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To the Editor: Dr Stephenson and colleagues¹ reported a 45% 4-year progression-free probability of isolated biochemical recurrence after radical prostatectomy at a median follow-up of 45-months following salvage radiotherapy. Although we concur with the authors that salvage radiotherapy may alter the natural history of prostate cancer in many men with isolated recurrence of prostate-specific antigen (PSA), we disagree with Dr Anscher's conclusion, in his accompanying Editorial,² that all men with positive surgical margins should receive adjuvant therapy.

The true status of surgical margins depends on the manner in which the specimen is handled. Indeed, this appears to be a weakness of the study of Stephenson et al, in which 5 institutions separately processed prostatectomy specimens. Positive margin rates vary from 26% when 4- to 5-mm sections are assessed to 46% when 2- to 3-mm step sections are used.³ The basis of any argument for empirical treatment of the surgical margin . . . [Full Text of this Article]

John F. Ward, MD
jfward@mar.med.navy.mil
Department of Urologic Oncology
Naval Medical Center
Portsmouth, Va

Michael L. Blute, MD
Department of Urology
Mayo Clinic
Rochester, Minn

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