Positive Margins and Seminal Vesicle Involvement

[luvmydad]

Hi,

My Dad recently got his pathology report back from his prostatectomy and it showed he has T3b prostate cancer with seminal vesicle involvement, positive margins, Gleason score 9, PSA prior to surgery 14.3,but thankfully no lymph node involvement. I was wondering if anyone else had this diagnosis and what/if any follow-up treatment did you do? How soon did you have your post-surgery PSA, if you started radiation, how soon after surgery?
It would be really great to hear from someone who has gone down this road already.

Have a good day,
Pauline

[luckypup]

Hi Pauline,
I also had path report from prostatectomy with Gleason 9, seminal vesicle involvement and "negative" margins (actually less than 1mm in some samples but tumor had grown outside the prostate).  It was a bit of a surprise.  No lymph node involvement.  Monitored PSA at 6 weeks (less than 0.1) then switched to ultrasensative assay at 8 weeks (0.04) and again at 12 weeks (0.01).  Planning to start hormone therapy combined with radiation and it will probably be about 4 months post-surgery.  I wish your Dad the best of luck and hope that he will obtain more than one expert opinion (medical oncologist, radiation oncologist, specializing in prostate cancer).  

[Ash Tewari, MD, M.Ch.]

Pauline:

Thank you for your question. With Gleason 9 disease and SV involvement, positive margins, your dad is certainly a candidate for adjuvant radiation therapy. A recent study in 2008 showed that patients with pT3 disease had a lower risk of biochemical recurrence when treated with radiation following their prostatectomy.

In the early 1990s, 425 men were enrolled in SWOG (Southwest Oncology Group) 8794 with aggressive prostate cancer. They were randomly assigned within 16 weeks after prostatectomy into groups of adjuvant radiation or observation. Immediate radiation following the removal of the prostate significantly reduced recurrence (biochemical, local failure and metastatic disease) and increased metastatic disease-free and overall survival.

The Fifteen-year metastasis-free survival was 46 percent with radiation and 38 percent for observation respectively. The overall survival was 47 percent and 37 percent, respectively. Radiation therapy also significantly reduced biochemical and local failure as well as the need for androgen ablation (or hormone therapy).

A PSA rise at this point would not necessarily mean metastatic disease. It is not clear if distant micrometastases would evolve before PSA elevation. It could mean prostate tissue was left in the body (not necessarily a positive surgical margin but a capsular invasion) or micrometastases. It may be prudent for urinary function to return prior to starting radiation.

All my patients get PSA tests at 6 weeks after surgery. By that time most of them are continent and any additional therapies wouldn't need to be delayed.

Best of luck

Ashutosh (Ash) K. Tewari, MD
www.cornellroboticprostate.org

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