Related Experiment Video
Updated: Jun 16, 2026
A New Technique for Treating Low-risk Prostate Cancer—Super Active Surveillance
Published on: November 7, 2025
Focal positive surgical margins decrease disease-free survival after radical prostatectomy even in organ-confined
Alison M Lake1, Chang He, David P Wood
1Department of Urology, University of Michigan, Ann Arbor, Michigan 48109, USA. alilake@med.umich.edu
Objectives:
To investigate the significance of focal positive margins (FPM) in prostatectomy patients. The significance of FPM after radical prostatectomy is unclear. The implication is that FPM are surgically induced, may not represent true tumor extension beyond the prostate, and thus would not affect disease-free survival (DFS).
Methods:
Data were retrospectively reviewed from 2468 patients undergoing radical prostatectomy between January 1996 and October 2008. The DFS probabilities were compared among different margin statuses (negative [NM], FPM, and extensively positive [EPM]) with the log-rank test. FPM was defined as less than/equal to 3 mm. EPM was greater than 3 mm. A multivariate Cox analysis was performed to evaluate the significance of FPM in patients with prostate cancer.
Results:
Of all patients, 2022 (82%) had NM, 344 (14%) had FPM, and 99 (4%) had EPM. Of the 1997 patients with pT2 disease, 1716 (86%) had NM, 229 (11.5%) had FPM, and 52 (2.6%) had EPM. The 10-year DFS for all patients was 84%, 64%, 38% for NM, FPM, and EPM, respectively (P < .0001). The 10-year DFS for organ-confined disease was 90%, 76%, and 53% for NM, FPM, and EPM, respectively (P < .0001). The risk of biochemical recurrence for all patients increases with worsening margin status. Margin status affects biochemical recurrence and depends on the Gleason grade on surgical pathology for all patients (P = .0005) and patients with pT2 disease (P = .0233).
Conclusions:
FPM and EPM after radical prostatectomy confer a decreased DFS even in patients with otherwise organ-confined disease.
Insights
Focal positive margins (FPM) after prostatectomy significantly decrease disease-free survival (DFS), even in organ-confined cases. This finding highlights the importance of margin status in predicting prostate cancer recurrence.
Area of Science:
- Urology
- Oncology
- Surgical Pathology
Background:
- The clinical significance of focal positive margins (FPM) after radical prostatectomy remains uncertain.
- It is hypothesized that FPM may be artifacts and not indicative of true tumor spread, thus not impacting disease-free survival (DFS).
Purpose of the Study:
- To investigate the prognostic significance of focal positive margins (FPM) in patients following radical prostatectomy.
- To determine if FPM impacts disease-free survival (DFS) in prostatectomy patients.
Main Methods:
- Retrospective review of 2468 radical prostatectomy cases (1996-2008).
- Comparison of DFS probabilities using log-rank test for negative margins (NM), FPM (≤3 mm), and extensively positive margins (EPM) (>3 mm).
- Multivariate Cox analysis to assess FPM significance in prostate cancer.
Main Results:
- FPM were identified in 14% of patients, EPM in 4%.
- 10-year DFS was significantly lower for FPM (64%) and EPM (38%) compared to NM (84%) (P < .0001).
- DFS reduction associated with positive margins persisted even in organ-confined disease, and recurrence risk correlated with margin status and Gleason grade.
Conclusions:
- Focal positive margins and extensively positive margins after radical prostatectomy are associated with decreased disease-free survival.
- These findings underscore the prognostic importance of margin status, even in cases of organ-confined prostate cancer.
