Harvard Perspectives on Prostate Disease

Positive surgical margins following radical prostatectomy

Three Harvard physicians explain what this pathological finding means and what patients should consider next

For some men, what they hope will be the end of their prostate cancer story turns out to be just an early chapter: with the radical prostatectomy complete, they head home from the hospital believing they have been cured, only to learn that some cancer may have been left behind. Today, about 10% to 20% of patients who have their prostate surgically removed receive this news.

Performing a prostatectomy requires a delicate balancing act. The surgeon aims to cut out the gland and enough surrounding tissue to completely remove the cancer yet leave enough of the nerves in the surrounding tissue to preserve erectile function. To the naked eye, it can look as if all of the cancer has been removed, but when a pathologist examines tissue samples, cancer cells may be lurking right along the edge of the cut tissue. This means that some cancer cells may have been left behind, in what doctors and pathologists term a positive surgical margin.

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