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Wade, I am no expert, but had a positive margin also. My post-op PSA was elevated at both one and two months out and I ended up having salvage radiation which lowered PSA to undetectable but has very slowly risen over the last 8+ plus years and I have had no further treatment as yet.
Wade, another surgery is usually not an option..there possibly could be a small micro amount of cancer at the margins or elsewhere, but due to scar tissue and not being able to see the small amount, I have not heard of a second surgery. Depending on your ongoing PSA levels, there are now ways to locate small PcA amounts using Choline 11 testing at Mayo clinic. Like if some cancer is present in lymph nodes, than surgery to remove them could potentially be performed. Check with your doctor to see if what I have stated is accurate or not, and depending on your PSA reading, see what options might be open to you and get more than one opinion.
Thank You again Allen. Choline 11 sounds interesting and also, my treatment has been with Mayo clinic so I will be sure to inquire about this. there was no perineural invasion indicated any place else, bladder, seminal vesicle, lympnodes, etc other than the right side of the prostate at posterior base .1cm in size and it was at the cauterized surface. In 3 more weeks they are checking PSA levels and I am hoping for the best.
I was hopeful after surgery to put this behind me but perhaps it's not over yet.
I think you are doing what many of us do - trying to resolve a problem that might not arise. It is often human nature to imagine the worst and to start thinking of potential solutions for this 'worst case' scenario before doing what Dr Strum recommends ASSESS STATUS BEFORE DETERMINING STRATEGY .
Part of the process of assessing stauts, in your case, might be to get a second opinion on the pathology and to get an opinion from your doctor as to his recommendation and compare this wth a second doctor's opinion.
In saying this I am not contradicting the advice that you have received here - the men who were good enough to respond to you may well be correct, but you may also be interested to read the commentary and summary of the New Guidance On Radiation After Radical Prostatectomy
Mike Scott writes these invaluable commentaries and it is important to note what he has to say, particularly:
There may be some considerable controversy about the interpretation of this new guideline. It is certainly the case that numerous men with “adverse pathologic findings including seminal vesicle invasion, positive surgical margins, and extraprostatic extension”at the time of surgery, and whose PSA level drops to an undetectable level post-surgery, have no rise in their PSA level after their surgery and appear to have been clinically cured of the original cancer. The question is therefore going to be exactly how individual surgeons apply some over the above guidance — i.e., by duly informing the patient but by adding “However, in your case I think we can afford to wait and monitor your PSA rather than applying radiation therapy immediately.”
The other issue that does not seem to be addressed in this guidance at all is the patient’s PSA doubling time. The situation of a man with a rising PSA post-surgery that goes from 0.1 to 0.4 over a period of 6 years (i.e., a PSA doubling time of 2 years) would seem to The “New” Prostate Cancer InfoLink to be very different to that of a man who’s PSA is doubling every 6 months or so and therefore goes from 0.1 to 0.4 in just 12 months. The former may never show signs of significant metastatic disease; the latter , on the other hand, probably will.
