Had my post RALP six weeks check up today

User

Posted 27 Jan 2026 at 19:01

PSA is now less than 0.1 which is where they want it to be. He said that all the cancer was contained in the prostate. However, there was a 3mm positive margin at the apex. He didn’t seem too over concerned by this; (but I am). They now monitor me 3 monthly for PSA level. PSA may well stay where it is, which would be great. If it rises to 0.2, then they will do a more specialist PSMA PET-CT scan. If this were to find anything, then I would be given radiotherapy. So just a life of PSA monitoring anxiety!

Most positive margins occur in the apex area of the prostate as there is no real capsule here. The biggest tumour was here.

The final Gleason grade is 7 (3+4) and tumour grading upgraded from T2a to T2c. Only the right hand side nerve bundle was saved.

Should I be worried about the 3mm positive margin as I really wanted the margins to be negative (clear)?

User

Posted 28 Jan 2026 at 13:15

Hi Andy,

Try not to worry. Whilst positive margins are not the best news, I think at this stage it's best to focus on your ongoing recovery. From now on, your PSA will be monitored regularly and action taken if necessary.

My post op histology showed a positive margin and after increases in my PSA, I had SRT. Now 6 years post op and 3 years post SRT, my PSA is undetectable.

Good luck,

Kev.

User

Posted 29 Jan 2026 at 08:24

Yes, it is hard to keep track of the current recommendations, particularly because they appear to me to differ depending on your location. This next bit may be a bit cynical but the surgeon who proudly declared at my 6 week post op consultation that he guaranteed my cancer was cured has lately termed my radiotherapy as 'adjuvant' (planned), rather than 'salvage'. Looks better on paper, I suppose.

Sorry Andy, I won't hijack your thread any further.

Peter

User

Posted 29 Jan 2026 at 12:28

Hi Adrian

Because you have already gone 2.5 years and remained undetectable at <0.02, I think your chances are actually a bit better than that. But, as we have said before, even if the risk of BCR was only 1%, that would be no consolation to the man who turned out to be the 1%. So all we can do is keep our fingers crossed while our luck lasts and then tackle whatever comes our way if we need to.

Best wishes

Kevin

User

Posted 29 Jan 2026 at 15:32

Yes, in fact what the nomogram actually measures is the probability of being free from BCR at various points in the future given the length of time that you have already been free from BCR.

The problem is that this is an average across all men (with a given set of characteristics in terms of Gleason score,etc) who have not yet hit BCR. So it will, for example, implicitly include in the calculation men with a steadily rising PSA which has now reached 0.19 (i.e. with a very high probability to get to 0.2) and, at the other end of the spectrum, men whose PSA has remained consistently less than 0.001, for whom the probability is much lower.

Their solution to this problem is to steer men who already have a detectable/rising PSA away from using the nomogram. But it does mean that the figures tend to err in a pessimistic direction for those with an undetectable ultrasensitive PSA who do use it.

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User

Posted 28 Jan 2026 at 09:33

Andy, don't worry,that doesn't help. Make sure you don't miss any tests , don't accept "it's normal" especially from GP surgeries. Your less than 0.1 could be 0.001or even less. Positive margins mean something was close to the edge. I was told it doesn't necessarily mean something has been left behind

My histology was poor 3mm positive margins staging upgraded ,I also had extraprostatic extension. It took just under three years for my PSA to go from 0.03 (post tarp) to 0.2. I then had SRT.

My diagnosis was 2013 , surgery 2014 , salvage RT 2017, a couple of lymph nodes zapped a couple of years ago and I started HT about 10 months ago.

Still here still moaning.

Thanks Chris

User

Posted 28 Jan 2026 at 10:39

Hi Andy

You say that you are 0.1. Ideally your PSA should be undetectable. If you are undetectable your 0.1 should have a less than arrow infront of it (<0.1).

Ideally you should not have any positive surgical margins.

Detectable PSA and PSMs are factors that may increase the risk of biochemical recurrence. I had extra prostatic extension, capsular breach T3a staging and a high Gleason 9 (4+5), which are also factors which increase the risk of BCR. However, up until now, touch wood, I'm still BCR free.

Good luck, mate.👍

User

Posted 28 Jan 2026 at 13:15

Hi Andy,

My post op histology showed a positive margin and after increases in my PSA, I had SRT. Now 6 years post op and 3 years post SRT, my PSA is undetectable.

Good luck,

Kev.

User

Posted 28 Jan 2026 at 14:22

Agree with Kev T - focus on your recovery. Yes is hard not to worry. Until they get in there as it were they can’t be 100% sure hence why sometimes the grading increases. That is why the histology is so important. You can’t compare either with others as everyone is unique. Concentrate on your recovery and take it one day at a time.

chris and Kev - your posts give me hope (hubby 2 weeks post SRT)

User

Posted 28 Jan 2026 at 15:31

Adrian, Andy's PSA result was less than 0.1.

Andy, when my PSA rose to 0.2 three years after RALP, my onco told me that it may not be enough to show up on a PET scan and so we went straight for radiotherapy to my prostate bed and pelvic lymph nodes to cover the most likely places. Too soon to know if it was successful as I completed 12 months post radiotherapy HT only 4 months ago but my first PSA reading earlier this month was <0.001.

Different onco's have different ideas, it seems.

Peter

User

Posted 29 Jan 2026 at 05:53

Originally Posted by: Online Community Member

Adrian, Andy's PSA result was less than 0.1

Hello mate.

Andy said that his PSA is now less than 0.1 which is where they want it to be.

My response to it wasn't brilliantly worded. I wasn't saying his 0.1 was not undetectable, I was just was trying to explain to him, and others who may be getting their post op results, the significance of the less than arrow in all post op PSA levels. As most of us know undetectable levels vary from laboratory to laboratory from 0.1 to 0.05 and 0.02 and even much lower.

I was also trying to convey the importance of having an undetectable (<) PSA post op result. It's a great indicator that the op went went well.

I'm sorry if I caused confusion.

Andy's results are great, but would have been even better with negatives margins. My post op report wasn't nearly so good, it up graded me to Gleason 9(4+5) and confirmed extraprostatic extension. However, 3 years on I've somehow, touch wood, managed to stay 'cancer free', but I still get the PSA test jitters every 6 months. I think most blokes get PSA anxiety, but find it diminishes over time.

Edited by member 29 Jan 2026 at 07:30 | Reason: Additional text

User

Posted 29 Jan 2026 at 07:29

PSMA PET at 0.2 seems to be the standard approach now, mine has been hovering below 0.2 for so long now I have witnessed at least 4 strategy changes for BCR restaging.

8 years ago it was 3 rises above 0.03 go straight to SRT

5 years ago it was 3 rises above 0.1

3 years ago it was restage at 0.2 with CT and MRI

6 months ago they now say it will be PSMA PET at 0.2

User

Posted 29 Jan 2026 at 07:32

Also try this nomogram, shows the difference in risk between + and - margins post op(very little!).

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

User

Posted 29 Jan 2026 at 07:47

Originally Posted by: Online Community Member

PSMA PET at 0.2 seems to be the standard approach now

As you know, mate, I've been following your story, as I may end up in the same boat.

Anyway, lets not get pessimistic on Andy's thread. Like the majority who've had RARP, he's got a very good chance, of it doing the trick. 👍

Edited by member 29 Jan 2026 at 08:12 | Reason: Typo

User

Posted 29 Jan 2026 at 08:24

Sorry Andy, I won't hijack your thread any further.

Peter

User

Posted 29 Jan 2026 at 09:16

Originally Posted by: Online Community Member

PSMA PET at 0.2 seems to be the standard approach now

As you know, mate, I've been following your story, as I may end up in the same boat.

Anyway, lets not get pessimistic on Andy's thread. Like the majority who've had RARP, he's got a very good chance, of it doing the trick. 👍

The nomogram will show that very effectively.

User

Posted 29 Jan 2026 at 10:52

Originally Posted by: Online Community Member

The nomogram will show that very effectively.

Cheers mate 👍

Chances of me remaining free from BCR at

5 years, 77%

7 years, 62%

10 years, 47%

I don't know if you've noticed that unfortunately we've had a bad run of lads getting BCR after 3 years. I hope they are all okay, and that I manage to buck the trend.

Edited by member 29 Jan 2026 at 11:01 | Reason: Typo

User

Posted 29 Jan 2026 at 12:28

Hi Adrian

Best wishes

Kevin

User

Posted 29 Jan 2026 at 14:45

Originally Posted by: Online Community Member

The nomogram will show that very effectively.

Cheers mate 👍

Chances of me remaining free from BCR at

5 years, 77%

7 years, 62%

10 years, 47%

I don't know if you've noticed that unfortunately we've had a bad run of lads getting BCR after 3 years. I hope they are all okay, and that I manage to buck the trend.

Felt the need to check your stats Adrian, bang on!

+ I know the MSKCC nomograms are based on the original PSA testing limit (0.1) so the fact your PSA is ultra sensitive is another point in your favour...

User

Posted 29 Jan 2026 at 15:32

Yes, in fact what the nomogram actually measures is the probability of being free from BCR at various points in the future given the length of time that you have already been free from BCR.

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