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Multicenter Study
. 2025 Aug 10;43(1):481.
doi: 10.1007/s00345-025-05806-y.

The perks of combining extension and Gleason score of positive surgical margins after robot-assisted radical prostatectomy

Stefano Tappero  1 , Daniele Amparore  2 , Mike Wenzel  3 , Riccardo Campi  4   5 , Francesco Barletta  6   7 , Umberto Anceschi  8 , Francesco Prata  9   10 , Edoardo Dibilio  11   4   5 , Federico Piramide  2 , Ofir Maltzman  11 , Cristina Cano Garcia  3 , Marco Colombo  11   2 , Alfredo Travino  10 , Mariavittoria Vescovo  12 , Sabrina De Cillis  2 , Carolin Siech  3 , Alberto Caviglia  11 , Lorenzo Masieri  4   5 , Rossella Nicoletti  4   5 , Philipp Mandel  3 , Cristian Fiori  2 , Giuseppe Simone  8 , Rocco Papalia  9   10 , Felix K H Chun  3 , Sergio Serni  4   5 , Francesco Porpiglia  2 , Antonio Galfano  11 , Paolo Dell'Oglio  11   13   14
Affiliations
Multicenter Study

The perks of combining extension and Gleason score of positive surgical margins after robot-assisted radical prostatectomy

Stefano Tappero et al. World J Urol. .

Abstract

Background: The role of positive surgical margins' (PSM) features in terms of cancer control outcomes is unclear. We aimed to test the association between PSM extension combined to highest Gleason score (GS) at margin and PSA persistence, biochemical recurrence (BCR) and clinical recurrence (CR) in prostate cancer (PCa) patients undergone robot-assisted radical prostatectomy (RARP).

Materials and methods: 2617 PCa patients treated with RARP at six European centers were stratified according to the PSM status and features, as follows): (a) negative SM; (b) focal PSM-GS 3; (c) extensive PSM-GS 3; (d) focal PSM-GS 4-5; (d) extensive PSM-GS 4-5. Multivariable logistic regression models addressed PSA persistence. Kaplan-Meier plots and multivariable Cox regression models addressed BCR and CR according to PSM status and features. Sensitivity analyses in patients with and without adverse pathological features were performed.

Results: Overall, 790 (30%) patients harbored PSM, 31% with GS 3 and 69% with GS 4-5, whereas 51% were focal and 49% were extensive. PSA persistence was independently predicted by "focal and extensive PSM-GS 4-5" combinations (odds ratios 1.57 and 2.17, respectively). BCR free survival at 36 months was 92 vs. 82% in respectively NSM and PSM patients. Only "extensive PSM-GS 4-5" combination was independently associated with BCR (hazard ratio [HR] 2.53). CR free survival at 36 months was 95 vs. 91% in respectively NSM and PSM patients. Only "extensive PSM-GS 4-5" combination was independently associated with CR (HR 1.45).

Conclusions: PCa patients harboring "extensive PSM-GS 4-5" combination at final pathology have worse oncological outcomes compared to their NSM counterparts or PSM patients with less unfavorable PSM features. These findings may help to improve patients counselling, especially in case of additional treatments' decision making.

Keywords: Biochemical recurrence; Clinical recurrence; Positive surgical margins; Prostate cancer; Radical prostatectomy.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that there is no conflict of interests. Approval of the research protocol by an institutional reviewer board: Due to the anonymously coded design of the exploited database, study-specific Institutional Review Board ethics approval was not required. Registry and the registration no. of the study/trial: Not applicable. Animal studies: Not applicable. Patient consent statement, permission to reproduce material from other sources and clinical trial registration: Not applicable.

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