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Posted 1/13/2012 11:16 AM (GMT -5)
Hi Guys
I am a bit confused I have just had a RP, and I am left with a 3mm positive margin...the surgeon has referred me to see the radiologist for RT.

I thought that I could sit here and watch my PSA results for a while before deciding upon on treatment, any one have advice ?

Gleason 7 before surgery
Posted 1/13/2012 11:45 AM (GMT -5)
sometimes based on the surgical results, the assumption is made that the horse has left the barn, and an adjunct therapy might be suggested immediately without need to wait for PSA results 6 weeks later.
In my area, there are advertisements for intra-operative RT for PCa

I certainly don't know about your situation or about the accepted protocols - but I don't think this is an unusual treatment suggestion

I'm sure others will chip in with more comments...
Posted 1/13/2012 12:04 PM (GMT -5)
Based on multiple positive margins and a G 4+5, I was started on the planning for IGRT the day the path report came back from my DaVinci surgery. My surgeon has a minimum wait of 18 weeks before actually starting IGRT, and for several reasons, mine didn't get started until about 25 weeks out.

 

Posted 1/13/2012 12:23 PM (GMT -5)
dick - sorry to hear you are in this situation - but then, nothing is ever "cut and dry" with prostate cancer - I am sure there is a bad pun in there somewhere...

- your doctor seems cautious and probably the reason for you seeing an oncologist so soon after surgery.
- do you have any more details from your copy of the post-op pathology report?

- a positive margin does not always mean the horse has left the barn and jumping into another treatment may be putting the cart in front of the horse ( confused yet?)

- personally, I would wait until my first and possibly second PSA result (depending on the first set of numbers)... I am a cautious worry-wart but have learned to get more information from reading other HW posters and their life experiences.
- I had a positive margin on my path report , but so far, so good - PSA<0.10.

-please remember HW is a great patient-to-patient forum , and comments are based on personal life experiences - we are not doctors-

-wishing you all the best,
Bronson
Posted 1/13/2012 12:33 PM (GMT -5)
You have time. It's ok to see the RO and look ahead to options. But you need to heal as best as possible. my docs suggested wait beyond 90 days before starting it. Watch the PSA in between. If you want ask for a PSA even if it's too soon after surgery. You can see it go down. You can also see if it won't go down enough. But it likely will.

Tony
Posted 1/19/2012 6:11 AM (GMT -5)
We are going through this literally as we speak. Had call from initial Radiologist today refering us to another in a closer city option to us. Hubby had surgery on the 23.11.2011 and cath out 2 weeks later. Dry and continent since. Leason of 9 initially and this was altered to a 7 with focoli of 5 after surgery. His PSA was 8.8 and 6 week PSA was 0.81 so his Urologist wants him to have IGRT as soon as possible. He had positive margins and clear CT and Bone Scans so I guess they are being cautious. He is 57. Will report again after Tuesday's appointment.
Posted 1/19/2012 12:16 PM (GMT -5)
Dick1, You COULD do wait and see, see if your PSA drops to undetectable and stays there...But the longer you wait, the greater the chance the cancer will metastasize and become systemic..There is a SLIGHT chance that 3mm positive margin will just go away, but this is high-stakes gambling..

So moving on to adjunct radiation to kill the remaining cancer is pretty much standard treatment..They will wait until you are healed up from the surgery before they start. The next thing to discuss is whether to add HT to the radiation..This combined treatment seems to be 30% more effective but of course the side-effect load is much greater..These are the things you need to be discussing with your R.O. Also, ask about what type of LINAC (radiation machine) they will be using..The newer equipment is far more accurate in delivering its dose while minimizing side-effects..
Posted 1/19/2012 12:57 PM (GMT -5)
Dick,
First you need to heal from the surgery and have your PSA tested. You don't have to act immediately but you do need to begin consultation with an Oncologist to discuss what follow up treatment options you should consider. Good luck.
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