Purpose: While prognostic indicators, such as Prostate Specific Antigen (PSA), are used in clinical decision making in prostate cancer care, prognostic information potentially can contribute to anxiety in patients. Because there is little empirical evidence for the association between prognostic indicators, other than PSA, and anxiety, we sought to understand the influence of positive surgical margin status on fear of cancer recurrence in men undergoing radical prostatectomy (RP) as primary therapy for localized prostate cancer. Methods: We identified 584 men who underwent RP from 1999 to 2002 from CaPSURE, a longitudinal, national cohort with prospectively collected clinical and HRQOL data. All men had both baseline and at least one follow-up assessment of fear of cancer recurrence using the Kornblith scale. Statistical analysis included chi-squared test, Wald test and ANOVA mixed model for longitudinal fear of cancer recurrence associations. Results: One hundred and sixty (27%) men had positive surgical margins. Baseline fear of cancer recurrence and clinical variables did not differ based on margin status. While both those with positive and negative surgical margins experienced a decrease in fear of recurrence immediately after RP, those with positive margins had less decrease in fear than those with negative margins. At 3 months post surgery, the gap in fear of recurrence according to margin status widened. After adjusting for adjuvant therapy, those with positive margins experienced rising fear while those with negative margins experienced a leveling off after the initial drop in fear (OR = 1.94, 95% CI = 1.22-3.07). Repeated measures analysis showed greater fear of cancer recurrence over time (14 month mean follow-up) for those with positive surgical margins compared to those with negative margins (p=0.019). There were no significant differences in Health Related Quality of Life based on margin status. Conclusion: In this prospective longitudinal study, we found that men with positive surgical margins experience less reduction in fear of recurrence immediately following surgery than those with negative margins, and have significantly greater increase in fear of recurrence during the first several years after treatment. While prognostic indicators may have meaning to physicians making clinical decisions, our work emphasizes the potential adverse impact of these factors on patients.