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Well said Terry as per usual. I firmly believe that salvage robotic surgery can easily be done on a patient with positive margins and high gleason scores. This should happen on younger otherwise healthy subjects BEFORE the P.S.A. moves up and is still undetectable. If the salvage surgery fails after a few months, and The PSA goes up they can quickly start radiation or hormones etc. as if there never was a 2nd surgery. I asked my surgeon about this and he said that he could do it but the morbidity rate would be to high. I said that I would take that chance. Would it still take 4 hours? But that was then and this is now. If a positive margin causes a rise in PSA after more than 6 months is it still "local" ? p.s. feel free to delete the other 2 posts of mine about the small study's on 4 men.
If a positive margin causes a rise in PSA after more than 6 months is it still "local" ?
This is my take
1. It is not the ‘positive margin’ that causes any PSA rise. Depending on the degree of the PSA increase, the continuity of the increase etc ( all the points covered in PSA 101 ) the PSA might be due to prostate cancer and this might be due the disease having escaped from the gland prior to the surgery.
2. It is simply not possible to put any accurate time frame on the relationship between a rise in PSA and the positive margin in a post-surgical pathology report. It seems that there might be some kind of relationship between positive margins and progression (not all positive margins are associated with progression of the disease) and there might be an association between an early increase in PSA levels and confirmed progression.
3. It is not possible to say whether a PCa associated PSA movement is due to a ‘local’ extension or a systemic condition or a metastasized disease.
It seems to me that you have not yet grasped the fact that there is simply no certainty in any aspect of this disease: not in diagnosis; not in treatment choice; not in treatment outcome: not in the definition of failure: not in the consequences of failure. So no one can answer your multiplicity of questions with any degree of certainty – all they can do is provide their interpretation of what is known.
