Illustration of a prostate gland with light networks symbolizing cancer cells and a hopeful path to recovery.

Positive Surgical Margins After Prostatectomy: What You Need to Know

Soraya Malik in Health & Wellness December 2025 • 4 min read.

"Understanding the impact of positive surgical margins on prostate cancer outcomes and how to navigate treatment options."

A prostatectomy, the surgical removal of the prostate, is a common treatment for localized prostate cancer. If the pathology report reveals cancer cells at the edge of the removed tissue, it's called a 'positive surgical margin' (PSM). This finding can be unsettling, but it's important to understand what it signifies for your long-term health.

It's crucial to remember that a PSM doesn't automatically mean cancer will return or progress. Many individuals with PSMs do not experience recurrence. The relationship between PSMs and outcomes is complex, influenced by other factors like Gleason score, pathological stage, and the amount of cancer present.

This article breaks down the complexities surrounding positive surgical margins. We'll explore what PSMs mean for your prognosis, discuss factors that influence recurrence risk, and review available treatment options to help you make informed decisions.

Decoding Positive Surgical Margins: What Does It Really Mean?

Illustration of a prostate gland with light networks symbolizing cancer cells and a hopeful path to recovery.

When a prostatectomy is performed, the goal is to remove the entire cancerous tumor. After surgery, a pathologist examines the tissue to ensure all cancer cells have been removed. If cancer cells are found at the edge of the removed tissue, this indicates that some cancer may have been left behind.

The impact of PSMs isn't uniform. Several factors determine how much a PSM influences your long-term outcome. These factors help doctors determine the best course of action.

Gleason Score: A higher Gleason score indicates a more aggressive cancer, increasing the likelihood of recurrence.
Pathological Stage: More advanced stages (where cancer has spread beyond the prostate) are associated with a higher risk.
Tumor Volume: A larger amount of cancer in the specimen can increase the risk of recurrence, even with PSMs.
Location of PSM: The location of the PSM on the prostate can impact risk. Some locations are associated with higher recurrence rates.
Number of PSMs: Having multiple positive margins may suggest a higher overall tumor burden and a greater risk of recurrence.

Research indicates that while PSMs are associated with a higher risk of biochemical recurrence (BCR) – a rise in PSA levels suggesting cancer cells may be present – many men with PSMs never experience BCR. The original study found that only 37.8% of patients with PSMs experienced BCR.

Navigating Your Path Forward

Receiving news of a positive surgical margin can be worrying, but remember that it's just one piece of the puzzle. Work closely with your oncology team to assess your individual risk factors, discuss treatment options, and develop a personalized plan. Open communication, proactive monitoring, and a focus on overall well-being will empower you to navigate your path forward with confidence.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1590/s1677-5538.ibju.2014.03.03, Alternate LINK

Title: Radical Prostatectomy And Positive Surgical Margins: Relationship With Prostate Cancer Outcome

Subject: Urology

Journal: International braz j urol

Publisher: FapUNIFESP (SciELO)

Authors: Ricardo L. R. Felts De La Roca, Isabela Werneck Da Cunha, Stephania Martins Bezerra, Francisco Paulo Da Fonseca

Published: 2014-06-01

Everything You Need To Know

What does a 'positive surgical margin' actually mean?

A 'positive surgical margin' (PSM) after a prostatectomy means that cancer cells were found at the edge of the tissue removed during the surgery. This finding suggests that some cancer cells may have been left behind in the patient's body. The presence of PSMs is an important factor to consider when evaluating a patient's prognosis and planning further treatment, as it indicates a potential risk of cancer recurrence.

What are the main factors that determine the impact of 'positive surgical margins'?

Several factors influence the impact of a 'positive surgical margin' on a patient's long-term outcome. These include the Gleason score, which indicates the aggressiveness of the cancer; the pathological stage, reflecting how far the cancer has spread; the tumor volume, or the amount of cancer present; the location of the PSM on the prostate, and the number of PSMs. The interplay of these factors helps doctors determine the likelihood of recurrence and tailor the best course of action for each individual.

Why is the Gleason score important in the context of 'positive surgical margins'?

The Gleason score plays a vital role because it indicates the aggressiveness of the prostate cancer. A higher Gleason score suggests a more aggressive cancer that is more likely to recur after a prostatectomy, especially if 'positive surgical margins' (PSMs) are also present. The score, determined by a pathologist, helps doctors assess the cancer's potential for growth and spread, informing treatment decisions.

How can a 'positive surgical margin' affect my prognosis after a prostatectomy?

After a prostatectomy, a 'positive surgical margin' (PSM) can affect your prognosis by increasing the risk of biochemical recurrence (BCR), which is a rise in PSA levels indicating the possible presence of cancer cells. However, having a PSM doesn't guarantee the cancer will return; the risk is influenced by multiple factors, including the Gleason score and the pathological stage. Patients with PSMs should be monitored closely.

What is the purpose of a prostatectomy, and what does it mean if the margins are 'positive'?

A prostatectomy involves surgically removing the entire prostate gland to treat localized prostate cancer. When the pathology report reveals 'positive surgical margins' (PSMs), it means cancer cells were found at the edge of the removed tissue. The goal of the procedure is to eliminate all cancerous tissue. PSMs suggest that some cancer cells may remain, which can influence the likelihood of recurrence and the need for additional treatments. It's a critical piece of information in assessing the patient's ongoing care.