3 months post RP appointment

Sorry to hear the unwelcome news.

I think once there's evidence of it breaking through the capsule (T3) then it's considered high risk but I suspect you're also right that your PSA level would contribute to the categorisation.

Intermediate risk is I think when the cancer is contained within the capsule, gleason is 7 or less and PSA is less than 20.

I don't know what happens now but it may be worth a new thread here to ask for advice - have you got a follow up appointment as a result of the histology? Do they consider immediately treating the prostate bed with RT in this situation? I honestly don't know but I'm sure there will people here who do.

Best wishes, Paul

The dilemma really comes from a rising PSA and negative margins because you don't know where it is.

Brilliant news Gerry, here's to the future! 🥂

I think the 'p' stands for pathological, as the prostate is sliced for analysis after the surgery.

So I was T2b pre surgery,  but increased to pT2c after the prostate was examined. 

P.

No, it doesn't. There are two types of positive margin - interior & exterior. An exterior positive margin means that, when they inspected the bits of prostate under a microscope, the cancer was touching the wax edge (they encase the prostate in wax and then slice it up to look at it). It might be that it was a tiny piece and that was cut or burnt during the operation anyway. The risk of recurrence is no higher than for men who had negative margins. An interior positive margin is usually surgeon error - it means that the surgeon left part of the prostate behind by mistake. If the bit left behind was clear of cancer, there is no increased risk of recurrence. If the bit left behind was cancerous, recurrence is more likely. 

Depending on what kind of positive margin it is, some urologists will refer the patient to an oncologist for adjuvant RT. If the positive margin is thought to be cancer-free and the first post-op PSA reading is okay, many urologists & oncologists will advise waiting to see whether a problem does develop and then opting for salvage RT if needed. My husband had exterior positive margins and waited until his PSA rose over 0.1 before he had salvage RT - that was 2 years post-op. 

My understanding pretty much accords with Steve86's. The prostate is surrounded by a very thin boundary layer, outside which is a neurovascular layer (also pretty thin) i.e.containing a network of fine blood vessels and nerves. Among those nerves are the ones supplying the penis.

When "sparing nerves" the surgeon tries to leave the neurovascular layer behind when removing the prostate underneath. There is a risk when doing so that the cut won't be neatly outside the prostate boundary, so that wouldn't be done if the original biopsy indicated there was cancerous tissue just under the boundary. However the biopsy is just a collection of samples at a few points, there can be cancer just below the surface where no sample was originally taken which is only seen during pathology on the removed prostate.

The pathology on the removed prostate after surgery should show the boundary layer all the way round - if there is a bit of boundary missing it is a positive margin. The implication is that a tiny bit of boundary and the prostate tissue next to it is still in the patient and a future risk, more so if there turned out to be cancerous cells around that region.

I think what LynEyre is saying is that there is a possibility that when the prostate if prepared for pathology (in a wax block from which microscope sections can be cut) some of the prostate edge hasn't been preserved and can't be examined. In that case they can't tell technically whether the removed prostate includes the thin boundary layer all the way round, which means there is a bit where they can't tell whether there is a risk of prostate tissue left behind or not.

Been following this thread with interest as OH was told he had a positive margin by the surgeon. Just checking the most recent letter it states ‘ with a 1.2 MM left apical anterior margin involvement with Gleason 3+3 disease’. Any thoughts? Presume with a 3+ 3 it’s less worrying than his overall Gleason 4 + 5? But it’s the first I’ve seen of a staging of a positive margin. 
thanks Kate