https://www.wileyhealthlearning.com/acs.aspx Since the dissemination of prostate‐specific antigen screening, most men with prostate cancer are now diagnosed with localized, low‐risk prostate cancer that is unlikely to be lethal. Nevertheless, nearly all of these men undergo primary treatment with surgery or radiation, placing them at risk for longstanding side effects, including erectile dysfunction and impaired urinary function. Active surveillance and other observational strategies (ie, expectant management) have produced excellent long‐term disease‐specific survival and minimal morbidity for men with prostate cancer. Despite this, expectant management remains underused for men with localized prostate cancer. In this review, various approaches to the expectant management of men with prostate cancer are summarized, including watchful waiting and active surveillance strategies. Contemporary cancer‐specific and health care quality‐of‐life outcomes are described for each of these approaches. Finally, contemporary patterns of use, potential disparities in care, and ongoing research and controversies surrounding expectant management of men with localized prostate cancer are discussed. CA Cancer J Clin 2015;65:264–282. © 2015 American Cancer Society.

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The oncologic impact of positive surgical margins after nephron-sparing surgery is controversial. Herein, we discuss current data surrounding surgical margins in the operative management of renal cell carcinoma. The prevalence, risk factors, outcomes, and subsequent management of positive surgical margins will be reviewed. Literature suggests that the prevalence of positive surgical margins following kidney surgery varies by practice setting, tumor characteristics, and operation type. For patients undergoing nephron-sparing surgery, it is not necessary to remove a margin of healthy tissue. Tumor enucleation may be appropriate and is associated with comparable outcomes. Reflexive intraoperative frozen section use does not provide beneficial information and many patients with positive margins can be monitored closely with serial imaging. The impact of positive surgical margins on recurrence and survival remains conflicting. Though every effort must be performed to obtain negative margins, a positive surgical margin appears to have a marginal impact on recurrence and survival.

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