What is it about?
In a study with 1552 prostate cancer men, we found that higher percent tumor volume, rather than positive surgical margin, was the stronger predictor of dying from prostate cancer 15-years post-surgery. This challenges the central question of whether surgeons should strive for negative margins, in the effort to improve mortality, at the potential expense of urinary and sexual quality of life.
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Why is it important?
Contrary to what's been published so far, this study shows that positive surgical margins themselves do not warrant wider surgical resections that aim to reduce positive margins at the cost of urinary and sexual functions. Further, this study challenges the common belief that positive surgical margins are oncologically bad. Instead, having more tumor volume makes the underlying disease more aggressive and responsible for increased mortality.
Perspectives
The problem with prostate cancer is that it is the least well-understood cancer. Why do I say that? In “other cancers,” wider resections essentially always improve recurrence rates and survival. In other words, recurrences are either cured immediately, or the patient dies within 5 years. This is also the reason that when people talk about other cancers, they only talk about the 5-year survival rate. In distinction, prostate cancer is unique in that “More men will die with prostate cancer, than from it,” and long-term survival is not established until 15-25 years. The only way to improve prostate cancer survival is to detect the cancer earlier. Thinking that you can make up for the lost time with a larger resection is simply wrong. This underscores the needs to preserve urinary and sexual function. Our study shows that multiple positive surgical margins are indicative of greater volume and severity of cancer and mortality.
Thomas Ahlering
University of California, Irvine Medical Center
Read the Original
This page is a summary of: Impact of Surgical Margin Status and Tumor Volume on Mortality After Robotic Radical Prostatectomy, European Urology Open Science, January 2025, Elsevier,
DOI: 10.1016/j.euros.2024.12.004.
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