So based on the NE Journal Med study, what would you have done?

Hi Bluebird,

Before surgery, a doctor cannot say there are positive margins unless he is also saying that the cancer has escaped the capsule into the bladder neck, urethra, seminal vesicles or even the prostate bed. He might, however, say that there is a chance of positive margins after surgery, which could be based on the position of the cancer, such as in the apex of the prostate.

To perform surgery on someone whose cancer has spread beyond the prostate is not the norm. To perform surgery on someone very likely to have positive margins afterward should not be advised as well. In either case, radiation will usually be required, so the surgery will have been a waste of time and money, while inflicting erectile dysfunction and urinary troubles needlessly. Some surgeons will make the argument that even in such cases, they are debulking the tumor, making what remains easier to treat. I personally wonder if they might instead have in mind debulking somebody's wallet.

I think asking a urologist his rate of positive margins is a good way to tell a surgeon's skill. Ten percent or less marks an excellent surgeon. Why would anyone settle for less? By the way, one famous surgeon at a major hospital used this very criteria to judge the skill of his surgeons. Just wish I could remember his name.

Best of luck, from one who ended up with positive margins.

Nellie