Positive surgical margins: the argument for androgen deprivation and chemotherapy

Management of patients with positive surgical margins after radical prostatectomy is a complex and debatable issue. It is clear, however, that many of these patients have high-risk disease characteristics. Because of a significant risk of relapse, patients with positive surgical margins and high-risk disease characteristics should be offered the option of participating in clinical trials evaluating the role of adjuvant therapy. A distinction between the concepts of adjuvant versus salvage therapy is made and the rationale for the use of androgen deprivation therapy, chemotherapy, or a combination in the adjuvant setting is discussed in the context of the on-going phase III trials in the United States.