Positive margins concern

User

Posted 01 Apr 2024 at 22:34

Hello

Was diagnosed october 23 aged 56 gleeson 3+4 PSA was 4.5 MRI showed one area but biopsy found 2 out 3 in area 1 out of 3 in another area same side and 2 out of 7 on other side contained cancer had it removed end of November 23

Pathology report says gleeson 3+4 =7 T2 and positive margins < 1mm

First PSA test showed 0.05 next one coming up but how concerned should I be regarding the positive margins consultant never mentioned them at all but finding it hard to understand info on internet is <1 mm better or worse than < 3 mm

Thanks

User

Posted 02 Apr 2024 at 23:28

I am afraid that Steve & Kev are giving you a much more worrying response than is fair.

A positive margin does not mean that the cancer had started to escape the gland.

It is not inevitable that your PSA will rise and you will need salvage treatment.

A positive margin of 0.3mm. No-one can say what the difference is between a positive margin of <0.1 and <0.3 as they might be the same thing.

When they removed your prostate, they wrapped it in wax and then carved it up into very fine slices. A positive margin means that there was some cancer touching the inside of the wax. With a positive margin of <0.1mm, the bit that was touching the wax was tiny. That does not mean that some cancer has been left inside you - that tiny bit of no more than 0.1mm could have been right on the cutting line or could have been burnt away when they were sealing blood vessels, etc.

The general outlook is that tiny positive margins (<0.3mm) make no difference to likelihood of recurrence but a positive margin of more than 0.3mm may do.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 03 Apr 2024 at 00:08

Andy, the following link is to a you tube video of what can happen to a prostate after removal. Not sure if the technique is the same in the UK.

https://youtu.be/XcKMydgye8c?si=wiHQ3wjzKNij_7mV

I had positive margins and extraprostatic extension, my post op PSA was 0.03. That was all ten years ago , I have had several follow up treatments but still dodged long term HT.

Thanks Chris

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User

Posted 02 Apr 2024 at 07:50

Hi Andy

Any positive margin indicates that the cancer has started to move outside of the prostate gland and is likely to be into the nerves. I'm 62 so a bit older and I went for surgery (RARP) but do have to embark on salvage radiotherapy due to my positive margins. Mentally I am in a good place as I feel that the mothership has been removed and it's now a case of mopping up the remnants.

Ideally they would have liked to have seen a <0.01 PSA post surgery so you should be on 3 month PSA tests - IF it reaches 0.2 then you should be referred to Oncology to start the salvage HT/RT - I had my first HT injection today so a bit ahead of you on the journey (PSA 0.19)

Good luck

Steve

User

Posted 02 Apr 2024 at 15:51

I have exactly the same concern Andy. Except my margin is 3mm. My surgeon wrote this off as not being concerning since my PSA level dropped off a cliff to <0.04. He stated it could be a nick in the prostate upon removal which exposed the tumour else the tumour went right up to the margin and not beyond. I remain less hopeful although currently my PSA has remained the same. But it does hang over you for sure, I wrote in my profile that I was very disappointed. All you can do is monitor.

User

Posted 02 Apr 2024 at 21:47

"Positive margin" means that there is one part of the removed tissue where it is prostate right up to the cut edge - implying the possibility that a very small bit of prostate has been left behind. If the entire cut edge is beyond the prostate ("negative margin") then it means that the whole prostate has been removed with nothing left behind. And <1mm suggests the left behind tissue is very small, and of course it may well not be cancerous tissue anyway.

However it does mean monitoring is important. If PSA doesn't stay low then salvage radiotherapy will undoubtedly be considered. 0.05 (was it <0.05?) suggests things are OK for now, but if it reaches 0.2 you should expect the hospital to propose action.

User

Posted 02 Apr 2024 at 23:28

I am afraid that Steve & Kev are giving you a much more worrying response than is fair.

A positive margin does not mean that the cancer had started to escape the gland.

It is not inevitable that your PSA will rise and you will need salvage treatment.

A positive margin of 0.3mm. No-one can say what the difference is between a positive margin of <0.1 and <0.3 as they might be the same thing.

The general outlook is that tiny positive margins (<0.3mm) make no difference to likelihood of recurrence but a positive margin of more than 0.3mm may do.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 03 Apr 2024 at 00:08

Andy, the following link is to a you tube video of what can happen to a prostate after removal. Not sure if the technique is the same in the UK.

https://youtu.be/XcKMydgye8c?si=wiHQ3wjzKNij_7mV

I had positive margins and extraprostatic extension, my post op PSA was 0.03. That was all ten years ago , I have had several follow up treatments but still dodged long term HT.

Thanks Chris

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