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Highest positive surgical margin predicts poor survival after prostatectomy

Key clinical point: Increased positive surgical margin was significantly associated with the poorest biochemical recurrent-free survival in prostate cancer patients after radical prostatectomy.

Major finding: Among patients with positive surgical margins (PSM), biochemical recurrence was associated with more than 2 PSM (hazard ratio 2.723), PSM length of 3mm or higher (HR 1.024) and a Gleason score of 4 or higher (HR 2.356).

Study details: The data come from a retrospective study of 150 prostate cancer patients who underwent radical prostatectomy for prostate cancer with no nodal or distant metastasis between 2010 and 2013.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.


“Positive surgical margins are associated with worse outcomes in many cancers, including prostate cancer. Previous studies have suggested that in patients who have undergone prostatectomy, positive surgical margins (PSM) are associated with biochemical recurrence (BCR). BCR is associated with a poorer prognosis. Pathologic T3a is a critical tumor stage, as disease extends outside of the prostate. Therefore, Lee et al conducted a retrospective study to determine characteristics of PSMs that may be associated with worse outcomes. In this study, more than 2 PSMs, PSM > 3 mm, and a highest margin Gleason score > 4 were associated with an increased risk of BCR. Further study is needed to determine ways to identify risk for positive margins after surgery and the optimal adjuvant treatment strategies when positive margins are found.”

Mark Klein, MD


Lee W et al. Prostate Int. 2021 Mar 9. doi: 10.1016/j.prnil.2020.12.004.