Treatment of the positive surgical margin following radical prostatectomy

OBJECTIVE: With increased incidence of prostate cancer and an increased number of patients undergoing radical prostatectomy in China, it will be necessary to elaborate the diagnosis, clinical significance and treatment of patients whose tumors have positive surgical margins following radical prostatectomy. DATA SOURCES: Positive surgical margin, prostate cancer and radical prostatectomy were used as subject words and the medical literature in recent decades was searched using the PubMed database and the results are summarized. STUDY SELECTION: Using positive surgical margin, prostate cancer and radical prostatectomy as subject words the PubMed medical database produced 275 papers of pertinent literature. By further screening 28 papers were selected and they represent relatively large-scale clinical randomized and controlled clinical trials. RESULTS: A pertinent literature of 275 papers was identified and 28 papers on large clinical studies were obtained. Analysis of results indicated that the positive rate of surgical margin after radical prostatectomy is 20%-40%, and although most patients with positive surgical margins are stable for a considerable period, the data available now suggested that the presence of a positive surgical margin will have an impact on the patient's prognosis. The risk factors of positive surgical margin include preoperative prostate specific antigen level, Gleason's score and pelvic lymph node metastasis. The most common site with positive surgical margin is in apical areas of the prostate; therefore surgical technique is also a factor resulting in positive surgical margins. From data available now it appears that as long as the surgical technique is skilled, different surgical modes do not affect the rate of surgical margin. Adjuvant radiotherapy is mainly used to treat patients with positive surgical margin after radical prostatectomy, but combination with androgen deprivation therapy may increase the curative effect. CONCLUSION: The current data indicated that the presence of positive surgical margins can markedly affect the patient's prognosis. Therefore we should be aware how we reduce the positive surgical margin, how to diagnose positive surgical margin and how to treat when there are positive surgical margins.