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T3a in one area with negative margins throughout--Immediate Radiation vs Follow PSA. Any thoughts?

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Posted 7/9/2015 9:39 PM (GMT 0)
I am two weeks after Robotic prostatectomy. Path shows focal extraprostatic capsular extension but with negative margins throughout. Tumor Gleason 7 involving both lobes but 5% and <5%. All nodes negative.

Surgeon says he feels comfortable watching PSA but says that many would have Radiation treatment immediately. My first followup and PSA is in Mid August.

Does anyone have any experience with low volume T3a with negative margins?
Posted 7/9/2015 9:54 PM (GMT 0)
I dont have experience, but some guys who do will chime in. IMHO, don't rush to radiation. Just watch PSA carefully and be ready to jump on it if there is a rise. 5% or less of tumor involved with negative margins, sounds to me like a hopeful pathology
Posted 7/9/2015 10:56 PM (GMT 0)
The most recent evidence is that there's no harm in waiting until the PSA exceeds the 0.03 ng/ml threshold in a case like yours. It's too early to even start measuring it because the operation releases PSA and it takes several weeks to dissipate.

- Allen
Posted 7/10/2015 12:09 AM (GMT 0)
As you can tell by the signature, my husband is in a similar situation. He just had his 3 month PSA and it came back less than 0.03. The doctor advised us that it was considered undetectable and we should not do anything until the numbers began to rise over 0.2. He said it would be important to let the body heal some rather than beginning further treatment.
Posted 7/10/2015 12:21 AM (GMT 0)
Wow! That sounds almost identical to me! My Dr said the same thing plus my numbers are close as well, except age. I'm 4 years out undetectable PSA. Good luck with it!
Posted 7/10/2015 12:33 AM (GMT 0)
The negative margins trump the ece from a diagnostic pov. the gl 8 and 7 mitigate that positive news, negatively, in that your cancer is still aggressive, relative to less aggressive grades{especially if the 7 is 4+3}, along with the hard gl8. I would listen to your surgeon on the BCR trigger and not a bunch of studies being bandied about. Studies are inherently "always wrong" in that they are skewed by to many variables that are at best very poor circumstantial evidence for a capital offense decision. the "hit it hard" mantra may be true i.e. if you hit it at all. Do you realize how minuscular .03 is as a piece of cancer… if it even is cancer. Do you realize how many of the folks in these studies have no cancer at all but are included in the group as being "helped " by the radiation. the answer to the first is might y small. To the second …no one knows, but 100% it is put out as evidentiary of success. The "evidence" would not even meet the preponderance of evidence in a civil trial, much less a capitol one. Pca is a life or death "trial" imo. FWIW…caveat emptor…regards...
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