Any idea of success rate for IMRT salvage with positive margin

So I'm looking at likely IMRT after my robotic surgery last month.

Came back with one positive margin and no other negative indicators.

But that positive margin is large - 1.2 cm, in the posterior and bladder neck area.

Pathologist says it's only Gleason 3 at the margin, and emphasized very little evidence of actual bladder neck involvement.

My question is this:

Does anyone know of studies showing success (as measured in biochemical recurrence rate or other markers) for salvage or adjuvant IMRT, both generally and for guys with my specific situation - one large positive margin in the posterior / bladder neck region.

My gut feeling is that the 'success' rates would be higher for me because almost certainly the cancer is local, and isolated in that one spot. Albeit a large spot, in terms of positive surgical margin.

Last, has anyone had experience with or know the reputation of radiation oncologists at Washington Hospital Center here in DC? US News rates several of their radiation oncologists as top 1% nationwide, but I don't know how much weight to give that.

Thanks for weighing in.

Much appreciated.

This may or may not apply to your case -- I hope it does.

When I visited Mayo Clinic for a second opinion on my PC diagnosis in 2011, I met with both a radiation oncologist and urologist.

The radiation oncologist told me that both surgery or EBR could cure me. He recommended, in my particular case, that I have surgery.

In looking at the stats of my particular case, he said that the cure rate with surgery is 90%. He said that, if salvage radiation should be needed, the cure is completed in 7 out of 10 cases.

I asked him if this meant I had a 97% chance of cure, he said yes.

So, if this should be applicable at all to your case, it could be the same thing. The odds would be very high for follow-up radiation treatments to finish curing you after the surgery.

Good luck!
Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1.
Semi-firm erections now happening 14 months post-op & slowly getting a bit stronger.

All:

Thank you.

The nomogram results and the individual studies seem WAY different.

By all nomograms I would be in the 90 percent or higher 'cured' (no rising PSA) levels at various year end time frames.

But so many studies out there say particularly after surgical margins the rising PSA rate is 40 percent or higher.

Anybody know why the disconnect?

I can't make sense of it.