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Total Positive Margin Length as a Novel Prognostic Indicator After Radical Prostatectomy.

Takafumi Hibino1, Masashi Kato2, Toyonori Tsuzuki3

  • 1Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

International Journal of Urology : Official Journal of the Japanese Urological Association
|March 8, 2026
PubMed
Summary

Detailed analysis of positive surgical margins (PSMs) after prostatectomy improves risk prediction for biochemical recurrence (BCR). Total margin length and Gleason pattern at the margin are key factors for stratifying BCR risk in localized prostate cancer patients.

Keywords:
margins of excisionprostatectomyprostatic neoplasmsrecurrencerisk factors

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Area of Science:

  • Urology
  • Oncology
  • Pathology

Background:

  • Positive surgical margins (PSMs) after radical prostatectomy (RP) are linked to biochemical recurrence (BCR), but their prognostic impact varies.
  • Current risk stratification may not fully capture the variability in BCR risk among patients with PSMs.

Purpose of the Study:

  • To investigate if detailed analysis of margin characteristics can enhance postoperative risk stratification for BCR after RP.
  • To identify specific PSM features that are most predictive of recurrence.

Main Methods:

  • Retrospective review of 1003 patients undergoing RP without neoadjuvant/adjuvant therapy.
  • Categorization of PSMs based on total length, maximum length, primary Gleason pattern (pGP), multifocality, and location.
  • Analysis of other pathological factors including T/N stage, ISUP grade group, and intraductal carcinoma of the prostate (IDC-P).

Main Results:

  • PSMs were identified in 37.4% of patients.
  • Total PSM length and pGP at the margin were the strongest predictors of BCR.
  • A risk stratification model using total PSM length (>5 mm) and pGP4-5 at the margin effectively stratified BCR risk in organ-confined disease with PSMs.

Conclusions:

  • A risk classification incorporating total PSM length and pGP at the margin significantly improves postoperative prognostic stratification for localized prostate cancer with PSMs.
  • Total PSM length may be more informative than maximum PSM length for predicting BCR in cases with multiple PSMs.