Prostate removed.... now i have small positve magin left,what are my options ?

It all depends on the exact situation with the margin, location, gleason score, etc. Generally speaking, it is very common to follow the surgery with radiation therapy to kill the cancer left in the margin. If the Gleason indicates intermediate or aggressive cancer, hormone therapy may also be prescribed. It is now best to get a skilled medical oncologist and radiation oncologist to determine the next steps. Each should do a lot of prostate cancer work.

Dick 1,

It all depends on your next few PSA results. If they remain stable and zero or near zero, great.

If it starts to go up then you will probably be offered Salvage Radiotherapy to clear up any cells left behind. Well, that's how I understand it but I'm no expert. This is how my journey is progressing and I actually start SRT tomorrow with 33 treatments over 6-7 weeks and finishing on 7th Feb.

Good luck to you.

Chris,

Here in the good old UK.

Hi Dick1,

The Patrick Walsh book has an excellent discussion of positive margins. Nearly half of positive margins (cancer cells left behind at a spot where the prostate was removed) are not viable after surgery, whether because of lack of blood supply or damage to the cells from the surgery. So you have a decent chance that all the cancer was removed. But if your PSA starts to rise, it's a sign that the cells at the margin may be starting to multiply.

With this situation, it is best to monitor your PSA with an ultrasensitive test because if you do have a recurrence, it is most effective to get radiation as quickly as possible, with a PSA of somewhere between .05 and .1. Of course, if your PSA stays undetectable, you win the lottery.

Other aspects of your pathology will determine the urgency and treatment options. If you have a Gleason 6, even recurrence might not trigger treatment; and if your Gleason score is grater than 7, you want to pounce quickly with all guns blazing. In fact, with a high Gleason score you might not want to wait for a rise, but instead go for adjuvant radiation therapy as soon as you recover from your surgery. In that case you might be advised to go for whole-pelvic radiation to target the pelvic lymph nodes, which weren't touched during surgery.

Hope this helps.
Nellie

I"ll add my words of encouragement along with the others.

I also have a positive margin. I'm 28 months post surgery and still getting 0's on my PSA.

The doctor will most likely check your PSA More frequent to be save.

I started on 3 month checks, then six month checks and now once a year check.

Hoping you the best and as you have seen there are several with positive margins that are doing OK. If the cancer returns again its a plus since they will know where to pin point the radiation.

lewvino age 57

Post surgery in March of 2008 I had a positive margin of 1/4 inch. My doctor was not concerned. My main goal choosing surgery was negative margins. Since then , my psa numbers have been undetectable, using the regular tests.


Pre psa 2.8 Gleason 6...before and after surgery Biopsy 3/12 no more than 30%.