Prognostic impact of positive surgical margins in surgically treated prostate cancer: Multi-institutional assessment of 5831 patients



      To assess the prognostic significance of a positive surgical margin in the radical prostatectomy specimen, and to test for the presence of statistically significant interactions between surgical margin status and select pathologic stage variables.


      We combined prospectively collected data from 7816 consecutive patients treated with radical prostatectomy at eight institutions. The pretreatment serum prostate-specific antigen level, pathologic Gleason sum, surgical margin status (positive versus negative), presence of extracapsular extension, seminal vesicle involvement, and pelvic lymph node status were examined as predictors of the rate of biochemical progression in 5831 patients with complete records.


      In multivariate Cox regression models, a positive surgical margin was associated with a 3.7-fold greater risk of progression (P = 0.001). Moreover, a statistically significant interaction was found between surgical margin status and Gleason sum 7 to 10 (P = 0.008) and lymph node invasion (P <0.001).


      The presence of a positive surgical margin in the radical prostatectomy specimen has an adverse effect on prognosis. The greatest risk of biochemical recurrence may be expected if a positive surgical margin is present with Gleason sum 7 to 10 disease or lymph node invasion.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Zincke H.
        • Oesterling J.E.
        • Blute M.L.
        • et al.
        Long-term (15 years) results after radical prostatectomy for clinically localized (stage T2c or lower) prostate cancer.
        J Urol. 1994; 152: 1850-1857
        • Eastham J.A.
        • Kattan M.W.
        • Riedel E.
        • et al.
        Variation among individual surgeons in the rate of positive surgical margins in radical prostatectomy specimens.
        J Urol. 2003; 170: 2292-2295
        • Wieder J.A.
        • Soloway M.S.
        Incidence, etiology, location, prevention, and treatment of positive surgical margins after radical prostatectomy for prostate cancer.
        J Urol. 1998; 160: 299-315
        • Catalona W.J.
        • Smith D.S.
        5-year tumor recurrence rates after anatomic radical retropubic prostatectomy for prostate cancer.
        J Urol. 1994; 152: 1837-1842
        • Blute M.L.
        • Bostwick D.G.
        • Bergstralh E.J.
        • et al.
        Anatomic site-specific positive margins in organ-confined prostate cancer and its impact on outcome after radical prostatectomy.
        Urology. 1997; 50: 733-739
        • Paulson D.F.
        • Stone A.R.
        • Walther P.J.
        • et al.
        Radical prostatectomy.
        J Urol. 1986; 136: 1041-1043
        • Paulson D.F.
        • Moul J.W.
        • Walther P.J.
        Radical prostatectomy for clinical stage T1-2N0M0 prostatic adenocarcinoma.
        J Urol. 1990; 144: 1180-1184
        • Smith R.C.
        • Partin A.W.
        • Epstein J.I.
        • et al.
        Extended follow-up of the influence of wide excision of the neurovascular bundle(s) on prognosis in men with clinically localized prostate cancer and extensive capsular perforation.
        J Urol. 1996; 156: 454-458
        • Watson R.B.
        • Civantos F.
        • Soloway M.S.
        Positive surgical margins with radical prostatectomy.
        Urology. 1996; 48: 80-90
        • Weldon V.E.
        • Tavel F.R.
        • Neuwirth H.
        • et al.
        Patterns of positive specimen margins and detectable prostate specific antigen after radical perineal prostatectomy.
        J Urol. 1995; 153: 1565-1569
        • Ohori M.
        • Wheeler T.M.
        • Kattan M.W.
        • et al.
        Prognostic significance of positive surgical margins in radical prostatectomy specimens.
        J Urol. 1995; 154: 1818-1824
        • Stamey T.A.
        • McNeal J.E.
        • Yemoto C.
        • et al.
        Biological determinants of cancer progression in men with prostate cancer.
        JAMA. 1999; 281: 1395-1400
        • Graefen M.
        • Noldus J.
        • Pichlmeier U.
        • et al.
        Early prostate-specific antigen relapse after radical retropubic prostatectomy.
        Eur Urol. 1999; 361: 21-30
        • Hull G.W.
        • Farhang R.
        • Farhat A.
        • et al.
        Cancer control with radical prostatectomy alone in 1,000 consecutive patients.
        J Urol. 2002; 167: 528-534
        • Cheng L.
        • Darson M.F.
        • Bergstralh E.J.
        • et al.
        Correlation of margin status and extraprostatic extension with progression of prostate carcinoma.
        Cancer. 1999; 86: 1775-1782
        • Wheeler T.M.
        • Dillioglugil O.
        • Kattan M.W.
        • et al.
        Clinical and pathological significance of the level and extent of capsular invasion in clinical stage T1-2 prostate cancer.
        Hum Pathol. 1998; 29: 856-862
        • Epstein J.I.
        • Carmichael M.J.
        • Pizov G.
        • et al.
        Influence of capsular penetration on progression following radical prostatectomy.
        J Urol. 1993; 150: 135-141
        • Hollenbeck B.K.
        • Nader B.
        • Wei J.T.
        • et al.
        Whole mounted radical prostatectomy specimens do not increase detection of adverse pathological features.
        J Urol. 2000; 164: 1583-1586
        • Obek C.
        • Sadek S.
        • Lai S.
        • et al.
        Positive surgical margins with radical retropubic prostatectomy.
        Urology. 1999; 54: 682-688