3mm apical positive margin

User

Posted 24 Apr 2026 at 10:15

Hi,

I’m currently 4 months post RP.

Continence fully back to normal. ED an issue.

My biggest concern is that they found a greater than 3mm positive margin after pathology looked at the removed prostate.

MARGIN STATUS - POSITIVE

EXTENT (TOTAL) - GREATER THAN 3MM

LOCATION - APEX

LYMPHOVASCULAR INVASION - NOT IDENTIFIED

INVASIVE CRIBRIFORM AND/OR INTRADUCTAL - NOT IDENTIFIED.

Consultant’s letter after six weeks check:

“ We had long discussions about the apical margin positivity. I have explained that the prostate is deficient of capsule at the apex but it is an area that he had a primary disease. All that can be done at the moment is to monitor the PSA. If it rises above 0.2, he will require a PSMA PET scan to decide if he could benefit from adjuvant radiotherapy. For the time being, I have reassured him that his PSA is where we expect it to be”.

How concerned should I be about this PSM?

Will I need further treatment?

Your thoughts please.

Thank you

User

Posted 24 Apr 2026 at 18:58

I guess no one else wants to say it.

Yes, you should be concerned.

As I say often you should never worry about something you don't have control over. You do have some element of control over this, i.e. making sure it is followed up thoroughly, so keep on the ball on this.

Presumably the surgeon could not have avoided this, if he had cut any closer to the bladder you would have became incontinent. What you are left with is probably treatable with radiotherapy.

It is possible this will never become a problem, if they are Gleason 3 cells, maybe they won't develop further, but on balance you are at a high risk of this cancer continuing.

How often are you having PSA tests? What values has your PSA been post surgery?

Dave

User

Posted 24 Apr 2026 at 19:26

Hi Dave,

I’m 4 months post op. My 6 weeks PSA was undetectable. My next PSA (3 months) is next Tuesday 28/04/2026. Im down to have 3 monthly PSA tests.

Kind of wished that I had gone for op straightaway when diagnosed August 2024 instead of going on AS for 14 months! It could have been so different!

I don’t know f the margin is Gleason 3 or Gleason 4.

Andy

Edited by member 24 Apr 2026 at 19:54 | Reason: Not specified

User

Posted 24 Apr 2026 at 22:07

The fact you started on AS, and looking at your previous posts, this doesn't look like it was ever a very aggressive cancer. Obviously it got to the point it needed more radical treatment though.

Hopefully what is left behind is still at the less aggressive of the spectrum. The undetectable PSA was good to get post surgery, I guess you just have to keep an eye on these up coming PSAs.

I don't know the official definition of recurrence I think it is >0.2 or three consecutive rises below 0.2 . Find out the definition and make sure you get referred to an oncologist the moment the criteria is reached.

Dave

User

Posted 24 Apr 2026 at 22:34

Hi, Andy.

I'm sorry to see that you have an apical positive surgical margin.

However, if you use this nomogram, I think that you'll be pleasantly surprised, even with a PSM with your chances of remaining BCR free .

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

Like you my active surveillance failed. I was on AS for 20 months prior to surgery. During that time, my diagnosis changed from Gleason 6 (3+3) T2a to Gleason 9(4+5) T3a, capsular breach.

Knowing what I know now, I dont believe my disease progressed as drastically as it seems. I think my initial biopsy just missed the most cancerous cells.

I don't regret going on active surveillance. I made an informed decision based on the facts that were given to me at the time.

Unfortunately, there are no guarantees with any treatment for this disease.

I'd take some comfort in the fact that your PSA is currently undetectable, your Gleason score is low, and the nomogram suggests your prognosis is good.

I hope that your PSA stays undetectable, and that there is no need for any further treatment.

Best of luck, mate.👍

Edited by member 25 Apr 2026 at 05:45 | Reason: Typo

User

Posted 26 Apr 2026 at 08:38

Hi Andy,

I know exactly how you feel.

Pre op I had been told I was T2c and that it was contained.

I was pT3a following surgery with a focal positive margin and capsular breach.

My gleason was 7(3+4).

I have been told I am at high risk of recurrence and will be on 3 monthly psa tests.

It is now over 2 years since my op (09.04.24) and my psa remains undetectable at <0.01. However I constantly worry about BCR and the month running up to the tests are stressful. I know worrying about it does me no good but unfortunately I am who I am!

All you can do is keep yourself fit, eat healthily, drink moderately and ensure you keep up with the tests.

All the best,

Mel

Edited by member 26 Apr 2026 at 21:58 | Reason: Not specified

User

Posted 26 Apr 2026 at 10:24

Hello, I also have a (3+4) T2 organ-confined tumor. Unfortunately, my pathology report shows two positive margins at the left apex (4 mm and 1 mm), classified as extensive margins. Everything else is fine except for the presence of PNI.

The cells found at the margin are pattern 3. I'm experiencing severe depression and am being treated with sertraline and lorazepam.

Surprisingly, my surgeon isn't worried and tells me to celebrate my good overall results. He explains these margins as artifacts inherent to robotic surgery manipulation. Micro-tears and cracks occur where the ink penetrates (my tumor was at the apex margin).

He asks me to take his advice and says my PSA will be undetectable. I've done my own research and found contradictory studies, making it impossible to reach a conclusion. This is very hard :(

https://www.iccr-cancer.org/docs/ICCR-Radprostate-Margin.pdf

User

Posted 26 Apr 2026 at 10:31

Originally Posted by: Online Community Member

It is now over 2 years since my op (09.04.24) and my psa remains undetectable at <0.01. However I constantly worry about BCR and the month running up to the tests are stressful.

Hi, Mel.

We're in a pretty similar position, mate. Both T3a with EPE. My Gleason was higher than yours but I had negative margins. I'm now three years post op, and my PSA is still undetectable, touchwood.

BCR is worrying. I think it stands for Brain Cannot Relax. 🙂

User

Posted 26 Apr 2026 at 19:44

Thank you everyone for your replies.

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