Cancer cells left behind: Even close surgical margins increase the risk of recurrence

This study investigated the risk of disease recurrence after prostate surgery based on surgical margins. Authors reported an increased risk of disease recurrence among men with close surgical margins.

Removal of the prostate gland is a common treatment of localized (confined) prostate cancer. Prostate surgery is generally associated with good treatment effectiveness. Surgical margins (the edges of the removed tissue) can be used to predict the likelihood of disease recurrence after surgery. When the margins are positive, it means that they show cancer cells. Positive surgical margins are associated with an increased likelihood of disease recurrence after prostate surgery. Close margins (tumor extending within 0.1 mm of the margin without reaching it) are usually considered negative. However, it has been argued that close margins may also increase the likelihood of disease recurrence. 

This study aimed to examine the link between close surgical margins and disease recurrence. The records of 1,588 men who underwent surgery for localized prostate cancer were analyzed. Patients were followed for an average of 25 months.

18.8% of men had positive surgical margins after surgery. Close surgical margins were identified in 15% of men. Positive or close surgical margins were more common among men with higher tumor stage, more aggressive cancer cells, and elevated prostate specific antigen levels in the blood (PSA, indicator of prostate growth) before surgery.

Overall, 12.5% of men experienced disease recurrence during the study period. Men with close surgical margins were 53% more likely to show disease recurrence compared to men with negative surgical margins. The risk increased to 71% for patients monitored for more than 2 years. No significant differences in recurrence rates were observed between positive and close surgical margins.

Authors concluded that close surgical margins are associated with an increased risk of disease recurrence after surgery. Additional local therapy after surgery should be offered in such cases.