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Stephan L. Werner, M.D., F.A.C.S.
Positive Margins means that there are cancer cells at the edge of tissue that has been removed. This can only be seen under the microscope, after the surgery. Positive margins occur about 25-35% of the time after non-nerve sparing radical prostatectomies and 35-45% of the time in nerve sparing radical prostatectomies. Positive margins mean the chance of the cancer recurring in the surgical area is significantly greater than if the margins are negative. There has been great controversy among urologists as to the treatment of positive margins. It is important to discuss with your urologist how extensive the positive margins are, and what is to be done about them. Recent research studies have shown that early institution of long term hormonal therapy in high risk patients, such as those with positive margins, will increase survival and probably decrease the frequency of recurrence. Some major university centers recommend no further treatment unless the margins are strongly positive, others recommend more aggressive therapy, including local radiation therapy and or institution of hormonal therapy. Some factors to consider are: the extent of the positive margins, extension into the seminal vesicles, the Gleason grade of the cancer, the PSA before and after surgery, the desire of the patient to "do everything" to cure the cancer and the willingness of the patient to accept potentially increased complications such as incontinence and impotence to optimize the treatment.
Hormonal therapy for several years or indefinitely reduces the frequency of, and increases the time to local recurrence of cancer, and appears to increase survival significantly in patients with intermediate and high risk disease. Observation, or simple follow-up examinations two to four times a year, may be a reasonable alternative in patients with minimally positive margins, low Gleason grade, and a preoperative PSA of less than 10, or a post operative PSA less than 0.1, or patients who do not wish more aggressive therapy. External Beam Radiation to the prostate bed starting within 90 days of surgery has been shown to decrease the local recurrence rate. Combined External Beam Radiation plus hormone therapy may be the best treatment for patients with strongly positive margins. Treatment of local or distant recurrence of prostate cancer Stephan Werner, M.D., F.A.C.S. Rev:09/04 [ Back] |
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[Home] Werner - Francis Urology Associates llc - Mid Atlantic Urology Associates llc Greenbelt - Bowie - Laurel Maryland (301) 441-8900 Fax (301) 982 0453 7500 Hanover Parkway Suite 206 Greenbelt, MD 20770
Rev:03/08 |