Predictors of Biochemical Recurrence in Patients with Positive Surgical Margin After Radical Prostatectomy

Objective: To investigate the predictors of biochemical recurrence (BCR) in patients with positive surgical margins (PSMs) after radical prostatectomy (RP).

Methods: The data of patients who underwent open RP between 2003 and 2011 were reviewed. Only patients with PSM and negative lymph node invasion were considered for further analysis. Multivariable Cox regression analysis was performed to evaluate the correlation between clinicopathologic criteria and BCR.

Results: Out of 116 patients, 80 (69%) developed BCR with a median (interquartile range [IQR]) time to recurrence of 19 (9-50) months. Median (IQR) time of follow-up in non-recurrent patients was 121 (47-148) months. The 5- and 10-year BCR-free survival  rates were 43% and 28%, respectively. Complete data regarding margin parameters were available only for 98 patients, of which 71 (72%) developed BCR. Univariable analysis demonstrated that prostate volume (PV) (HR 0.97, 95% CI 0.95-0.99, P = .005), highest Gleason grade (GG) at the margin (HR 1.73, 95% CI: 1-2.83, P = .028 for GG 4-5 vs. 3), tumor GG group 2 (HR [Hazard Ratio] 2, 95% CI 1.09-3.94, P = .025) and 4-5 (HR 2.34, 95% CI 1-4.98, P = .028) were significant predictors of BCR. In multivariable analysis, only PV remained an independent predictor of BCR (HR 0.98, 95% CI 0.96-0.99, P = .03).

Conclusion: In patients with PSM after RP, smaller prostates have a higher probability of BCR. Further studies are needed to investigate this association. The highest GG at the margin has important predictive accuracy and should be reported in the pathol ogy report.

Cite this article as: Mahmuod O, Al-Nader M, Grevendieck A, et al. Predictors of biochemical recurrence in patients with positive surgical margin after radical prostatectomy. Urol Res Pract. 2025;51(5):198-202.