Well, I can relate to getting a report that is worse than you were expecting or at least hoping for. I remember how I felt when I got my report that I was not contained, even though the main reason I had surgery ( as opposed to other treatments) was because of the hope of a cure if I was contained. Which, despite my G9 and PSA >10, was my extremely experienced surgeons gut feeling after he gave me another DRE. He felt there was a fairly good chance it was contained, and if so the surgery would offer me a cure pretty well confirmed by a path report that would tell me about
things like SV and LN, yay or nay. So I went for it, even though the thought of the possible or even probable SEs made me nearly throw up.
So my heart really sank when I got the call that I was NOT contained, had a positive margin plus SV+. Though I was too crushed to see any positives at the moment, at least I knew I was not LN+, and got a minor down grade from 5+4 to 4+5. Then I got another shock when I got it together enough to ask " OK, what's next" and getting the answer "nothing, at least not if and when PSAs go up". I figured there would be immediate RT and HT.
But I can relate to how you might be feeling. Still, take heart, it does not seem to me all that bad relatively speaking. Just not the best possible. But still, you already knew you were G7. So no change there, no upgrade! And you are good with your nodes and SV, and that is a big plus. My understanding ( could be wrong) is that positive margins are not in the same ball park as are LN or even SV invasion as far as prognosis ( especially considering survival) goes, and you are in good shape as far as the others go.
So all your results tell you for sure is that, like the rest of us, you will want to keep a close watch on your PSAs for quite a few years going forward, but you wer probably going to be in the boat any way. It is great news that you were not upgraded and are SV- and especially LN- . YAY!urology.jhu.edu/newsletter/prostate_cancer410.php
And, even if the surgical margins are positive, this does not necessarily mean that the cancer is left behind.
Radiotherapy is best suited for patients with positive margins and/or extracapsular tumor extension, because they are more likely to have a tumor recurrence in the bed of the prostate gland.
However, not all patients with these findings require radiation therapy, and, in fact, most will not have a tumor recurrence, even without radiotherapy.
Among men undergoing prostatectomy, 479 (38%) had positive margins. In the multivariate logistic regression analysis, period, clinical- and pathological T stage, Prostate Specific Antigen (PSA) level, Gleason score and percentage of tumour in the prostate were significantly associated to positive margins. Ten-year prostate cancer-specific survival was 96.6% for the negative margins group and 92.0% for the positive margins group (log rank p = 0.008). In the Cox survival analysis adjusted for tumour characteristics, surgical margin status per se was not an independent prognostic factor while age, pathological T, PSA level and Gleason score remained associated with prostate cancer-specific survival.
PSA 10.9 ~112013
Bx on 112013 at age 64 yrs 11 months, with 5 of 12 pos with one G9(5+4), 1 PNI, T2B.
RALP with lymph nodes at Vanderbilt 021914. (nodes clear, SV+, still G9 but down graded to 4+5, cut wide, but 1 tiny foci right at the edge of margin ) Pros. 106.7 gms!
At 15 months, not wearing a pad most days, mostly dry
PSA <.01 on 6/11, 8/20/14 and 3/4/15, up to .01 on 9/1/15, .01 3/10/16
Post Edited (BillyBob@388) : 6/9/2016 8:07:36 AM (GMT-6)