The perks of combining extension and Gleason score of positive surgical margins after robot-assisted radical prostatectomy

Stefano Tappero ¹, Daniele Amparore ², Mike Wenzel ³

¹Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy. stefano.m.tappero@gmail.com.
²Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy.
³Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany.
⁴Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
⁵Unit of Urology and Renal Transplantation, Oncology Department, Careggi University Hospital, Florence, Italy.
⁶Unit of Urology, Division of Oncology, IRCCS Ospedale San Raffaele, Milan, Italy.
⁷Vita-Salute San Raffaele University, Milan, Italy.
⁸Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
⁹Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
¹⁰Research Unit of Urology, Campus Bio-Medico University of Rome, Rome, Italy.
¹¹Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy.
¹²Operative Research Unit of Anatomical Pathology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
¹³Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
¹⁴Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.

⁰Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy. stefano.m.tappero@gmail.com.

World Journal of Urology +

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August 10, 2025

View abstract on PubMed

Summary

Extensive positive surgical margins with high Gleason scores in prostate cancer patients undergoing robot-assisted radical prostatectomy are linked to worse oncological outcomes, including PSA persistence and recurrence. These findings aid in patient counseling and treatment decisions.

Area Of Science

Urology
Oncology
Surgical Pathology

Background

The prognostic significance of positive surgical margins (PSM) features in prostate cancer (PCa) remains unclear.
This study investigates the impact of PSM extension and Gleason score (GS) on outcomes after robot-assisted radical prostatectomy (RARP).

Purpose Of The Study

To assess the association between PSM characteristics and PSA persistence, biochemical recurrence (BCR), and clinical recurrence (CR) in PCa patients.
To stratify PSM based on extension (focal/extensive) and GS (3 or 4-5).

Main Methods

Retrospective analysis of 2617 PCa patients from six European centers who underwent RARP.
Patients were categorized by PSM status and features (negative, focal/extensive GS 3, focal/extensive GS 4-5).
Statistical models (logistic regression, Cox regression) were used to evaluate PSA persistence, BCR, and CR.

Main Results

30% of patients had PSM, with 69% having GS 4-5 and 51% having focal extension.
PSA persistence was associated with focal and extensive PSM-GS 4-5 (OR 1.57-2.17).
Extensive PSM-GS 4-5 independently predicted BCR (HR 2.53) and CR (HR 1.45).

Conclusions

Prostate cancer patients with extensive positive surgical margins and high Gleason scores (GS 4-5) experience poorer oncological outcomes.
These findings are crucial for improving patient counseling and guiding decisions on adjuvant therapies.

Keywords:

Biochemical recurrence Clinical recurrence Positive surgical margins Prostate cancer Radical prostatectomy