Biochemical reoccurrence with positive margins.

My impression is from reading various bits of research is that positive marginas do increase the chance of recurrence, especially in the early years. However, the other factors do count, e.g. a Gleason 3+3 is "good".

You could try inputting your numbers into the Kattan post-prostatectomy nomogram which aims to estimate your probability of recurrence at intervals up to 10 years after surgery. One interesting feature of it is that it aims to take account of how long you have had an undetectable PSA. Here is  a link if it sounds of interest:

https://www.mskcc.org/nomograms/prostate/post_op

This can also let you see what the effect of the positive margins might be in various circumstances. For example, I tried inputting some numbers similar to yours and it came up with  25% chance of recurrence at 10 years with positive margins, compared with about 11% without positive margins. But you need to put in as much detail as you can to get their best estimate. And of course it only gives a rough idea of the statistical probabilities based on historic results from people with characteristics similar to yours. It does not give a definite yes or no.

Hi Jeff.

I'm delighted that your PSA is still undetectable, long may it continue. I'm afraid I'm useless at what margins mean and how relevant EPE is.

To tell you the truth, I've packed in exploring the chances of having BCR. I was Gleason 9 (4+5) with EPE, not certain about margins. I've been told I've got a 60% chance of recurrence but I don't know over what time span.

I'm now over a year post op,  and happily find my PSA is still undetectable.

It's taken me ages, but I've eventually began to believe in 'what will be will be.'

Best of luck mate.

Edited by member 22 Apr 2024 at 18:22  | Reason: Typo

Jeff, I had positive margins and extraprostatic extension and was 4+3, my staging was upgraded after histology. I was told there was a 30 percent chance of recurrence. 

I was fortunate to have more sensitive testing, my post op PSA was 0.03 which would have been reported as <0.1 in your hospital. At 23 months my PSA was 0.07, again still below the so called undetectable range. I was told the consultant had many patients who levelled off at 0.1. 

At 26 months I reached 0.13 and was brought back under urology for monitoring. 

At 33 months I hit 0.2 ,at 35 months I was 0.27. I started salvage RT at 36 months. 

We are all different and you may be absolutely fine. 

Thanks Chris 

Thanks for the reply Chris.

I guess all we can do is wait for our next psa tests, as with your undetectable levels at 2 years I suppose a reoccurrence could happen at any time.

All the very best with your treatment. 
Jeff.

Exactly right Kevin, all we can do is keep up with our psa testing, I see you are into your 4 th year undetectable  post surgery, long may it continue.

Jeff.

There is no such thing as internal or external margin. The margin is one: the point where the surgeon divides the prostate away of the surrounding connective tissue. If cancer cells are found at the peripheral edge of the specimen the margin is positive. The PSA should not significantly increase even in the presence of prostate tissue left behind. Oncologists do not deliver high dose radiotherapy on the suspicion of possible cancer cells. What is true is that (1) multifocality of the prostate cancer may have not been appreciated at the time of the prostatectomy and (2) once you have prostate cancer, your risk of developing further cancer in the potential remnant prostate tissue is higher than the 'normal' population.

Edited by member 25 Apr 2024 at 19:47  | Reason: Not specified

That is why the definition of BCR is as it is - traditional view is that benign prostate material could account for a reading of up to 0.2 but in reality is very unlikely to lead to a PSA of more than 0.1 - hence BCR is generally defined as (and referral to oncology should be considered at)

- 0.2 or

- three successive rises above 0.1 or

- PSA started as undetectable post-op and is still below 0.1 but demonstrates steady increases and the pathology was of concern 

Doctors will also take account of the possibility of minute amounts of PSA being generated elsewhere in the body - prostate specific antigen is not prostate-specific! 

Wow! 😲

That revelation was like an episode of Undercover Boss. 😁

Your inbox has just exploded.💥

Edited by member 25 Apr 2024 at 21:43  | Reason: Emoji

Not at all, we are talking about risks; If there was EPE which was not resected (removed) at surgery, then you are not clear of cancer and should have radiation treatment. If it is removed, then you are talking about having an increased risk of relapse but this is far from definite. Risk is a difficult concept to swallow and live with. But there is always risk that the disease reappears even with the best prognostic indicators; it's just that the number varies. Learning to live with that knowledge is the most important thing, in my view. 

I met with my own surgeon last night and debated at length the value is supersensitive PSA vs 2 decimal point PSA my hospital offers. The reality is the outcome doesn't change, as the intervention doesn't change with picking up slow rising (3 decimal point) PSA. All the supersensitive PSA does is to increase my anxiety with a potentially slow rising PSA which I may not need treatment for, for years. I haven't decided yet which one I'll have next week! 

The risk is made up by more than one factor as you know. It's obviously good that your margins were clear. EPE raise the chance of biochemical recurrence but as I said it's all about figures/risk.