If you have not already, I strongly suggest picking up a copy of Patrick Walsh's book Surviving Prostate Cancer. It does a good job explaining all of this.
Positive Surgical Margin means that the final pathology showed the tumor extending to the edge of the specimen removed, so that some cancer was likely left behind. This is much more likely to occur (>20%) in pathological stages (not to be confused with clinical c-stage) pT3 or pT4 where the cancer actually extends beyond the prostate.
Pathologically organ-confined disease, stage pT2, is the best-case scenario which is usually assumed (cT2) but not actually known until post-op. If the patient turns out to be pT2, then a positive margin means that even though the cancer was completely confined to the prostate, the surgeon somehow did not get it all out (i.e. did not get the entire prostate out). There are reasons this happens even with the best surgeon, but you definitely want to know how often
it happens (PSM rate for pT2) for your prospective surgeon.
Dr. Walsh suggests asking these questions and basically suggests that if they can't or won't answer them well, then that is a red flag. "Urologists who don't know their own results may not realize that their technique should be better". So I think you are wise for looking for a different urologist to do you surgery!
Five of the six docs I talked to readily gave me their numbers with the one exception being William Catalona at Northwestern and for me this instantly disqualified him notwithstanding his experience (6000+ surgeries) and notoriety. Two of the top local surgeons here were 6% and 8% for pT2 disease, which are actually fairly good. By contrast however, the published PSM rate for
open surgery on over 10000 patients at Hopkins is 1.2%. I figured if I can reduce the likelihood of PSM by a factor of 6 to 8, it was well worth the minor hassle of traveling.
Post Edited (njs) : 7/5/2013 9:35:11 AM (GMT-6)