Post-radical prostatectomy management options for positive surgical margins: Argument for observation

The screening zeal for prostate cancer in the PSA era resulted in and continues to produce an unprecedented number of men who have clinically localized prostate cancer seeking radical prostatectomy. Even before the advent of robotic laparoscopic-assisted radical prostatectomy (RALP), the topic of positive margins was hot. However, now it is even more contested in the era of the “RALP learning curve”, the era of “The role of the experienced surgeon,” and the era of the “well-informed Internet-savvy patient.” The typical modern-era man with localized prostate cancer has very high expectations. He may be a younger Baby-Boomer who has been used to getting things his way and has been raised in a consumer-driven society. He is diagnosed with prostate cancer and his knowledge-seeking behavior then may be analogous to “finding religion.” He, and/or his family, seeks “the best” surgeon and “the best” method of surgery, and he is expecting the trifecta outcome of cure, continence, and potency. The first episode to potentially deflate his sails is when the surgical pathology report returns and shows a positive margin.