Positive margins after radical prostatectomy: correlation with local recurrence and distant progression

The impact of positive and negative surgical margins of resection on the interval to and incidence of progression was analysed in 172 patients after radical retropubic prostatectomy combined with lymphadenectomy; 56 had positive margins. Lateral and apical positive margins were evaluated separately. The status of surgical margins was correlated with other prognostic factors, such as the T category, the presence or absence of seminal vesicle invasion and the G category. This analysis showed that positive and negative margins significantly influenced time to progression independently of the other prognostic factors. Positive margins at the apex contrary to lateral margins did not significantly influence time to progression. This may be due to the definition of the status of apical margins used in this analysis. A total of 108 patients underwent a nerve-sparing radical prostatectomy, which did not lead to a higher incidence of positive margins than the standard procedure. Prostate specific antigen accurately predicted tumour recurrence after radical prostatectomy. A rise of > or = 1.0 ng/ml preceded other evidence of recurrence by a mean of 11 months.