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Assessment of Local and Metastatic Recurrence Following Robot-Assisted Radical Prostatectomy by Margin Status Using

Thomas Edward Ahlering1, Yeagyeong Hwang1, Michael Matthew Lee1

  • 1Department of Urology, University of California, Irvine Medical Center, Orange, CA 92868, USA.

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|January 10, 2026
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Summary

Local recurrence rates after prostatectomy are similar regardless of positive surgical margins (PSMs). Findings suggest recurrence is linked to metastatic spread rather than incomplete resection, questioning aggressive surgical approaches.

Keywords:
PSMA PET/CTlocal neoplasm recurrencemetastatic prostate cancerradical prostatectomysurgical resection

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Area of Science:

  • Urology
  • Oncology
  • Radiology

Background:

  • Radical prostatectomy (RP) for prostate cancer can lead to local recurrences, often attributed to positive surgical margins (PSMs).
  • However, many men with PSMs do not experience biochemical recurrence (BCR), indicating other factors influence outcomes.
  • Prostate-specific membrane antigen positron emission tomography (PSMA PET) scans help detect recurrence sites.

Purpose of the Study:

  • To investigate the relationship between surgical margin status (negative vs. positive) and the risk and location of local and metastatic recurrences.
  • To evaluate the predictive value of margin status for local recurrence following radical prostatectomy using PSMA PET imaging.

Main Methods:

  • Retrospective analysis of prospectively collected data from 159 men who underwent radical prostatectomy with BCR and subsequent PSMA PET scans (2017-2023).
  • Comparison of recurrence risk and location between men with negative surgical margins (NSMs) and positive surgical margins (PSMs).
  • Inclusion of 13 equivocal PSMA PET findings, analyzed first as positive and then as negative to assess impact.

Main Results:

  • No significant difference in the risk of positive PSMA PET scans between NSM (73%) and PSM (69%) groups (p=0.56).
  • Local recurrence rates were similar for NSM (39.2%) and PSM (45%) groups (p=0.55).
  • Lymph node and bone lesion recurrence rates also did not differ significantly between the groups; margin status was not a predictor of local recurrence.

Conclusions:

  • Local recurrence rates after radical prostatectomy are independent of surgical margin status.
  • Findings suggest local recurrences are more associated with metastatic dissemination than incomplete resection.
  • These results challenge the oncologic rationale for aggressive surgical margins if it compromises functional outcomes.