Purpose-Positive surgical margins (PSM) in men undergoing radical prostatectomy (RP) for prostate cancer (PCa) are associated with an increased risk of biochemical recurrence. Little data have evaluated the role of PSM in PCa-specific mortality (PCSM). Using a large, populationbased national cancer registry, we evaluate the risk of PCSM associated with margin status. Methods-The SEER cancer registry data for patients diagnosed in 1998-2006 were used to identify men undergoing RP for PCa. Margin

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... status, pathologic stage, Gleason grade and postoperative radiation therapy were recorded along with demographic data. Multivariate Cox regression analysis was used to estimate the risk of PCSM associated with PSMs. Results-A total of 65,633 patients comprised the cohort in which 291 (0.44%) PCa-specific deaths occurred over an average follow-up of 50 months. PSMs were reported in 21.2% and were more common in pT3a than pT2 tumors (44% vs. 18%, p<0.001) and higher grade tumors (28% vs. 18%, p<0.001). The 7-year disease-specific survival rates for those at highest risk of PCSM (higher grade pT3a) were 97.3% for cases with negative surgical margins and 92.4% for those with PSMs. PSMs were associated with a 2.9-fold increased risk of PCSM (HR 2.55, 95% CI 2.02 -3.21). PSM remained an independent predictor of PCSM in the multivariate analysis (HR 1.70, 95% CI 1.32 -2.18). Conclusion-These data demonstrate the independent role of positive surgical margin in PCSM. These finding support the importance of optimizing surgical technique to achieve a sound oncologic surgical outcome with negative surgical margins when possible.