just got my pathology report and I have one positive surgical margin. My gleason was upgraded to a (3+4) from a 3+3. My stage is T2cR1. In looking at journal articles this seems to lower my free from recurrence rate consideralby. My surgeon says wait but I have seen studies on Positive margins that say the earlier the followup with radiation, the more effective the outcome. By waiting for the psa to start to rise even if the first reading is non detectable, the outcoome is poorer. Since I have already had surgery i would just as soon go ahead and have radiation therapy as a follow up and get all the side effects over with at once. any thoughts or experiences?

I always suggest reading the book by Lee Nelson.
It has a few observations on positive margins including the fact that the number of positive margins is also significant. Men with only one positive margin have half the risk of the cancer returning as men with more than one positve margin. In one study, 25% of men with positive margins had their cancer recur with median follow up time of 22 months.

Gleason score of 3 + 4 is better than 4 + 3

John

rabnud,

You mentioned "getting all the side effects over with at once". From what I've observed among patients I know, the side effects of surgery tend to be immediate, whereas the side effects of radiation tend to be more gradual. My father's long-term side effects from radiation did not appear until years after treatment.

If you decide to go ahead with radiation, you might want to investigate the conformal (focused) forms of radiation treatment. A guy in a local support group had a positive margin with PSA elevating a year after surgery. He went to Loma Linda for conformal proton therapy, where they focused the radiation on the suspect part of the prostate bed. He is now six years post-radiation with a very low and stable PSA. And, the only side effects he has are the same ones he had a year after surgery (stress incontinence and moderate impotence).

Best wishes to you.