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The effect of positive surgical margins (PSM) on cancer-specific mortality (CSM) in high/very high‐risk (HR/VHR) prostate cancer (PCa) with aggressive Gleason Grade Group (GGG) is unknown. Therefore, the study tested PSM effect on CSM in this setting, in addition to testing radiotherapy (RT) benefits in PSM patients. In HR/VHR PCa patients with exclusive GGG 4–5, PSM at RP adversely affects survival. Moreover, RT has no protective effect on CSM. In consequence, the lowest possible PSM rates are crucial in such patients.
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