Positive surgical margins after prostate surgery: what should we care about?

The authors determined how positive surgical margins increased the risk of prostate cancer return in patients following prostate surgery.

Prostate surgery is a common treatment in prostate cancer that involves surgically removing the prostate gland. Surgical margin refers to the visible normal tissue that is also surgically removed along with the tumor. It is used to determine whether the cancer has been fully removed from the tumor site after surgery. This is carried out by taking tissue samples from the tumor site for analysis. Positive surgical margins (PSMs) indicate that some cancer cells have been left behind at the tumor site following surgery.

Patients with PSMs have an increased risk of experiencing biochemical recurrence. This is an increase in prostate specific antigen (PSA) indicating the presence or return of prostate cancer. PSA is a protein elevated in the blood when prostate cancer is present.

Further studies are needed to determine how PSMs can increase the risk of biochemical recurrence. 

The aim of this study was to determine how PSMs could increase the risk of biochemical recurrence in patients following prostate surgery.

Data from 110 patients with PSMs were analyzed in this study. None of the patients received additional treatment or hormone therapy following surgery. The average follow-up time was 72 months.

The biochemical recurrence rate was 30%. The 5-year biochemical recurrence-free survival (patients who did not experience biochemical recurrence after treatment) was 83.9%.

Patients who had large tumor volumes (size and length of tumor) had over 4 times increased risk of experiencing biochemical recurrence. Patients who had high PSMs (large amount of cancer tissue left at the tumor site following surgery) had over 4 times increased risk of experiencing biochemical recurrence. 

The authors concluded that biochemical recurrence only occurred in one third of patients with PSMs following treatment and that postponing further treatment should be considered in patients with undetectable PSA and PSMs after surgery. 

Determination of PSMs depends on the technical expertise of the medical staff. So the results could have been biased.