Objective: A treatment dilemma exists when finding positive surgical margins after radical prostatectomy. Our aim is to better understand the effect of positive surgical margins (PSM) on biochemical recurrence and differences between delayed vs immediate treatment after radical prostatectomy.Materials and Methods: Records for patients who underwent radical prostatectomy for prostate cancer from 2000-2010 were identified and analyzed in our local registry.Results: 468 patients underwent radical prostatectomy. 56 subjects were found to have a PSM (12%). 51 patients chose surveillance. With a mean follow-up of 61 months, 38 patients (75%) remained cancer free. Overall, 13 patients developed biochemical recurrence (PSA > 0.2). 6 patients underwent salvage external beam radiation (XRT) and continue to do well. Conclusion:Despite positive surgical margins, 75% of men remained cancer free at 5 years with no adjuvant radiation. Undergoing salvage XRT when biochemical recurrence occurs offers patients an opportunity to avoid radiation and have acceptable outcomes.3