prostatectomy.

Extraprostatic extension (EPE) is the spread of prostate cancer beyond the gland's capsule into surrounding fat, classified as pT3a stage. It is a significant adverse prognostic factor, increasing the risk of biochemical recurrence (rising PSA) after surgery. EPE management often involves wider surgical margins, adjuvant radiation, or hormonal therapy.

Intraductal carcinoma of the prostate (IDC-P) is an aggressive form of prostate cancer where malignant cells spread within the prostate ducts, often associated with high-grade invasive cancer. It is characterized by poor prognosis, high recurrence rates, and increased, rapid metastasis. Treatment usually requires immediate, intensive intervention like radical prostatectomy or radiation.

Invasive carcinoma at the prostate margin (positive surgical margin) means cancer cells are touching the inked edge of the removed tissue, indicating a higher risk of remaining cancer cells. This finding, occurring in roughly 20% of surgeries, often prompts consideration of follow-up treatments like radiation therapy to manage potential biochemical recurrence. NIH

The pT2 Doesn’t sound good, but there is a lot of spread which appears to be outside the prostate.. I would ask the doctor how come it is not a pT3a Since EPE and margins were not clear.

Definitely get a second opinion of all this and Mayo Jacksonville would be a great place to start.

@jeffmarc It says: Intraductal Carcinoma (IDC): Not identified

@jeffmarc It says: Intraductal Carcinoma (IDC): Not identified

@topf I believe it does say no intraductal, no cribiform & no EPE, but concerned over 2 (0.5mm) pattern 3 positive margins at bladder base & neck.
I haven’t heard from surgeon, but will contact Mayo second opinion. I texted a friend oncologist who said consider follow PSA & if get BCR do radiation & ADT.

@lyricw He is correct; positive margins are the biggest factor in the possibility of recurrence.
What it’s saying is that cancer cells are present even at the very edge of the specimen; so there are probably some cells still there in the bed and possibly beyond.
As previously stated you could initiate adjuvant therapy now by starting ADT to prevent spread and growth and then have radiation about 3 months post surgery. Or you can monitor PSA’s at 3 month intervals and start ADT/SRT after 3 consecutive increases in PSA even before it reaches 0.2.
The choice is really yours depending on how proactive you want to be or how you deal with anxiety and the emotional upheaval of living from blood test to blood test.
My own personality demands that I go all in early on, since the waiting is more harmful to my health than the disease itself! Best,
Phil

@heavyphil thank you. I was disappointed to see he left margins at bladder junction. I contacted Mayo to initiate second opinion. I would be open to early versus delayed RT & ADT.