{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T04:47:14Z","timestamp":1777956434501,"version":"3.51.4"},"reference-count":0,"publisher":"Canadian Urological Association Journal","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CUAJ"],"abstract":"<jats:p>Introduction: We aimed to evaluate the prognostic significance of positive surgical margins (PSM) and associated clinicopathologic factors on long-term oncologic outcomes following robot-assisted radical prostatectomy (RARP).\nMethods: We analyzed a prospectively maintained registry of patients undergoing RARP between 2003 and 2022, stratified by surgical margin status (positive vs. negative [NSM]). Primary outcomes were overall survival (OS) and biochemical recurrence-free survival (BCRFS). Multivariable Cox regression adjusted for age, prostate-specific antigen (PSA), Gleason grade group (GGG), pathologic stage, nodal status, and adjuvant therapy. A prognostic nomogram for OS was developed in the PSM cohort.\nResults: Among 3969 patients, 459 (11.4%) had PSM, which was more common in the presence of adverse pathologic features. On unadjusted analysis, PSM was associated with worse OS (hazard ratio [HR] 1.39, 95% confidence interval [CI] 1.02\u20131.90, p=0.036) and BCRFS (HR 2.20, 95% CI 1.62\u20132.97, p&lt;0.001). After adjustment, PSM was not independently associated with OS (adjusted [a]HR 1.16, p=0.377) or BCRFS (aHR 0.86, p=0.343). In the PSM cohort, \u2265pT3a disease, node-positive status, and advanced pathologic stage were strong predictors of mortality (HRs 3.91, 3.86, and 3.62, respectively), while adjuvant radiation therapy was associated with improved survival (HR 0.46, p=0.025). The PSM-specific nomogram demonstrated time-dependent area under the curves of 0.737 (three years), 0.713 (five years), 0.774 (10 years), and 0.932 (20 years).\nConclusions: PSMs are associated with worse unadjusted outcomes, largely driven by their association with high-risk pathologic features, but are not independently prognostic after accounting for tumor biology and disease stage. A PSM-specific nomogram may support individualized postoperative risk stratification and shared decision-making, pending external validation.<\/jats:p>","DOI":"10.5489\/cuaj.9598","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T02:23:40Z","timestamp":1777947820000},"source":"Crossref","is-referenced-by-count":0,"title":["Positive surgical margins after robot-assisted radical prostatectomy"],"prefix":"10.5489","volume":"20","author":[{"given":"Kamil","family":"Malshy","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yusheng","family":"Jia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zijing","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Steidle","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denzel","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashley","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Trevor C.","family":"Hunt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victor","family":"Sandoval","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jathin","family":"Bandari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean V.","family":"Joseph","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3456","published-online":{"date-parts":[[2026,5,4]]},"container-title":["Canadian Urological Association Journal"],"original-title":[],"link":[{"URL":"https:\/\/cuaj.ca\/index.php\/journal\/article\/download\/9598\/6822","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/cuaj.ca\/index.php\/journal\/article\/download\/9598\/6836","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/cuaj.ca\/index.php\/journal\/article\/download\/9598\/6822","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T02:23:40Z","timestamp":1777947820000},"score":1,"resource":{"primary":{"URL":"https:\/\/cuaj.ca\/index.php\/journal\/article\/view\/9598"}},"subtitle":["Long-term oncologic consequences"],"short-title":[],"issued":{"date-parts":[[2026,5,4]]},"references-count":0,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5,4]]}},"URL":"https:\/\/doi.org\/10.5489\/cuaj.9598","relation":{},"ISSN":["1920-1214","1911-6470"],"issn-type":[{"value":"1920-1214","type":"electronic"},{"value":"1911-6470","type":"print"}],"subject":[],"published":{"date-parts":[[2026,5,4]]}}}