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After radical prostatectomy for prostate cancer, men who have positive surgical margins (evidence that surgery may not have entirely removed the cancer) are more likely to have a prostate cancer recurrence than men who do not have positive surgical margins, according to a study published in The Journal of Urology.

The prostate is a gland of the male reproductive system, which produces some of the fluid that transports sperm during ejaculation. After skin cancer, prostate cancer is the most common form of cancer diagnosed in men. Current treatment options include watchful waiting (delay of treatment until signs of cancer progression), surgery, chemotherapy, radiation, and/or hormonal therapy. When surgery is recommended as part of the treatment plan, the surgeon may remove the entire prostate and some of the tissue around it. This procedure is known as a radical prostatectomy.

Several factors may influence how likely prostate cancer is to recur (come back) after treatment with radical prostatectomy. These factors include prostate-specific antigen (PSA) level, stage and grade of the cancer, and the presence of positive surgical margins. Surgical margins refer to the edges of the tissue that was surgically removed. After the tissue is removed, it is examined by a pathologist. If the pathologist finds cancer cells at the edges of the tissue, the margins are “positive.” Positive surgical margins suggest that not all of the cancer was removed.

In order to assess whether surgical margin status is associated with prostate cancer recurrence, researchers in New York and Texas evaluated 1389 men with clinical stage T1-T3 prostate cancer who were treated with radical prostatectomy between 1983 and 2000. Positive surgical margins were found in 179, 13%, of these men. After accounting for several other factors known to be associated with recurrence, researchers found that patients with positive surgical margins were more likely to have a cancer recurrence, as measured by PSA increase, than men without a positive surgical margin. Among men with positive surgical margins, 58% survived at least 10 years without a worsening of their cancer, whereas significantly more (81%) without positive surgical margins survived at least 10 years without their- disease worsening.

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The researchers conclude that surgeons “should continue to strive to reduce the rate of positive surgical margins to improve cancer control outcomes.” The frequency of positive surgical margins has decreased over the last several years, most likely due to improved surgical techniques and a shift toward smaller cancers at diagnosis.

Reference: Swindle P, Eastham JA, Ohori M et al. Do margins matter? The prognostic significance of positive surgical margins in radical prostatectomy specimens. The Journal of Urology. 2005;174:903-907.

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