Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review
  • Published:

Avoidance and management of positive surgical margins before, during and after radical prostatectomy

Abstract

Positive surgical margins after radical prostatectomy lead to an increased risk of progression and reduced disease free survival. Earlier detection of prostate cancer, appropriate patient selection and improved operative techniques can reduce the incidence of positive margins, though the risk can not be eliminated as pre-operative staging techniques are not sufficiently sensitive. Nerve sparing and bladder neck sparing do not adversely affect margin status in appropriately selected men. Once positive margins have been diagnosed the optimal management and the timing of treatment remains controversial. Adjuvant radiotherapy or salvage radiotherapy in men with a low PSA may improve local control and PSA free survival in some individuals, a survival benefit has not yet been established.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Oliver SE, Gunnell D, Donovan JL . Comparison of trends in prostate-cancer mortality in England and Wales and the USA Lancet 2000 355: 1788–1789

    Article  CAS  PubMed  Google Scholar 

  2. Epstein JL, Walsh PC, Carmichael M, Brendler CB . Pathological and clinical findings to predict tumour extent of non-palpable (stage T1c) prostate cancer JAMA 1994 271: 368–374

    Article  CAS  PubMed  Google Scholar 

  3. Catalona WJ, Bigg SW . Nerve sparing prostatectomy: evaluation of results in 250 patients J Urol 1990 143: 538–543

    Article  CAS  PubMed  Google Scholar 

  4. Ohori M et al. Prognostic significance of positive surgical margins in radical prostatectomy specimens J Urol 1995 154: 1818–1824

    Article  CAS  PubMed  Google Scholar 

  5. Ackerman DA et al. Analysis of risk factors associated with prostate cancer extension to the surgical margin and pelvic node metastasis at radical prostatectomy J Urol 1993 150: 1845–1850

    Article  CAS  PubMed  Google Scholar 

  6. Gomez CA, Soloway MS, Civantos F, Hachiya T . Bladder neck preservation and its impact on positive surgical margins during radical prostatectomy Urology 1993 42: 689–693

    Article  CAS  PubMed  Google Scholar 

  7. Watson RB, Civantos F, Soloway MS . Positive surgical margins with radical prostatectomy: detailed pathological analysis and prognosis Urology 1996 48: 80–90

    Article  CAS  PubMed  Google Scholar 

  8. Epstein JI . Evaluation of radical prostatectomy capsular margins of resection. The significance as negative, closely approaching, and positive Am J Surg Pathol 1990 14: 626–632

    Article  CAS  PubMed  Google Scholar 

  9. Stamey TA et al. Positive surgical margins at radical prostatectomy: importance of apical dissection J Urol 1990 143: 1166–1172

    Article  CAS  PubMed  Google Scholar 

  10. Blute ML et al. Anatomic site-specific positive margins in organ-confined prostate cancer and its impact on outcome after radical prostatectomy Urology 1997 50: 733–739

    Article  CAS  PubMed  Google Scholar 

  11. Epstein JI, Walsh PC, Brendler CB . Radical prostatectomy for impalpable prostate cancer: the Johns Hopkins experience with tumours found on transurethral resection (stages T1A and T1B) and on needle biopsy (stage T1C) J Urol 1994 152: 1721–1729

    Article  CAS  PubMed  Google Scholar 

  12. Van Poppel H et al. Neoadjuvant hormonal therapy before radical prostatectomy decreases the number of positive surgical margins in stage T2 prostate cancer: interim results of a prospective randomised trial J Urol 1995 154: 429

    Article  CAS  PubMed  Google Scholar 

  13. Blute ML et al. Pathologic classification of prostate cancer. The impact of margin status Cancer 1998 82: 902–908

    Article  CAS  PubMed  Google Scholar 

  14. Epstein JI, Pizov G, Walsh PC . Correlation of pathologic findings with progression after radical retropubic prostatectomy Cancer 1993 71: 3582–3593

    Article  CAS  PubMed  Google Scholar 

  15. Sakr WA et al. International Consultation on Prostatic Intraepithelial Neoplasia and Pathologic Staging of Prostate Cancer. Workgroup 2: Staging and reporting of prostate cancer-sampling of the radical prostatectomy specimen Cancer 1996 78: 366–368

    Article  CAS  PubMed  Google Scholar 

  16. Epstein JI, Partin AW, Sauvageot J, Walsh PC . Prediction of progression following radical prostatectomy. A multivariate analysis of 721 men with long-term follow-up Am J Surg Pathol 1996 20: 286–294

    Article  CAS  PubMed  Google Scholar 

  17. Van den Ouden D, Bentvelsen FM, Boevé ER, Schroder FH . Positive surgical margins after radical prostatectomy: correlation with local recurrence and distant progression Br J Urol 1993 72: 489–494

    Article  CAS  PubMed  Google Scholar 

  18. Cheng L et al. Correlation of margin status and extracapsular extension with progression of prostate cancer Cancer 1999 86: 1775–1782

    Article  CAS  PubMed  Google Scholar 

  19. Lowe BA, Lieberman SF . Disease recurrence and progression in untreated pathologic stage T3 prostate cancer: selecting the patient for adjuvant therapy J Urol 1997 158: (4) 1452–1456

    Article  CAS  PubMed  Google Scholar 

  20. Grossfeld GD et al. Impact of positive surgical margins on prostate cancer recurrence and the use of secondary cancer treatment: data from the CAPSURE database J Urol 2000 163: 1171–1177

    Article  CAS  PubMed  Google Scholar 

  21. Stamey TA et al. Biological determinants of cancer progression in men with prostate cancer JAMA 1999 281: 1395

    Article  CAS  PubMed  Google Scholar 

  22. Grossfeld GD et al. Management of a positive surgical margin after radical prostatectomy: decision analysis J Urol 2000 164: 93

    Article  CAS  PubMed  Google Scholar 

  23. Wieder JA, Soloway MS . Incidence, etiology, location, prevention and treatment of positive surgical margins after radical prostatectomy for prostate cancer J Urol 1998 160: 299–315

    Article  CAS  PubMed  Google Scholar 

  24. Walsh PC, Partin AW, Epstein JI . Cancer control and quality of life after anatomic radical retropubic prostatectomy results at 10 years J Urol 1994 152: 1831–1836

    Article  CAS  PubMed  Google Scholar 

  25. Hall GS, Kramer CE, Epstein JI . Evaluation of radical prostatectomy specimens. A comparative analysis of sampling methods Am J Surg Pathol 1992 16: 315

    Article  CAS  PubMed  Google Scholar 

  26. Ayala AG et al. The prostate capsule: does it exist? Its importance in the staging and treatment of prostate carcinoma Am J Surg Pathol 1989 13: 21–27

    Article  CAS  PubMed  Google Scholar 

  27. Weldon VE, Tavel FR, Neuwirth H, Cohen R . Patterns of positive specimen margins and detectable prostate specific antigen after radical perineal prostatectomy J Urol 1995 153: 1565

    Article  CAS  PubMed  Google Scholar 

  28. Epstein JI et al. Disease progression following radical prostatectomy in men with Gleason score 7 tumour J Urol 1998 160: 97–101

    Article  CAS  PubMed  Google Scholar 

  29. True LD . Surgical pathology examination of the prostate gland. Practice survey by American society of clinical pathologists Am J Clin Pathol 1994 102: (5) 572–579

    Article  CAS  PubMed  Google Scholar 

  30. Partin AW et al. Combination of prostate specific antigen, clinical stage and Gleason score to predict pathological stage of localised prostate cancer JAMA 1997 277: 1445–1451

    Article  CAS  PubMed  Google Scholar 

  31. D'Amico AV et al. Critical analysis of the ability of the endorectal coil magnetic resonance imaging scan to predict pathological stage, margin status and postoperative prostate-specific antigen failure in patient with clinically organ-confined prostate cancer J Clin Oncol 1996 14: 1770–1777

    Article  CAS  PubMed  Google Scholar 

  32. Zincke H et al. Long term (15 years) results after radical prostatectomy for clinically localised (stage T2c or lower) prostate cancer J Urol 1994 152: 1850–1857

    Article  CAS  PubMed  Google Scholar 

  33. Stovsky MD, Reznicek M . The diagnosis prevention and treatment of margin positive disease after radical prostatectomy for adenocarcinoma of the prostate AUA Update Ser 1997 16: 58

    Google Scholar 

  34. Wahl S et al. Incidence of surgical margin involvement in various forms of radical prostatectomy Urology 1990 36: 23–26

    Article  Google Scholar 

  35. Hammerer P, Henke P, Meyer-Moldenhauer WH, Huland H . Preoperative evaluation of tumour aggressiveness in patients with localised prostate carcinoma J Urol pt 2 1995 153: 428A (abstract 798)

    Google Scholar 

  36. Ohori M et al. Can radical prostatectomy alter the progression of poorly differentiated prostate cancer? J Urol 1994 152: 1843–1849

    Article  CAS  PubMed  Google Scholar 

  37. Ross JS et al. Needle biopsy DNA ploidy status predicts grade shifting in prostate cancer Am J Surg Pathol 1999 23: (3) 296–301

    Article  CAS  PubMed  Google Scholar 

  38. Lerner SE et al. Analysis of risk factors for progression in patients with pathologically confined prostate cancers after radical retropubic prostatectomy J Urol 1996 156: 137–143

    Article  CAS  PubMed  Google Scholar 

  39. Bostwick DG et al. Prognostic factors in prostate cancer. College of American Pathologists Consensus Statement 1999 Arch Pathol Lab Med 1999 124: 995–1000

    Article  Google Scholar 

  40. Powell IJ et al. The predictive value of race as a clinical prognostic factor among patients with clinically localised prostate cancer: a multivariate analysis of positive surgical margins Urology 1997 49: 726–731

    Article  CAS  PubMed  Google Scholar 

  41. Shekarriz B et al. Impact of location and multifocality of positive surgical margins on disease-free survival following radical prostatectomy: a comparison between African-American and white men Urology 2000 55: 899–903

    Article  CAS  PubMed  Google Scholar 

  42. Cornud F et al. Endorectal color doppler sonography and endorectal MR imaging features in nonpalpable prostate cancer: correlation with radical prostatectomy findings Am J Radiol 2000 174: (4) 1161–1168

    Google Scholar 

  43. D'Amico AV et al. Endorectal magnetic resonance imaging as a predictor of biochemical outcome after radical prostatectomy in men with clinically localised prostate cancer J Urol 2000 164: 759–763

    Article  CAS  PubMed  Google Scholar 

  44. Yu KK, Hricak H . Imaging prostate cancer Radiol Clin N Am 2000 38: 59–85

    Article  PubMed  Google Scholar 

  45. Huncharek M, Muscat J . Serum prostate specific antigen as a predictor of staging abdominal/pelvic computerised tomography in newly diagnosed prostate cancer Abdom Imag 1996 21: 364–367

    Article  CAS  Google Scholar 

  46. Manyak MJ, Javitt MC . The role of computerised tomography, magnetic resonance imaging, bone-scan and monoclonal antibody nuclear scan for prognosis prediction in prostate cancer Sem Urol Oncol 1998 16: 145–152

    CAS  Google Scholar 

  47. Ikonen S, Karkkainen P et al. Magnetic resonance imaging of clinically localised prostate cancer J Urol 1998 159: 915–919

    Article  CAS  PubMed  Google Scholar 

  48. Hoh CK et al. Positron emission tomography in urological oncology J Urol 1998 159: (2) 342–356

    Article  Google Scholar 

  49. Kotzertke J et al. Experience with carbon-11 choline positron emission tomography in prostate carcinoma Eur J Nuc Med 2000 27: (9) 1415–1419

    Article  Google Scholar 

  50. De Grado TR et al. Synthesis and evaluation of 18F-labelled choline as an oncologic tracer for positron emission tomography: initial findings in prostate cancer Cancer Res 2001 61: (1) 110–117

    CAS  Google Scholar 

  51. Frazier HA, Robertson JE, Paulson DF . Radical prostatectomy: the pros and cons of the perineal versus retropubic approach J Urol 1992 147: 888–890

    Article  CAS  PubMed  Google Scholar 

  52. Guillonneau B, Vallancian G . Laparoscopic radical prostatectomy: the Montsouris experience J Urol 2000 163: 418–422

    Article  CAS  PubMed  Google Scholar 

  53. Abbou CC et al. Laparoscopic radical prostatectomy: preliminary results Urology 2000 55: 630–634

    Article  CAS  PubMed  Google Scholar 

  54. Epstein JI . Incidence and significance of positive margins in radical prostatectomy specimens Urol Clin N Am 1996 23: (4) 651–663

    Article  CAS  Google Scholar 

  55. Walsh PC . Anatomic radical prostatectomy: evolution of the surgical technique J Urol 1998 160: 2418–2424

    Article  CAS  PubMed  Google Scholar 

  56. Lowe BA . Comparison of bladder neck preservation to bladder neck resection in maintaining post prostatectomy urinary continence Urology 1996 48: (6) 889–893

    Article  CAS  PubMed  Google Scholar 

  57. Licht MR, Klein EA, Tuason L, Levin H . Impact of bladder neck preservation during radical prostatectomy on continence and cancer control Urology 1994 44: (6) 883–887

    Article  CAS  PubMed  Google Scholar 

  58. Shelfo SW, Obek C, Soloway MS . Update on bladder neck preservation during radical retropubic prostatectomy: impact on pathologic outcome, anastomotic strictures and continence Urology 1998 51: (1) 73–78

    Article  CAS  PubMed  Google Scholar 

  59. Poon M et al. Radical retropubic prostatectomy: bladder neck preservation versus reconstruction J Urol 2000 163: (1) 194–198

    Article  CAS  PubMed  Google Scholar 

  60. Walsh PC . Radical retropubic prostatectomy Cambell's Urology 6th edn, ed. PC Walsh, AB Retnik, TA Stamey & AD Vaughan Jr WB Saunders: Philadelphia, PA 1992 pp 2865–2886

    Google Scholar 

  61. Catalona WJ, Bigg SW . Nerve sparing radical prostatectomy: evaluation of results after 250 patients J Urol 1990 143: 538

    Article  CAS  PubMed  Google Scholar 

  62. Walsh PC, Donker PJ . Impotence following radical prostatectomy: insight into etiology and prevention J Urol 1982 128: 492–497

    Article  CAS  PubMed  Google Scholar 

  63. Pound CR, Partin AW, Epstein JI, Walsh PC . Prostate specific antigen after anatomic radical retropubic prostatectomy Urol Clin N Am 1997 24: (2) 395–406

    Article  CAS  Google Scholar 

  64. Rosen MA et al. Frequency and location of extracapsular extension and positive surgical margins in radical prostatectomy specimens J Urol 1992 148: 331

    Article  CAS  PubMed  Google Scholar 

  65. Eggleston JC, Walsh PC . Radical prostatectomy with preservation of sexual function: pathological findings in the first 100 cases J Urol 1985 134: 1146–1148

    Article  CAS  PubMed  Google Scholar 

  66. Catalona WJ, Dresner SM . Nerve sparing radical prostatectomy: extraprostatic extension and preservation of erectile function J Urol 1985 134: 1149

    Article  CAS  PubMed  Google Scholar 

  67. Daniels GF, McNeil JE, Stamey TA . Predictive value of contralateral biopsies in unilaterallly palpable prostate cancer J Urol 1992 147: 870–874

    Article  PubMed  Google Scholar 

  68. Catalona WJ . Patient selection for, results of, and impact on tumour resection of potency-sparing radical prostatectomy Urol Clin N Am 1990 17: 819

    Article  CAS  Google Scholar 

  69. Villers A et al. The role of perineural space invasion in the local spread of prostate adenocarcinoma J Urol 1989 142: 763

    Article  CAS  PubMed  Google Scholar 

  70. Jones EC . Resection margin status in radical retropubic prostatectomy specimens: relationship of type of operation, tumour size, tumour grade and local tumour extension J Urol 1990 144: 89–93

    Article  CAS  PubMed  Google Scholar 

  71. Stephenson RA, Middleton RG, Abbott TM . Wide excision (non nerve sparing) radical retropubic prostatectomy using an initial perirectal dissection J Urol 1997 157: 251–256

    Article  CAS  PubMed  Google Scholar 

  72. Smith RC, Partin AW, Epstein JI, Brendler CB . Extended follow up of the influences of wide excision of the neurovascular bundle(s) on prognosis in men with clinically localised prostate cancer and extensive capsular penetration J Urol 1996 156: 454

    Article  CAS  PubMed  Google Scholar 

  73. Graefen M et al. Incidence of positive surgical margins after biopsy-selected nerve sparing radical prostatectomy Urology 1998 51: (3) 437–442

    Article  CAS  PubMed  Google Scholar 

  74. Walsh PC, Partin AW, Epstein JI . Cancer control and quality of life following anatomical radical retropubic prostatectomy: results at 10 years J Urol 1994 152: 1831–1836

    Article  CAS  PubMed  Google Scholar 

  75. Soloway MS, Neulander E . Bladder-neck preservation during radical prostatectomy Sem Urol Oncol 2000 18: (1) 51–56

    CAS  Google Scholar 

  76. Voges G et al. The predictive significance of substaging stage A prostate cancer (A1 vs A2) for volume and grade of total cancer in the prostate J Urol 1992 147: 858

    Article  CAS  PubMed  Google Scholar 

  77. Montironi R et al. Effect of total androgen ablation on pathologic stage and resection limit status of prostate cancer. Initial results of the Italian PROSIT study Pathol Res Pract 1999 195: (4) 201–208

    Article  CAS  PubMed  Google Scholar 

  78. Soloway M, Sharifi R, Wajsman Z, McLeod D, Wood DP, Puras-Beaz A . Randomised prospective study comparing radical prostatectomy alone vs radical prostatectomy preceded by androgen blockade in clinical stage B2 (T2bN×M0) prostate cancer J Urol 1995 154: 424–428

    Article  CAS  PubMed  Google Scholar 

  79. Van Poppel H et al. Neoadjuvant hormonal therapy before radical prostatectomy decreases the incidence of positive surgical margins in stage T2 prostate cancer: interim results of a prospective randomised trial J Urol 1995 154: 429

    Article  CAS  PubMed  Google Scholar 

  80. Goldenberg SL et al. A randomised prospective, controlled study comparing radical prostatectomy alone and neoadjuvant androgen withdrawal in the treatment of localised prostate cancer J Urol 1996 156: 873–879

    Article  CAS  PubMed  Google Scholar 

  81. Witjies WP, Schulmann CC, Debruyne FM . Preliminary results of a prospective randomised study comparing radical prostatectomy alone versus radical prostatectomy associated with neoadjuvant hormonal combination therapy in T2–3 N0M0 prostatic carcinoma Urology 1997 49: (Suppl) 65–69

    Article  Google Scholar 

  82. Goldenberg S et al. A randomised trial of neoadjuvant androgen withdrawal therapy prior to radical prostatectomy: 24 month post-treatment PSA results J Urol pt 2 1997 157: 92 (abstract 357)

    Google Scholar 

  83. Soloway M et al. Radical prostatectomy alone versus radical prostatectomy preceded by androgen blockade in cT2b prostate cancer—24 month results J Urol pt 2 1997 157: 160 (abstract 619)

    Article  Google Scholar 

  84. Lee HH, Warde P, Jewett MA . Neoadjuvant hormonal therapy in carcinoma of the prostate BJU Int 1999 83: (4) 438–448

    Article  CAS  PubMed  Google Scholar 

  85. Takayama TK, Lange PH . Radiation therapy for local recurrence of prostate cancer after radical prostatectomy Urol Clin N Am 1994 21: (4) 687–700

    Article  CAS  Google Scholar 

  86. Coetzee LJ, Hars V, Paulson DF . Postoperative prostate-specific antigen as a prognostic indicator in patients with margin positive prostate cancer, undergoing adjuvant radiotherapy after radical prostatectomy Urology 1996 47: 232

    Article  CAS  PubMed  Google Scholar 

  87. Walsh PC, Cadeddu JA, Partin AW, DeWeese TL . Long-term results of radiation therapy for isolated PSA elevation following radical prostatectomy J Urol pt 2 1997 157: 94 (abstract 363)

    Google Scholar 

  88. Zincke H et al. Long-term (15 years) results after radical prostatectomy for clinically localised (stage T2c or lower) prostate cancer J Urol 1994 152: 1850

    Article  CAS  PubMed  Google Scholar 

  89. Pound CR et al. Prostate-specific antigen after anatomic radical retropubic prostatectomy. Patterns of recurrence and cancer control Urol Clin N Am 1997 24: 395

    Article  CAS  Google Scholar 

  90. Kupelain PA et al. Stage T1-2 prostate cancer: a multivariate analysis of factors affecting biochemical and clinical failures after radical prostatectomy Int J Radiat Oncol Biol Phys 1997 37: 1043

    Article  Google Scholar 

  91. Catton C, Gospodarowicz M, Warde P, Panzarella T, Catton P, McLean M, Milosevic M . Adjuvant and salvage radiation therapy after radical prostatectomy for adenocarcinoma of the prostate Radiother Oncol 2001 59: (1) 51–60

    Article  CAS  PubMed  Google Scholar 

  92. Anscher MS, Robertson CN, Prosnitz R . Adjuvant radiotherapy for pathologic stage T3/4 adenocarcinoma of the prostate: ten year update Int J Radiat Oncol Biol Phys 1995 33: 37

    Article  CAS  PubMed  Google Scholar 

  93. Leibovich BC et al. Benefit of adjuvant radiation therapy for localised prostate cancer with a positive surgical margin J Urol 2000 163: 1178–1182

    Article  CAS  PubMed  Google Scholar 

  94. Vicini FA et al. Treatment outcome with adjuvant and salvage irradiation after radical prostatectomy for prostate cancer Urology 1999 54: 111–117

    Article  CAS  PubMed  Google Scholar 

  95. Peschel RE et al. PSA based review of adjuvant and salvage radiation therapy vs observation in postoperative prostate cancer patients Int J Cancer 2000 90: 29–36

    Article  CAS  PubMed  Google Scholar 

  96. Van Poppel H et al. Is postoperative irradiation after radical prostatectomy necessary? Eur J Cancer 1999 35: 1763–1770

    Article  CAS  PubMed  Google Scholar 

  97. Jacobson GM, Smith JA Jr, Stewart JR . Postoperative radiation therapy for pathologic stage C prostate cancer Int J Radiat Oncol Biol Phys 1987 13: 1021

    Article  CAS  PubMed  Google Scholar 

  98. Meier R et al. Postoperative radiation therapy after radical prostatectomy for prostate carcinoma Cancer 1992 70: 1960

  99. Gibbons R et al. Adjuvant radiotherapy following radical prostatectomy: results and complications J Urol 1986 135: 65–68

    Article  CAS  PubMed  Google Scholar 

  100. Cheng W et al. Radical prostatectomy for stage C prostate cancer: influence of pathologic variables and adjuvant treatment on disease outcome Urology 1993 42: 283

    Article  CAS  PubMed  Google Scholar 

  101. Cox J et al. Consensus statements on radiation therapy on prostate cancer: guidelines for prostate re-biopsy after radiation and for radiation therapy with rising prostate-specific antigen levels after radical prostatectomy. American Society for Therapeutic Radiology and Oncology Consensus Panel J Clin Oncol 1999 17: 1155

    Article  CAS  PubMed  Google Scholar 

  102. Nudell D et al. Radiotherapy after radical prostatectomy: treatment outcomes and patterns of failure Urology 1999 54: 1049–1057

    Article  CAS  PubMed  Google Scholar 

  103. Billis A et al. Vas deferens involvement in radical prostatectomies: Prevalence and significance United States and Canadian Academy of Pathology AGM. Chicago, IL 2002 Abstract 647 155A

  104. Cadeddu JA et al. Long-term results for radiation for prostate cancer recurrence following radical prostatectomy J Urol 1998 159: 173–177

    Article  CAS  PubMed  Google Scholar 

  105. Bolla M et al. Improved survival in patients with locally advanced prostate cancer treated with radiotherapy and goserelin New Engl J Med 1997 337: 295–300

    Article  CAS  PubMed  Google Scholar 

  106. Petrovich Z et al. Comparisons of outcomes of radical prostatectomy with and without adjuvant pelvic irradiation in patients with pathologic stage C (T3N0) adenocarcinoma of the prostate Am J Clin Oncol 1999 22: 323–331

    Article  CAS  PubMed  Google Scholar 

  107. Fomenti SC et al. Update on impact of moderate dose of adjuvant radiation on urinary continence and sexual potency in prostate cancer patients treated with nerve sparing prostatectomy Urology (Online) 2000 56: (3) 453–458

    Article  Google Scholar 

  108. Early Breast Cancer Trialists Collaborative Group. Systemic treatment by hormonal, cytotoxic or immune therapy Lancet 1992 339: 1–15

  109. Zincke H, Utz DC, Taylor WF . Bilateral pelvic lymphadenectomy for clinical stage C prostatic carcinoma: role of adjuvant treatment for residual carcinoma and disease progression J Urol 1986 135: 1199–1205

    Article  CAS  PubMed  Google Scholar 

  110. Messing EM, Manola J, Sarodsy M, Wilding G, Crawford ED, Trump D . Immediate hormonal therapy compared with observation after radical prostatectomy and pelvic lymphadenectomy in men ith node-positive prostate cancer New Engl J Med 1999 341: (24) 1781–1788

    Article  CAS  PubMed  Google Scholar 

  111. Chay C, Smith DC . Adjuvant and neoadjuvant therapy in prostate cancer Sem Oncol 2001 28: (1) 3–12

    Article  CAS  Google Scholar 

  112. Prayer-Galetti T, Zattoni F, Capizzi A et al. Disease free survival in patients with pathological ‘C Stage’ prostate cancer at radical prostatectomy submitted to adjuvant hormonal treatment Eur Urol 2000 38: 504 (abstract 48)

    Google Scholar 

  113. Wirth M et al. Bicalutamide (Casodex) 150 mg as immediate therapy in patients with localized or locally advanced prostate cancer significantly reduces the risk of disease progression Urology 2001 58: (2) 146–151

    Article  CAS  PubMed  Google Scholar 

  114. Pound CR, Partin AW, Eisenberger MA, Chan DW, Pearson JD, Walsh PC . Natural history of progression after PSA elevation following radical prostatectomy JAMA 1999 281: (17) 1591–1597

    Article  CAS  PubMed  Google Scholar 

  115. Lawton CA et al. Updated results of the phase ??? Radiation Therapy Oncology Group (RTOG) trial 85-31 evaluating the potential benefit of androgen suppression following standard radiation therapy for unfavourable prognosis carcinoma of the prostate Int J Radiat Oncol Biol Phys 2001 49: (4) 937–946

    Article  CAS  PubMed  Google Scholar 

  116. Eulau SM et al. Effect of combined transient androgen deprivation and irradiation following radical prostatectomy Int J Radiat Oncol Biol Phys 1998 41: 735–740

    Article  CAS  PubMed  Google Scholar 

  117. Anscher MS, Prosnitz LR . Multivariate analysis of factors predicting local relapse after radical prostatectomy—possible indications for postoperative radiotherapy Int J Radiat Oncol Biol Phys 1991 21: 941–947

    Article  CAS  PubMed  Google Scholar 

  118. Meng MV, Carroll PR . Local therapy for prostate-specific antigen recurrence after definitive treatment Prostate Cancer Prostat Dis 2001 4: 1–8

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to S R J Bott.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bott, S., Kirby, R. Avoidance and management of positive surgical margins before, during and after radical prostatectomy. Prostate Cancer Prostatic Dis 5, 252–263 (2002). https://doi.org/10.1038/sj.pcan.4500612

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.pcan.4500612

Keywords

This article is cited by

Search

Quick links