Opinions about the likelihood of BCR with Gleason 3+4 and clean margins less than 0.1 mm

My less than 0.1 mm "clean negative" margins have always caused concern for the last 22 months.

Almost 2 years laters looks like my odds of BCR are closer to 25% as opposed to the better number of 10% after 3 years given the current research.

Still better than 50% odds but not as good as 90%

I need to catch some good luck and avoid bad luck.

USPSA is 0.01.

I am 3+4 (20% +4) with small prostate and 1.2 cc tumor at the edge with a negative margin less than 0.1 mm.

The USPSA next blood test in 11 / 12 days will start to tell the story.

Epstein still thinks all negative margins are more or less the same. These studies seems to say otherwise.

Close surgical margins after radical prostatectomy mimic biochemical recurrence rates of positive margins.

https://www.ncbi.nlm.nih.gov/pubmed/26259665

MATERIALS AND METHODS:
Pathologic records of men who underwent RP from 2005-2011 were retrospectively reviewed. Margin status was classified as "positive" (PSM), "negative" (NSM), or "close" (<1mm from margin). BCR was defined as 2 consecutive postoperative prostate specific antigen measurements >0.2ng/ml. Probability of BCR was estimated using the Kaplan-Meier method and stratified by margin status. Univariable and multivariable Cox proportional hazards models were used to determine whether close margin status was associated with an increased rate of BCR.

RESULTS:
A total of 609 consecutive patients underwent RP (93% robotic) and had complete pathologic data. A total of 126 (20.7%) had PSM, 453 (74.4%) had NSM, and 30 (4.9%) had CSM (mean<0.44mm). The 3-year BCR-free survival for patients with CSM was similar to those with PSM (70.4% vs. 74.5%, log rank P = 0.66) and significantly worse than those with NSM (90%, log rank P<0.001). On multivariable regression, positive margin status (HR = 3.26, P<0.001) was significantly associated with a higher risk of BCR, along with close margins (HR = 2.7, P = 0.04).

CONCLUSIONS:
BCR for patients with CSM at RP is tantamount to PSM patients. CSM <1mm should be explicitly noted on pathology reports. Patients with this finding should be followed up closely and offered adjuvant therapy.

Short (≤ 1 mm) positive surgical margin and risk of biochemical recurrence after radical prostatectomy.

https://www.ncbi.nlm.nih.gov/pubmed/22759270


PATIENTS AND METHODS:
Margin status and length were evaluated in 2866 men treated with radical prostatectomy (RP) for clinically localized prostate cancer at our institution from 1994 to 2009. We compared the BCR-free survival probability of men with NSMs, a PSM ≤ 1 mm, and a PSM < 1 mm using the Kaplan-Meier method and a Cox regression model adjusted for preoperative prostate-specific antigen (PSA) level, age, pathological stage and pathological Gleason score (GS).

RESULTS:
Compared with a NSM, a PSM ≤ 1 mm was associated with 17% lower 3-year BCR-free survival for men with pT3 and GS ≥ 7 tumours and a 6% lower 3-year BCR-free survival for men with pT2 and GS ≤ 6 tumours (log-rank P < 0.001 for all). In the multivariate model, a PSM ≤ 1 mm was associated with a probability of BCR twice as high as that for a NSM (hazard ratio [HR] 2.2), as were a higher PSA level (HR 1.04), higher pathological stage (HR 2.7) and higher pathological GS (HR 3.7 [all P < 0.001]).

CONCLUSION:
In men with non-organ-confined or high grade prostate cancer, a PSM ≤ 1 mm has a significant adverse impact on BCR rates.

First, so according to the study you cite, yes, with CSM you have as much chance of recurrence as someone with positive margins. But you still have a 75% chance of no BCR. I would focus on that.

Second, the last two readings in your signature are the same, .010, and .009. Those two numbers, for all practical purposes, are identical. So there's that.

Third, all those times you were using an assay that had a threshold of .015, and you were <.015, you could easily have been .009, or .01.

Fourth, any of us can recur. No matter what our pathology. Worrying about it wont change anything. I dont mean to be trite, believe me i know what it is like to worry (we all do). And i know what it is to lose the "<". But you are in great shape.

So nothing has changed. You have good pathology, and are still undetectable, almost 2 years out of surgery.
Even I wouldn't be worried in your situation.

Have a drink tonight, and celebrate

just wondering what you're expecting to get from this forum. Clearly, nothing we've said so far seems to have affected you in any way.

Sending some luck your way! I understand your concern.
Hero

I was also less than 0.1..... 6 years undetectable!