u/Last_Temperature_908

My PSA values after RALP have been:
7 weeks: 0.22 ng/mL
11 weeks: 0.20 ng/mL
13 weeks (different lab): 0.18 ng/mL

So far, the PSA has remained around 0.2 without a confirmed upward trend.
My pathology was pT2, Gleason 3+4 (only 6–10% pattern 4), no EPE, no SVI, no LVI, no cribriform or IDC, but I had two positive apical margins (4 mm. & 1 mm) with Gleason pattern 3 at the margin.

My surgeon believes the stable PSA may still represent benign residual prostate tissue (full nerve sparing) especially because it has not shown a clear rise. He has ordered a pelvic MRI and another PSA in September.

His plan is that if the PSA starts to increase, he will arrange a PSMA PET within about a week and expedite a consultation with a radiation oncologist within a few days, so treatment would not be delayed if needed.
I know it is impossible to know at this stage whether the PSA is coming from benign tissue, microscopic local cancer, or a mixture of both. I’m interested in hearing from anyone who had a persistent but initially stable PSA around 0.2 after surgery. How did your case evolve?

Hello everyone,
I am looking for opinions and experiences from men who have been in a similar situation.

Pathology after robotic radical prostatectomy:
pT2
Gleason 3+4=7 (Grade Group 2)
Only 6–10% pattern 4
No extraprostatic extension identified
No seminal vesicle invasion
No lymphovascular invasion
No cribriform pattern
Perineural invasion present
Two positive apical margins:
4 mm
1.2 mm
Total margin length: 5.2 mm
Cancer at the margin was Gleason pattern 3
The report also states:
“Margin involved by carcinoma in area of extraprostatic extension: Not identified.”

Postoperative course:
Catheter removed on day 10.
Acute urinary retention 4 days later.
Re-catheterized for 5 days.
Final catheter removal on day 18 after surgery.

PSA results:
59 days after surgery (41 days after final catheter removal): 0.22 ng/mL
About 4 weeks later: 0.20 ng/mL

So the PSA is still detectable, but it has decreased slightly rather than increased.
My main questions are:
Has anyone had a similar pathology (pT2 + apical positive margins + low-volume pattern 4) with a PSA around 0.2 after surgery?
Did your PSA continue to decline, remain stable, or eventually rise?
Was salvage radiation recommended immediately, or did your doctors prefer to monitor PSA kinetics first?
If you had a persistent PSA around 0.2, what was ultimately found to be the cause (benign residual tissue, local residual cancer, etc.)?
I understand nobody can predict my individual outcome, but I would appreciate hearing from men with similar pathology and PSA patterns.
Thank you very much.

Hello everyone,
I had a robotic radical prostatectomy a little over 7 weeks ago. Final pathology report:
• pT2 Nx Mx
• Gleason 3+4 (only 6-10% pattern 4)
• Two positive margins at the left apex: one 4 mm and another 1.2 mm (total 5.2 mm), both with pattern 3
• Perineural invasion present
• No cribriform pattern, no intraductal carcinoma, no lymphovascular invasion, no seminal vesicle invasion
• Intraoperative Histolog Scan (confocal microscopy) was negative
My main doubt is this phrase from the report:
“Margin affected by infiltrating carcinoma in zone of extraprostatic extension: Not identified.”
Does this mean it is mainly a capsular incision (the surgeon cut inside the prostatic plane at the apex) rather than true extraprostatic extension?
I have persistent PSA of 0.22 ng/mL at 7 weeks and I’m quite worried. Has anyone had a similar situation (pT2 + positive apical margins + negative intraoperative Histolog Scan + this phrase in the report)? How did it evolve?
Thank you very much in advance. I know every case is different, but I’m trying to better understand the prognosis.

Hi everyone,
I'm a 52-year-old man who recently underwent radical prostatectomy for prostate cancer.
My final pathology was:
pT2 (organ-confined disease)

Grade Group 2 (Gleason 3+4)

Preoperative PSA 8 ng/mL

No extraprostatic extension

No seminal vesicle invasion

Perineural invasion present

No lymphovascular invasion

No cribriform or intraductal carcinoma

Gleason pattern 4: 6–10%

Estimated total prostate involvement by tumor: 12%

Positive apical margin, approximately 5.2 mm in total length

Gleason pattern 3 at the margin

No lymphadenectomy was performed

No PSMA PET was performed

What is confusing me is my first postoperative PSA.
Many of the positive-margin stories I read involve:
Initially undetectable PSA followed by biochemical recurrence months or years later, or

Very slow PSA rises over time.

In my case, my first PSA at 7 weeks after surgery was already 0.22 ng/mL.
That seems different from the more common pattern of positive margins followed by an undetectable PSA.
I understand that positive margins can result from either residual local disease or more aggressive biology, but my pathology otherwise appears relatively favorable (pT2, no EPE, no seminal vesicle involvement, low-volume pattern 4).
Has anyone here had:
Organ-confined (pT2) disease,

A positive surgical margin,

And a detectable PSA immediately after surgery?

If so:
Did your PSA continue to fall?

Did you eventually require salvage radiation?

Was the recurrence local or was disease found elsewhere?

I would really appreciate hearing from anyone with a similar situation.
Thank you.

53 years old. Initial diagnosis: prostate cancer ISUP 2 (Gleason 3+4), PSA <10, small lesion (~14x7 mm), apparently organ-confined. Underwent robotic radical prostatectomy.
Final pathology:
pT2
No extraprostatic extension
No seminal vesicle invasion
No lymphovascular invasion
No cribiform
No intraductal
Perineural invasion: present
Pattern gleason 4: 6-10%
Prostate volume total afeccted: 6-10%
Low tumor volume
Positive left apical surgical margin (4 mm + 1.2 mm)
Gleason pattern at the margin: pattern 3
The pathology report specifically states twice:
“Extraprostatic extension: not identified”
“Positive margin associated with extraprostatic extension: not identified”
Intraoperative Histolog Scan was negative.
First postoperative PSA: 0.22 ng/mL.
My main concern right now is whether this is more suggestive of microscopic local residual disease (due to the apical margin) or if occult lymph node involvement is still possible despite the otherwise relatively favorable pathology.
Has anyone had a similar case (pT2 + apical positive margin + low persistent PSA) and can share their experience regarding outcome and response to early salvage radiation therapy?