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Objective-To evaluate the role of combination of endorectal coil and external multicoil array MRI in the management of prostate cancer and predicting the surgical margin status in a single surgical practice.Materials and Methods-We reviewed all patients referred by a single surgeon from January 1993 to May 2002 for staging prostate MRI prior to selecting treatment. All MRI examinations were performed using 1.5T (Signa; GE Medical Systems) with a combination of endorectal and pelvic multi-coil array. The tumor size, stage and total gland volume on MR, PSA and Gleason grade were all compared with the pathological stage and diagnosis of positive surgical margin (PSM).Result-A total of 232 patients were evaluated, of which 110 underwent radical prostatectomy all performed by one surgeon (Group 1), and 122 did not (Group 2). The results showed MRI stage, PSA and age, all significantly different (P<0.001). In Group 1, the results showed a high specificity (99%) and accuracy (91%) of the MRI staging T3. Post-surgical follow up (median 4.5 years) showed 90% of men had PSA levels below 0.1ng/ml. The positive surgical margin (PSM) rate was 16%. There was no significant difference found on MR imaging between PSM group and non-PSM group. A single tumor length above 1.8cm was the cut point above which there was PSM (P=0.002).Conclusion-In conclusion, the combined use of clinical data and endorectal MR imaging can help optimize patient management and selection for surgery, and in a single surgeon's practice lead to successful outcomes.