With the continuous improvement of prostate cancer diagnosis and treatment in China in recent years, traditional open and laparoscopic radical prostate cancer treatment has been widely used in clinical practice and has become the main treatment modality for limited prostate cancer at present. Positive cutting edge is one of the most frequently encountered problems in radical prostate cancer surgery, but it has not yet attracted sufficient attention in China. Therefore, how to correctly diagnose and evaluate positive margins, reduce the incidence of positive margins, and improve the efficacy of radical prostate cancer treatment is an urgent issue for urologists to address. In the past, positive margins were defined as a tumor ≤1mm from the specimen margin or ≤5mm from the distal margin of the prostate tip, but studies have shown that the proximity of the tumor to the specimen margin does not mean that the tumor is residual, nor does it increase the chance of biochemical recurrence or clinical progression after surgery, so it cannot be called positive margins. The current positive cut edge refers to the presence of cancer cells on the ink-stained surface of the prostatectomy specimen. The common sites are at the tip of the prostate, anterior to the gland, and posterior to the prostate, while the bladder neck and sides are less common. The other is that the cancerous tissue is confined to the envelope, but for various reasons the periprostatic fascia or envelope is cut open and mistakenly enters the prostate gland, resulting in the disappearance of part of the fascia and envelope in the specimen, leaving cancerous tissue in the prostate gland on the ink-stained surface of the specimen, which is true positive. This is a false positive. The significance of positive margins A positive margin is an independent predictor of biochemical recurrence after radical prostatectomy. The 10-year biochemical recurrence-free rate was 79% in those with negative cut margins compared to 55% in those with positive cut margins. However, it is controversial whether positive margins can predict clinical progression, and due to the limitation of follow-up time, there is no report that positive margins can predict the overall survival time of patients. How to prevent and reduce positive cut margins The first step is to select the right patients for radical prostate cancer surgery. The incidence of positive cut margins can be prevented and reduced by combining preoperative PSA, clinical staging and a Partin table with a puncture Gleason score. Extraperitoneal invasion is often a microscopic change, and current imaging techniques have not yet reached sufficient resolution to detect such a small lesion, so preoperative imaging is not very reliable in reducing positive cut margins. The next step is to improve surgical technique. The tip of the prostate is a common site for positive cutting edges, so special attention should be paid to surgical manipulation of the tip. For example, sever the periprostatic levator muscle fibers to identify the prostatic urethral junction; sever the deep dorsal venous plexus 10-15 mm distal to the apical prostate; separate the urethra 1-3 mm distal to the apical region and then sever it; sever the posterior urethral wall distal to the plane of the anterior urethra and then sharply sever the rectus urethralis muscle. In addition, bladder neck preservation techniques should be used with caution in radical prostatectomy, especially in prostate cancer with suspected perineal involvement. Again, review the previous surgical videos. Surgical videos detail every detail of the surgical procedure, especially for laparoscopic radical prostatectomy. It is best to have a pathologist with you so that pathological sections of the surgical specimen can be correlated with the surgical video to maximize the surgeon’s understanding of why and where positive margins occur and the correct anatomical levels during surgery. Neoadjuvant endocrine therapy can result in prostate and tumor volume reduction and tumor downstaging, but reducing cut margin positivity with this approach is subjective in nature. There is no evidence from prospective clinical trials that neoadjuvant endocrine therapy delays biochemical recurrence and prolongs survival in patients. Some scholars in Europe and the United States believe that some patients with positive cut margins will not experience biochemical recurrence and clinical progression and have a good prognosis, so they can wait for observation and start treatment when the PSA rises above 0.4 ng/ml. However, the current status of prostate cancer diagnosis and treatment in China is very different from that of European and American countries. The clinical stage of patients with radical prostate cancer in China is generally later than that of patients in Europe and the United States, and the proportion of high-risk patients is higher, so waiting for observation is chosen with caution. Recent randomized controlled studies of EORTC 22911 and SWOG 8794 showed that adjuvant radiotherapy significantly improved the local control rate and prolonged biochemical progression-free and clinical progression-free survival time in patients with positive cut margins after radical prostate cancer surgery compared with wait-and-see. Therefore, it is now recommended as evidence for Class I evidence-based medicine. Non-randomized controlled studies of adjuvant endocrine therapy have shown that the use of bicalutamide 150 mg in locally advanced prostate cancer (stage T3-4) significantly improved progression-free survival of patients compared to patients awaiting observation, reducing the risk of progression by 34%. However, the results are currently inconclusive for patients with high-risk factors such as positive cut margins, and relevant clinical trials are ongoing.