Objective:To explore risk factors for positive surgical margin (PSM) after laparoscopic radical prostatectomy (LRP) in high risk prostate cancer (PCa) patients with and without neoadjuvant hormornal therapy (NHT).Methods:The clinicopathological data of 202 high risk patients who underwent LRP from January 2012 to July 2020 was retrospectively analyzed. There were 111 cases performed in Beijing Chaoyang Hospital and 91 cases in National Cancer Center. Mean age was(67.7±6.5)years, mean BMI was (25.65±3.21)kg/m 2. Median highest preoperative PSA was 20.97(11.00, 34.40)ng/ml, median preoperative prostate volume was 32.88(23.33, 46.20)ml. Among all 202 high risk PCa patients, 97 did not receive NHT(non-NHT group) and 105 received NHT(NHT group). There were significant statistical difference in term of highest PSA, preoperative prostate volume between NHT and non-NHT groups ( P<0.05), while there was no significant difference in term of age or BMI between the two groups. Among NHT patients, 80 cases accepted complete androgen blockade therapy with median course of 3 months; 3 cases accepted simple castration therapy with median course of 3 months; 22 cases accepted simple anti-androgen therapy with median course of 1 month. Risk factors for PSM after LRP in NHT and non-NHT groups were respectively explored, including age, BMI, hypertension, diabetes, history of pelvic surgery, highest PSA before puncture, ISUP before puncture, preoperative prostate volume, ISUP after LRP, postoperative pathological stage T, pathological lymph node involvement, vessel carcinoma embolus, etc. Results:PSM rate was 50.5%(49/97) and 24.8% (26/105) in non-NHT and NHT, respectively. The apex was the most common location of PSM in non-NHT group(35.1%, 34/97), while the fundus was the most common location of PSM in NHT group(14.3%, 15/105). Multiple logistic regression revealed that postoperative pathological stage T was the only independent factors affecting the PSM for high risk patients without NHT ( OR=3.814, 95% CI 1.302-11.173, P=0.015), while postoperative pathological stage T, pathological lymph node involvement, and vessel carcinoma embolus were independent risk factors affecting PSM for high risk patients with NHT ( OR=18.434, 95% CI 4.976-68.297, P<0.001; OR=7.181, 95% CI 2.089-24.689, P =0.002; OR=3.545, 95% CI 1.109-11.327, P=0.033). Conclusions:Postoperative pathological stage T was independent risk factors affecting PSM for all high risk PCa patients no matter with or without NHT, while pathological lymph node involvement, and vessel carcinoma embolus were also independent risk factors affecting PSM for high risk PCa patients with NHT.