Margin status Reason/Evidentiary Support: A positive surgical margin (PSM) significantly reduces the likelihood of progression-free survival, including PSA recurrence-free survival, local recurrence-free survival and development of metastases

A positive surgical margin (PSM) significantly reduces the likelihood of progression-free survival, including PSA recurrence-free survival, local recurrence-free survival and development of metastases after radical prostatectomy in multivariate analysis. Moreover, positive margins are associated with a 2.6-fold increased risk of prostate cancer specific mortality. Careful inking of the outer surface of the radical prostatectomy specimen before macroscopic dissection (grossing) greatly facilitates the determination of margin status. A PSM can then be defined as cancer extending to the inked surface of the specimen, representing a site where the urologist has cut through cancer (See Fig. 5 below). PSMs are reported in between 10 – 48% of patients treated by radical prostatectomy for both organ confined and non-organ confined prostate cancer with the rates in the lower range typically found in more modern cohorts.