Hangin...from what I read from some articles...the
location is a factor, however the amount or size of the positive margin is even a greater factor. I believe if memory serves me, anything greater than 3 cm is going to be the biggest factor, next followed by the
location and number of positive margins. The two
locations of greatest concerns are those located nearest the bladder neck and the apex (apical), but that doesn't matter much if the margin was fairly large. Again I would see if your surgeon has this info if available, it might help you in your decision process.
Just keep in mind that because you have had a positive margin, you still have a greater chance on remaining cancer free. Somewhere along the lines of having an 80% probability of being cancer free at the 10 year mark. However...I am pretty sure you didn't have surgery for those kinds of odds...you wanted them to be 95% or better.
All of this is going to be a tough decision, so I would continue your research for what YOU want to do.
For me...I am going to role the dice that I am in the 80%. If not...then I will do what I need to do at that time.
I don't really know if it makes any difference to have radiation before or after PSA rise in the grand scheme of things and I don't know if the dose is higher in one vs. the other either.
I am sure there are differences...but it all depends on who you talk to. The biggest thing is...if you have treatment adjuvantly and no PSA rise...did the radiation do it's job...or was it because you were already in the 80% bracket in the first place. Also, I don't know of any that had adjuvant therapy and still had a subsequent rise in PSA. I do know some that some have failed with salvage...so maybe there is some merit to doing it before.
Tough decision that is for sure.
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base)
Gleason (3+3) 6 Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1,2008
Gleason 7 (4+3) Staged pT2c NO MX
Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
4 tumors in prostate - largest being 6 cm
PSA Oct 08 <.05