apical margin

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I am 8 months down the road after the robotic.  I have a bad margin like you.  This is a very hard personal decision to make.  You should do just as your Doctor says and I even recomend meeting with a regular oncologist.  My Doc said they now recomed seeing a Oncologist and radiation oncologist as a matter of protocol when there is a bad margin.  Many here in our situation have decided to radiate adjuvantively while others watch their PSA's very closely and consider salvage radiation if their PSA goes up measurably.  I am the latter. 

My Urologist who is also an oncologist,  recomended if he was in my shoes he would watch and wait based on what he saw. My margin was a single margin and very short.  Radiation Oncologist stated that maybe at most two cells could be left behind.  There is the rub, two cells can cause alot of problems or die off. No one knows.

I think about my decision alot, alot.  My PSA's were undetectable at 6 weeks, 3 months and 6 months this I was told is a positive thing. 

If you choose adjuvant ratiation, which I dont blame you one bit indeed,  they would not be able to start radiation until you heal adequately which can differ from man to man.  But for sure no sooner than 3 months.  You should be able to see at least your 6 week PSA and your 3 month. 

I believe that adjuvant radiation is administered in lower doses than salvage radiation. 

I wish you all the best in making your decision. Knowledge is power.  Do what's right for you.  Do some research on positive margins.   A good sight is UroToday.com.  Its free

Frank

I am in the same situation. I had a positive apical margin and I am considering radiation. My Surgeon says it is not necessary to do anything at this time and he recommends watching the PSA closesly. My first 3 month PSA test is at the end of Dec. I saw a radiation oncolgist that said it is a tough decision and that either way would be ok - my decision (Thanks!!). This is really a tough one.

So far I have no incontinence or ED problems at all so I am very hesitant to introduce new problems. On the other hand, if it lowers the risk of future cancer, I wouldn't hesitate to get radiation NOW. I still did not get the size of the margin and percent tumor invovement from my Dr. It was not on the post op pathology report. Is it available?? I am waiting to hear from my Dr.

I agree with Frank about the amount of radiation being less than if you would not have done surgey. I think it's 10 weeks instead of 14 weeks (but Im not 100% sure on that). Also you will have to wait until the surgey heals.

One thing I can say... I agonize over this every single day. I think I am postponing the decision until The end of Dec because a) that's when I get the next PSA results and b) I need to wait until the surgery heals.

Good luck to you and let us know what you decide.

It's a very personal descison, and i wish you (and all of us) the best whatever we decide.

BillSD

hi hangin-in

i found this at http://www.malecare.com/surgery_page_5.htm

Margins It is the goal of surgery to remove all the cancer. A positive margin means that the pathologist notices that cancer cells are at the very edge of the prostate touching the ink that was applied during initial processing of the prostate gland. The pathologist will note the number and location of any positive margins. Those patients with positive surgical margins are at an increased risk of cancer recurrence. Patients with more than one positive margin are more likely to have cancer recur compared to those with a single positive margin.

Patients with an extensive positive margin (large area where the cancer is in contact with the edge of the prostate) are more likely to have recurrence of their cancer compared to those with a very small area (focal positive margins) where the cancer just touches the edge.

It is important to note that most patients with positive margins are cured. Depending on the number and extent of margins your physician may recommend post-operative radiation to decrease the risk of recurrence

Well... Since my surgeon will not be available until next week I called the Pathologist's office directly and asked about the size of the positive margin. I was told it was negliglble and they said .01mm . This sounds good but I don't know if I should be satisfied since it sounds so small. Does it make sense? Should I question it? I feel a little guilty that I don't trust them but it just sounds weird.

Is it normal to find .01mm positive margin and just note on the pathology report "Positive apical margin", and only upon further questioning by me, advise that it was really negligible at .01mm?

Anyone have ideas? Thanks.

thanks frank

but i do not know what my margin is yet

hangin-in made the post

but you right you still have to make the decision and live with it good or bad

thanks

thanks lads

my next appointment is in 3 months
have to wait till I became continent
Currently working on incontinence Very minor leakage at night but go thru 1-2 pads during the day time and it will give me more time to think about getting the radiation + i will get a psa test in february 2009