Positive Surgical Margins After Radical Retropubic Prostatectomy: The Influence of Site and Number on Progression

Abstract

In patients with localized prostate cancer and positive surgical margins biochemical progression is not dictated by the specific location of a positive margin. However, multiple positive margins are associated with a significantly increased risk of biochemical recurrence. Longer followup and larger sample size are necessary to confirm these findings.

Assessment of low prostate weight as a determinant of a higher positive margin rate after laparoscopic radical prostatectomy: a prospective pathologic study of 1,500 cases

“…The positive margin rate in the current study was lower than some and similar to or slightly higher than other reported positive margin rates of radical retropubic prostatectomy [2,4,6,7,[16][17][18][19][20][21][22][23][24] and laparoscopic radical prostatectomy [20,23,[25][26][27] (Table 7). The most important determinants of positive margin rate are tumor stage and Gleason score.…”

“…The risk of cancer recurrence increases significantly with positive margins, independent of pathologic grade and PSA levels [4,5]. The risk of progression at 5 years is approximately 50-60%, with 20% of cases experiencing local recurrence [6,7].…”

Intrafascial Dissection Significantly Increases Positive Surgical Margin and Biochemical Recurrence Rates after Robotic-Assisted Radical Prostatectomy

“…As commonly observed, in this series most of the positive margins in pT2 disease were located at the prostatic apex, where the different fascial layers become less distinctive and are often mixed with skeletal muscle of the sphincter [26,27]. This distribution of PSMs is even more prominent if INS is performed.…”

Presence and Number of Positive Surgical Margins after Radical Prostatectomy for Prostate Cancer: Effect on Oncological Outcome in a Population-Based Cohort

“…Treatment failure risk was significantly higher in patients with multiple PSM compared to those with a single PSM, unlike findings of some others [15]. Sub-classification into locations of PSM showed that different locations of PSM (apical and non-apical) led to comparable risk of treatment failure, a finding supported by some studies [16,17] but refuted by others [12]. Although apical PSM do not reflect higher treatment failure risks, it still is the most frequent site of PSM, as found in the current study as well as others.…”