Association of surgical margin positivity with preoperative mpMRI-identified index lesions in radical prostatectomy A retrospective study.

Introduction: Prostate cancer remains the second most common malignancy in men worldwide. Positive surgical margins (PSMs) following radical prostatectomy are associated with an increased risk of biochemical recurrence. This study investigated the relationship between preoperative multiparametric magnetic resonance imaging (mpMRI)-detected index lesions and PSMs, aiming to assess whether specific lesion locations correlate with margin involvement.

Methods: A retrospective cohort study was conducted at Health Sciences University Haseki Training and Research Hospital, analyzing 148 patients who underwent radical prostatectomy between 2017 and 2023. Patients were stratified based on surgical margin status, with comparisons made between mpMRI features, pathologic outcomes, and the anatomical distribution of PSMs. Binary logistic regression was used to identify independent predictors of PSMs.

Results: Of the 148 patients, 49 had PSMs. Higher preoperative prostate-specific antigen levels, prostate-specific antigen density, and Prostate Imaging-Reporting and Data System (PI-RADS) scores were significantly associated with PSMs. Multivariate analysis revealed that PI-RADS 5, International Society of Urological Pathology grade 4 or above, and extraprostatic extension were independent predictors of PSMs. Although lesions in the apical and posterior regions showed higher rates of PSMs, the regional differences were not statistically significant.

Conclusions: Our findings suggest that mpMRI plays a critical role in preoperative risk stratification and may guide surgical planning to reduce PSMs; however, further prospective studies are needed to validate these results and explore the potential benefits of targeted resections in high-risk regions for improving oncologic outcomes.