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User
Posted 05 Feb 2024 at 15:47

Hi everyone


I had radical prostatectomy on 2nd October 2023. I'm 58, had histology of Gleason 7 (3+4) grade group 2, considered to be margin negative but question over left side of prostate.


My physical recovery was really good. Full continence regained almost immediately and ED is not an issue so far. In that respect the surgery was highly successful.


Went for follow up with consultant on 2nd Feb and had wind blown out of sales a bit.  3 post op PSA tests have been 0.02, 0.02 & 0.03 in that order.


My consultant is referring me to radiologist for possible adjuvant radiotherapy.  It's possible something was left in there so idea would be to give it a blast to make sure.  I'm a bit concerned at this stage.


Does anyone have a similar experience that they could advise on please?


Best regards, Ian.

User
Posted 07 Feb 2024 at 00:23
NICE defines biochemical recurrence as 0.2 OR three successive rises above 0.1 OR 0.1 with a negative post-op pathology. Referral to oncology should be made when one of these thresholds is reached. I guess men can be referred quicker if they are paying privately but it would be immoral for an oncologist to offer salvage treatment before there is medical evidence of biochemical recurrence.

Whether it is called adjuvant or salvage RT is a sematic issue in many ways but technically, adjuvant RT is planned prior to the RP or identified as necessary during the op / by the first post-op PSA. Salvage RT is when it was believed that the primary treatment had worked but there is then a biochemical recurrence.

The 0.2 limit is quite old but was set at that level because it is possible for a man with no prostate to generate up to 0.2 from benign cells and / or other organs. However, if a man had undetectable PSA which then rises above 0.1 and keeps on rising, the likelihood is that this is not benign. If a man had a poor post-op pathology, there may be no point waiting for the PSA to reach 0.1 - just need to get on with the RT.

My husband has had RP and SRT - his PSA has been wobbling between <0.1 and 0.11 for the last 5 years or so but has never gone back over 0.11 so the onco thinks he may just produce a lot of benign PSA.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 05 Feb 2024 at 18:26

Hi Ian, 


I had a positive margin and had a run of 18 months before my PSA started rising. I had 20 fractions of SRT to the prostate bed in July 2022 without HT. I found the treatment pretty easy compared to surgery, the only hassle being driving on the M25.


You say your continence is good so you should be able to hold a full bladder during treatment. Even so, as treatment progresses, you might want to make a mental note of potential toilet stops on your journey home. 


You'll know more when you meet your oncologist, particularly whether your treatment will include HT or not. 


Hope this helps. 


Kev.

User
Posted 05 Feb 2024 at 20:45
Surely the key thing is that they are thinking of this as adjuvant radiotherapy, i.e. part of the original treatment on the basis of the query over the surgical margin. It is different from salvage radiotherapy which would result from a relapse following surgery, typically needing PSA to rise to 0.2 to trigger treatment.

Like others I am impressed by your continence and erectile function, and hope that this treatment (hopefully avoiding hormone therapy) won't impact that.
User
Posted 06 Feb 2024 at 16:35

There are various scientific studies on survival rates at 0.2 which Google gave me - for example 

ASCO - Absolute PSA


and

Achieving 0.2 before radiation


I am sure there are others as this target has been around for a long time.

It probably means the best balance between survival and Health Care costs. The world we live in I'm afraid.

Edited by member 06 Feb 2024 at 16:37  | Reason: Not specified

User
Posted 06 Feb 2024 at 20:22
Adrian, I was just trying to say that the protocol for immediate further treatment if PSA is detectable is likely to be different for the one for salvage treatment when there is a subsequent rise.

But I agree, all Ian's figures are lower than the reporting limits at your hospital (and also mine) so they hardly represent a significant amount. It may be the doubt over the margin is the reason for referral. But then the referral is only for consideration by the consultant who would oversee the radiotherapy, it isn't a decision to do it - but having said that I have a feeling there have been trials of going straight to adjuvant RT where there are problems with margins, and it may be deemed beneficial in Ian's case.
User
Posted 07 Feb 2024 at 08:40
Positive margins ie some cancer left where the surgeon cut.
High G score that hadn't previously been detected.
Seminal vesicle invasion.

Personally I think the Urologist is just referring you to Oncology because he cannot do anymore, that is a positive.
You still have detectable PSA after a prostatectomy, that is a negative. So you can't say you are cured, but until it goes above 0.1 and keeps rising you can't say you have a recurrence either. But as with lots of cases on here you may think you are cured and then 15 years later it comes back from nowhere, that is the nature of the beast.

I have been on this forum long enough to remember when adjuvant radio therapy was in favour for cases like yours (and mine). That approach led to over treatment and poor QOL. All the latest research says it ok to wait until 0.2 IF you are low risk Gleason etc.
User
Posted 08 Feb 2024 at 19:27

On my post op histology report (note I had in op Neurosafe frozen section) each section is marked with a different coloured ink and the inking protocol is defined. Right=red, left= blue etc. I'm just guessing, but perhaps red= red is a typo and should be right = red. Perhaps CS is centre section????


Peter

User
Posted 05 Feb 2024 at 15:47

Hi everyone


I had radical prostatectomy on 2nd October 2023. I'm 58, had histology of Gleason 7 (3+4) grade group 2, considered to be margin negative but question over left side of prostate.


My physical recovery was really good. Full continence regained almost immediately and ED is not an issue so far. In that respect the surgery was highly successful.


Went for follow up with consultant on 2nd Feb and had wind blown out of sales a bit.  3 post op PSA tests have been 0.02, 0.02 & 0.03 in that order.


My consultant is referring me to radiologist for possible adjuvant radiotherapy.  It's possible something was left in there so idea would be to give it a blast to make sure.  I'm a bit concerned at this stage.


Does anyone have a similar experience that they could advise on please?


Best regards, Ian.

User
Posted 05 Feb 2024 at 17:11
I'm in the same situation but my PSA is 0.12 and not being referred to radio until it hits 0.2
Are you sure you have the right numbers?
User
Posted 05 Feb 2024 at 17:43

IRW, my post op histology was not great, positive margins and extraprostatic extension. My post op PSA was 0.03 and hovered around there for a year. Three years after surgery,I eventually had the "educated guess" salvage RT to the prostate bed when my PSA was around 0.27. My PSA did drop but five years later my PSA was rising  and they found a tumor in a lymph node and found another one last year. 


Is having SRT early over treatment or a good idea to mop up anything that "may" be left. My PSMA scan six years after surgery did not see anything in the prostate bed, but as we know not seeing anything does not mean nothing is there.


Hope all goes well for you.


Thanks Chris 

Edited by member 05 Feb 2024 at 19:36  | Reason: Not specified

User
Posted 05 Feb 2024 at 19:31

Originally Posted by: Online Community Member
My physical recovery was really good. Full continence regained almost immediately and ED is not an issue so far. In that respect the surgery was highly successful.


Went for follow up with consultant on 2nd Feb and had wind blown out of sales a bit.  3 post op PSA tests have been 0.02, 0.02 & 0.03 in that order.


Does anyone have a similar experience that they could advise on please?


Evening Ian.


May I congratulate you on your continence and for having no ED issues. This appears to be rare, so quickly after the op.


I had RARP in Feb 2023. I was T3a with EPE, Gleason 9 (4+5), Grade group 5.  I was told that 0.2 ng/ml would indicate possible recurrence and possibly trigger further treatment.. Since then my PSA has been <0.02, <0.05, <0.02, and <0.02. All these figures were the lowest the labs measured to. The slightly higher one was done at a different hospital.


I find it hard to see why at this stage you're being considered for salvage RT?


Adrian

Edited by member 05 Feb 2024 at 19:32  | Reason: Not specified

User
Posted 05 Feb 2024 at 21:24
J-B - that makes perfect sense as my post op PSA was <0.01 and it rose to 0.12 after 7 months hence mine is salvage but as the OP (Ian) says his was always 0.02 after the op then it would be adjuvant and makes a lot of sense.
User
Posted 05 Feb 2024 at 21:50

Originally Posted by: Online Community Member
Surely the key thing is that they are thinking of this as adjuvant radiotherapy, i.e. part of the original treatment on the basis of the query over the surgical margin. It is different from salvage .


Hi J_B


I still don't follow. ART is also called ESRT early salvage radiotherapy. Ian's and mine PSA levels maybe very similar my Gleason score is much higher  and I have extra prostatic extension, the capsule is breached so why am I deemed less risk? I haven't got a clue what my margins are, I've never been told?


Adrian


 

User
Posted 05 Feb 2024 at 23:02
I had a similar experience to the OP. March'22 RP, followed by negative margins (but only 0.3mm on one side). PSA never quite undetectable and then a steady rise to 0.05 over the course of the next year, which prompted an oncology referral. Registrar in the surgery term referred to the radiotherapy that would likely follow as adjuvant. But when I spoke to oncology they called it salvage. No matter, the 20 sessions to the prostate bed went smoothly and six months on (Dec'23), PSA was noted as undetectable. So the radiotherapy seems to be doing what it was intended for, and I am glad I endured it. Here's hoping for enduring success.
User
Posted 06 Feb 2024 at 09:06

I am confused by the different levels at which referrals to oncology are made. My op was just over two years ago. Initial reading was undetectable. Since then it has slowly risen to 0.1 last month. My surgeon has now asked for the next test to be in June, that is a six month interval. Perhaps he is waiting for the magic 0.2 or to see if it levels out? 


Peter


 

User
Posted 06 Feb 2024 at 10:59
Peter, that seems to be the consensus. If your first post op PSA is undetectable (ie it has a < in it) then nothing seems to happen until it hits 0.2
However, if the post op PSA is not undetectable then RT seems to be done in quick succession.
So you, like me, are awaiting the magic (devil???) 0.2
User
Posted 06 Feb 2024 at 15:47
Interesting thread. I am in a similar situation. My PSA post surgery was undetectable (i.e. <0.01) for a couple of years and recently shot up to 0.1 over a period of 6 months.

Surgeon consultant thinks it's either cancer growth (in which case PSA will rise quickly and over 0.2) or benign glandular tissue growth (in which case PSA would rise and plateau below 0.2). Either way, he doesn't think there is a need for urgent action.

I wish they could come up with a more meaningful marker for prostate cancer that distinguishes between malignant and benign tissue!

Anyway, it seems to me that a PSA rise of <0.01 to 0.1 over a 6 month period is quite fast, therefore indicative of cancer return, and should qualify for SRT even if 0.2 has not been reached yet. I find this 0.2 limit a bit artificial. How was it arrived at? Is there a rational behind 0.2?

Maybe I am panicking. Maybe it is possible for PSA to rise and stabilise somewhere below 0.2?





One day at a time...

User
Posted 06 Feb 2024 at 17:52

The papers linked to Steve's post appear to refer to ADT & RT as the primary treatment. The PSA of <0.2 is what it ideally should be reduced to by ADT before commencing RT, so it would not be relevant to RT as a secondary treatment after RP. I always thought the magic 0.2 was more to do with it getting to a PSA level where the location of the residual PCa might be identified with a PSMA scan. If a PSMA is successful then it's better than just shooting in the dark at the prostate bed when it might be in a local lymph node..

User
Posted 08 Feb 2024 at 09:16

I have copies of all my medical records. Margins have only been mentioned once.


Following my first MRI and biopsy in a letter to my GP from the consultant he wrote I had reasonable safety margins.  I presume this meant that the foci of the two tumours (one visible on the MRI and the other detected by the biopsy but not seen by the MRI) were safely contained within the prostate away from the outer edges?


Margins are never mentioned again.


In the examination report of my removed prostate it showed that I had EPE, T3a but fortunately the seminal vesicles, nodes and fatty tissue that were also removed, were all clear. So does this mean,  post op I had negative margins?

Edited by member 08 Feb 2024 at 09:18  | Reason: Not specified

User
Posted 08 Feb 2024 at 09:48
It should state if you had a positive or negative margin. If in doubt ask your medical team.
User
Posted 08 Feb 2024 at 23:45
Sounds like it's all good, negative is good for margins, means negative for cancer.
User
Posted 09 Feb 2024 at 02:07

My post-op PSA was 0.014, 0.015, 0.019 and 0.023.  At 0.023, I had a PSMA scan and it showed 2 nodes that needed treatment.  I had salvage radiotherapy 15 months after my surgery.  I was on 18 months of bicalutimide.  Since the SRT, my PSA has been undetectable.


Post op, I was pT3b, gleason 9, positive margins, extra capsular extension, peri neural spread.

User
Posted 09 Feb 2024 at 07:47

Originally Posted by: Online Community Member
My post-op PSA was 0.014, 0.015, 0.019 and 0.023.  At 0.023, I had a PSMA scan and it showed 2 nodes that needed treatment.


Presumably, the scan was triggered by the 4 consecutive rises, miniscule though they were.


At one of my local hospitals they only measure to 0.05. So had you had the tests there, they would have all come back <0.05 and all been classed as undetectable.

Edited by member 09 Feb 2024 at 07:48  | Reason: Typo

User
Posted 14 Feb 2024 at 23:19

Had my prostate removed by robotic surgery in February 2020 PSA never dropped below 17 when tested 3 months later it was still.rising scans showed lymph node spread  .I was referred to oncology immediately and put on Hormone treatment .PSA dropped to undetectable within 4 weeks and I had a course of 33 salvage  radio therapy treatments in January 2021 .As of today all my scans are completely clear and my PSA is still  undetectable .I am considered in remission by my consultant .Dont be overly concerned as  salvage RT is very effective at destroying stray cancer cells. Your consultant is doing the right thing as your PSA level is rising and they want to make sure any stray cancer cells are  destroyed .Read my profile for full story, hopefully your PSA will soon be undetectable and remain that way .

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User
Posted 05 Feb 2024 at 17:11
I'm in the same situation but my PSA is 0.12 and not being referred to radio until it hits 0.2
Are you sure you have the right numbers?
User
Posted 05 Feb 2024 at 17:19

Thanks for your reply.  Yes, definitely the correct numbers.


I think it's the margin question that is getting my consultant thinking.

User
Posted 05 Feb 2024 at 17:43

IRW, my post op histology was not great, positive margins and extraprostatic extension. My post op PSA was 0.03 and hovered around there for a year. Three years after surgery,I eventually had the "educated guess" salvage RT to the prostate bed when my PSA was around 0.27. My PSA did drop but five years later my PSA was rising  and they found a tumor in a lymph node and found another one last year. 


Is having SRT early over treatment or a good idea to mop up anything that "may" be left. My PSMA scan six years after surgery did not see anything in the prostate bed, but as we know not seeing anything does not mean nothing is there.


Hope all goes well for you.


Thanks Chris 

Edited by member 05 Feb 2024 at 19:36  | Reason: Not specified

User
Posted 05 Feb 2024 at 18:26

Hi Ian, 


I had a positive margin and had a run of 18 months before my PSA started rising. I had 20 fractions of SRT to the prostate bed in July 2022 without HT. I found the treatment pretty easy compared to surgery, the only hassle being driving on the M25.


You say your continence is good so you should be able to hold a full bladder during treatment. Even so, as treatment progresses, you might want to make a mental note of potential toilet stops on your journey home. 


You'll know more when you meet your oncologist, particularly whether your treatment will include HT or not. 


Hope this helps. 


Kev.

User
Posted 05 Feb 2024 at 19:31

Originally Posted by: Online Community Member
My physical recovery was really good. Full continence regained almost immediately and ED is not an issue so far. In that respect the surgery was highly successful.


Went for follow up with consultant on 2nd Feb and had wind blown out of sales a bit.  3 post op PSA tests have been 0.02, 0.02 & 0.03 in that order.


Does anyone have a similar experience that they could advise on please?


Evening Ian.


May I congratulate you on your continence and for having no ED issues. This appears to be rare, so quickly after the op.


I had RARP in Feb 2023. I was T3a with EPE, Gleason 9 (4+5), Grade group 5.  I was told that 0.2 ng/ml would indicate possible recurrence and possibly trigger further treatment.. Since then my PSA has been <0.02, <0.05, <0.02, and <0.02. All these figures were the lowest the labs measured to. The slightly higher one was done at a different hospital.


I find it hard to see why at this stage you're being considered for salvage RT?


Adrian

Edited by member 05 Feb 2024 at 19:32  | Reason: Not specified

User
Posted 05 Feb 2024 at 20:45
Surely the key thing is that they are thinking of this as adjuvant radiotherapy, i.e. part of the original treatment on the basis of the query over the surgical margin. It is different from salvage radiotherapy which would result from a relapse following surgery, typically needing PSA to rise to 0.2 to trigger treatment.

Like others I am impressed by your continence and erectile function, and hope that this treatment (hopefully avoiding hormone therapy) won't impact that.
User
Posted 05 Feb 2024 at 21:24
J-B - that makes perfect sense as my post op PSA was <0.01 and it rose to 0.12 after 7 months hence mine is salvage but as the OP (Ian) says his was always 0.02 after the op then it would be adjuvant and makes a lot of sense.
User
Posted 05 Feb 2024 at 21:50

Originally Posted by: Online Community Member
Surely the key thing is that they are thinking of this as adjuvant radiotherapy, i.e. part of the original treatment on the basis of the query over the surgical margin. It is different from salvage .


Hi J_B


I still don't follow. ART is also called ESRT early salvage radiotherapy. Ian's and mine PSA levels maybe very similar my Gleason score is much higher  and I have extra prostatic extension, the capsule is breached so why am I deemed less risk? I haven't got a clue what my margins are, I've never been told?


Adrian


 

User
Posted 05 Feb 2024 at 23:02
I had a similar experience to the OP. March'22 RP, followed by negative margins (but only 0.3mm on one side). PSA never quite undetectable and then a steady rise to 0.05 over the course of the next year, which prompted an oncology referral. Registrar in the surgery term referred to the radiotherapy that would likely follow as adjuvant. But when I spoke to oncology they called it salvage. No matter, the 20 sessions to the prostate bed went smoothly and six months on (Dec'23), PSA was noted as undetectable. So the radiotherapy seems to be doing what it was intended for, and I am glad I endured it. Here's hoping for enduring success.
User
Posted 06 Feb 2024 at 09:06

I am confused by the different levels at which referrals to oncology are made. My op was just over two years ago. Initial reading was undetectable. Since then it has slowly risen to 0.1 last month. My surgeon has now asked for the next test to be in June, that is a six month interval. Perhaps he is waiting for the magic 0.2 or to see if it levels out? 


Peter


 

User
Posted 06 Feb 2024 at 10:59
Peter, that seems to be the consensus. If your first post op PSA is undetectable (ie it has a < in it) then nothing seems to happen until it hits 0.2
However, if the post op PSA is not undetectable then RT seems to be done in quick succession.
So you, like me, are awaiting the magic (devil???) 0.2
User
Posted 06 Feb 2024 at 12:01

Yup. Devil it is Steve

User
Posted 06 Feb 2024 at 15:47
Interesting thread. I am in a similar situation. My PSA post surgery was undetectable (i.e. <0.01) for a couple of years and recently shot up to 0.1 over a period of 6 months.

Surgeon consultant thinks it's either cancer growth (in which case PSA will rise quickly and over 0.2) or benign glandular tissue growth (in which case PSA would rise and plateau below 0.2). Either way, he doesn't think there is a need for urgent action.

I wish they could come up with a more meaningful marker for prostate cancer that distinguishes between malignant and benign tissue!

Anyway, it seems to me that a PSA rise of <0.01 to 0.1 over a 6 month period is quite fast, therefore indicative of cancer return, and should qualify for SRT even if 0.2 has not been reached yet. I find this 0.2 limit a bit artificial. How was it arrived at? Is there a rational behind 0.2?

Maybe I am panicking. Maybe it is possible for PSA to rise and stabilise somewhere below 0.2?





One day at a time...

User
Posted 06 Feb 2024 at 16:35

There are various scientific studies on survival rates at 0.2 which Google gave me - for example 

ASCO - Absolute PSA


and

Achieving 0.2 before radiation


I am sure there are others as this target has been around for a long time.

It probably means the best balance between survival and Health Care costs. The world we live in I'm afraid.

Edited by member 06 Feb 2024 at 16:37  | Reason: Not specified

User
Posted 06 Feb 2024 at 17:30
Steve,
interesting papers, especially the second one. If someone is going private as opposed to NHS, can they get SRT before their PSA rises to 0.2 then?

One day at a time...

User
Posted 06 Feb 2024 at 17:52

The papers linked to Steve's post appear to refer to ADT & RT as the primary treatment. The PSA of <0.2 is what it ideally should be reduced to by ADT before commencing RT, so it would not be relevant to RT as a secondary treatment after RP. I always thought the magic 0.2 was more to do with it getting to a PSA level where the location of the residual PCa might be identified with a PSMA scan. If a PSMA is successful then it's better than just shooting in the dark at the prostate bed when it might be in a local lymph node..

User
Posted 06 Feb 2024 at 20:22
Adrian, I was just trying to say that the protocol for immediate further treatment if PSA is detectable is likely to be different for the one for salvage treatment when there is a subsequent rise.

But I agree, all Ian's figures are lower than the reporting limits at your hospital (and also mine) so they hardly represent a significant amount. It may be the doubt over the margin is the reason for referral. But then the referral is only for consideration by the consultant who would oversee the radiotherapy, it isn't a decision to do it - but having said that I have a feeling there have been trials of going straight to adjuvant RT where there are problems with margins, and it may be deemed beneficial in Ian's case.
User
Posted 07 Feb 2024 at 00:23
NICE defines biochemical recurrence as 0.2 OR three successive rises above 0.1 OR 0.1 with a negative post-op pathology. Referral to oncology should be made when one of these thresholds is reached. I guess men can be referred quicker if they are paying privately but it would be immoral for an oncologist to offer salvage treatment before there is medical evidence of biochemical recurrence.

Whether it is called adjuvant or salvage RT is a sematic issue in many ways but technically, adjuvant RT is planned prior to the RP or identified as necessary during the op / by the first post-op PSA. Salvage RT is when it was believed that the primary treatment had worked but there is then a biochemical recurrence.

The 0.2 limit is quite old but was set at that level because it is possible for a man with no prostate to generate up to 0.2 from benign cells and / or other organs. However, if a man had undetectable PSA which then rises above 0.1 and keeps on rising, the likelihood is that this is not benign. If a man had a poor post-op pathology, there may be no point waiting for the PSA to reach 0.1 - just need to get on with the RT.

My husband has had RP and SRT - his PSA has been wobbling between <0.1 and 0.11 for the last 5 years or so but has never gone back over 0.11 so the onco thinks he may just produce a lot of benign PSA.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 07 Feb 2024 at 07:44

Lyn


What exactly is meant by a negative post-op pathology? I had negative margins with a first Post-op PSA of less than 0.06 (undetectable to the lab). Does that qualify? 


Peter


 

User
Posted 07 Feb 2024 at 08:40
Positive margins ie some cancer left where the surgeon cut.
High G score that hadn't previously been detected.
Seminal vesicle invasion.

Personally I think the Urologist is just referring you to Oncology because he cannot do anymore, that is a positive.
You still have detectable PSA after a prostatectomy, that is a negative. So you can't say you are cured, but until it goes above 0.1 and keeps rising you can't say you have a recurrence either. But as with lots of cases on here you may think you are cured and then 15 years later it comes back from nowhere, that is the nature of the beast.

I have been on this forum long enough to remember when adjuvant radio therapy was in favour for cases like yours (and mine). That approach led to over treatment and poor QOL. All the latest research says it ok to wait until 0.2 IF you are low risk Gleason etc.
User
Posted 08 Feb 2024 at 00:21

Originally Posted by: Online Community Member


Lyn


What exactly is meant by a negative post-op pathology? I had negative margins with a first Post-op PSA of less than 0.06 (undetectable to the lab). Does that qualify? 


Peter


 



Sorry, I didn't word it very well. Negative margins is a good thing, it means they don't believe they left anything behind during the op. Positive margins is not a good thing- they can't be sure whether they got it all out.


A positive (good news) post-op pathology would be to be told that you had negative margins; a negative (bad news) post-op pathology would be to be told that you had a positive margin and your Gleason 4+3 had turned out to be a G4+5  :-( 

Edited by member 08 Feb 2024 at 00:21  | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 08 Feb 2024 at 08:45

Gotcha, thanks


Peter

User
Posted 08 Feb 2024 at 09:16

I have copies of all my medical records. Margins have only been mentioned once.


Following my first MRI and biopsy in a letter to my GP from the consultant he wrote I had reasonable safety margins.  I presume this meant that the foci of the two tumours (one visible on the MRI and the other detected by the biopsy but not seen by the MRI) were safely contained within the prostate away from the outer edges?


Margins are never mentioned again.


In the examination report of my removed prostate it showed that I had EPE, T3a but fortunately the seminal vesicles, nodes and fatty tissue that were also removed, were all clear. So does this mean,  post op I had negative margins?

Edited by member 08 Feb 2024 at 09:18  | Reason: Not specified

User
Posted 08 Feb 2024 at 09:48
It should state if you had a positive or negative margin. If in doubt ask your medical team.
User
Posted 08 Feb 2024 at 12:46

Originally Posted by: Online Community Member
It should state if you had a positive or negative margin. If in doubt ask your medical team.


Hello mate,


Whoops. Seek and ye shall find. 😳


I've just reviewed the report on my removed prostate.


Under Macroscopy


[COMMENTS: Red=Red. Left=Green. CS=Orange (not true margin)]


Complete Double Dutch to me.


Under Microscopy


[Apical margin: Negative. Basal margin: Negative. Circumferential margin; Negative.]


Again complete Double Dutch to me.


I've got my one year follow up consultation in a couple of weeks. I'll raise the margins issues with him.


 


 

Edited by member 08 Feb 2024 at 14:04  | Reason: Additional text.

User
Posted 08 Feb 2024 at 18:23
No idea about the red green stuff but the second line looks all negative which is actually positive 😂😂
User
Posted 08 Feb 2024 at 18:44

Originally Posted by: Online Community Member
No idea about the red green stuff but the second line looks all negative which is actually positive 😂😂


You are a tease. Is it good 👍 or is it bad 👎


I'm having a terrible day. On another thread I've frightened blokes to death giving the wrong needle length of the Invicorp jab. I gave them the length of the needle for sucking up the Invicorp from the phial, a whooping 38mm compared to the 12mm injection needle. Its only an inch difference. 😬 


 

User
Posted 08 Feb 2024 at 19:27

On my post op histology report (note I had in op Neurosafe frozen section) each section is marked with a different coloured ink and the inking protocol is defined. Right=red, left= blue etc. I'm just guessing, but perhaps red= red is a typo and should be right = red. Perhaps CS is centre section????


Peter

User
Posted 08 Feb 2024 at 20:52

Originally Posted by: Online Community Member
 I'm just guessing, but perhaps red= red is a typo and should be right = red. Perhaps CS is centre section????


Cheers Peter. You are correct it was right = red. My typo not theirs. I'm having 'one of those days' 🙂

User
Posted 08 Feb 2024 at 23:45
Sounds like it's all good, negative is good for margins, means negative for cancer.
User
Posted 09 Feb 2024 at 02:07

My post-op PSA was 0.014, 0.015, 0.019 and 0.023.  At 0.023, I had a PSMA scan and it showed 2 nodes that needed treatment.  I had salvage radiotherapy 15 months after my surgery.  I was on 18 months of bicalutimide.  Since the SRT, my PSA has been undetectable.


Post op, I was pT3b, gleason 9, positive margins, extra capsular extension, peri neural spread.

User
Posted 09 Feb 2024 at 07:47

Originally Posted by: Online Community Member
My post-op PSA was 0.014, 0.015, 0.019 and 0.023.  At 0.023, I had a PSMA scan and it showed 2 nodes that needed treatment.


Presumably, the scan was triggered by the 4 consecutive rises, miniscule though they were.


At one of my local hospitals they only measure to 0.05. So had you had the tests there, they would have all come back <0.05 and all been classed as undetectable.

Edited by member 09 Feb 2024 at 07:48  | Reason: Typo

User
Posted 12 Feb 2024 at 14:33

Hi Lyn


My post op histology was confirmed at 3+4 (same as biopsy).


Some great info from everyone on here including yourself.


Many thanks, Ian.

User
Posted 12 Feb 2024 at 14:38

Very useful info.


Many thanks.

User
Posted 14 Feb 2024 at 23:19

Had my prostate removed by robotic surgery in February 2020 PSA never dropped below 17 when tested 3 months later it was still.rising scans showed lymph node spread  .I was referred to oncology immediately and put on Hormone treatment .PSA dropped to undetectable within 4 weeks and I had a course of 33 salvage  radio therapy treatments in January 2021 .As of today all my scans are completely clear and my PSA is still  undetectable .I am considered in remission by my consultant .Dont be overly concerned as  salvage RT is very effective at destroying stray cancer cells. Your consultant is doing the right thing as your PSA level is rising and they want to make sure any stray cancer cells are  destroyed .Read my profile for full story, hopefully your PSA will soon be undetectable and remain that way .

 
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