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What Prostate Surgery Margins Can Tell Us About Cancer Coming Back

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What Prostate Surgery Margins Can Tell Us About Cancer Coming Back

After prostate cancer surgery, doctors check the removed tissue to see if cancer cells were found at the edge—this is called a positive surgical margin (PSM). But not all PSMs are the same. A new study looked at how the size of the margin and the aggressiveness of the cancer at the edge (called Gleason score) affect the chances of cancer returning.

The study included over 2,600 men who had robot-assisted prostate surgery in Europe. About 1 in 3 had a positive margin. Some had only a small area (focal), and others had a larger one (extensive). Doctors also looked at the Gleason score at the margin, which ranges from low (3) to high (4-5).

Men with both a large margin and a high Gleason score were more likely to have early signs that the cancer might return. This included higher PSA levels after surgery and a higher chance of the cancer coming back within 3 years.

For men with small margins or lower Gleason scores, the risk was much lower—similar to men with no positive margins at all.

This research helps doctors better understand who might need extra treatment after surgery and who might not. It also helps patients feel more informed about what their pathology report means.

DOI: 10.1007/s00345-025-05806-y

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