Korean J Urol.  2013 Aug;54(8):510-515. 10.4111/kju.2013.54.8.510.

Do Positive Surgical Margins Predict Biochemical Recurrence in All Patients Without Adjuvant Therapy After Radical Prostatectomy?

• Lee JW
• Ryu JH
• Kim YB
• Yang SO
• Lee JK
• Jung TY

• KMID: 1840462
• DOI: http://doi.org/10.4111/kju.2013.54.8.510

Abstract

PURPOSE
The objective was to study whether positive surgical margins (PSMs) predict biochemical recurrence (BCR) in all patients without adjuvant therapy after radical prostatectomy (RP).
MATERIALS AND METHODS
We retrospectively reviewed the medical records of patients who underwent RP for prostate cancer at Veterans Health Service Medical Center from 2005 to 2011. BCR was defined by a prostate-specific antigen (PSA) value > or =0.2 ng/mL. The clinicopathological factors of the PSM group were compared with those of the negative surgical margin (NSM) group, and the predictive impact of a PSM for BCR-free survival were evaluated. In addition, we analyzed the prognostic difference for BCR-free survival between solitary and multiple PSMs.
RESULTS
A PSM was noted in 167 patients (45.5%). BCR was reported in 101 men in total (27.5%). The BCR-free survival rate of the PSM group was lower than that of the NSM group (p<0.001). In a multivariate analysis for the total patients, PSM was significantly associated with BCR-free survival (p<0.001). After stratification by pathological T stage, Gleason score (GS), and preoperative PSA value, PSM was significantly predictive for BCR-free survival in men with pT2 and/or GS < or =6 or 7 and/or a PSA value <10 or 10-20 ng/mL (all p<0.05). Multiple PSMs were more predictive of BCR-free survival than was a solitary PSM (p=0.001).
CONCLUSIONS
A PSM is a significant predictor of postoperative BCR in patients with pT2 and/or GS < or =7 and/or preoperative PSA <20 ng/mL. Multiple PSMs are considered a stronger prognostic factor for prediction of BCR than is a solitary PSM.

Keyword

Prostatectomy; Prostatic neoplasms; Recurrence

MeSH Terms

Humans
Male
Medical Records
Multivariate Analysis
Neoplasm Grading
Prostate-Specific Antigen
Prostatectomy
Prostatic Neoplasms
Recurrence
Retrospective Studies
Survival Rate
Veterans Health
Prostate-Specific Antigen

Figure

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  FIG. 1 Biochemical recurrence-free survival curve stratified by the surgical margin status (NSM group vs. PSM group). NSM, negative surgical margin; PSM, positive surgical margin; SE, standard error.

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  FIG. 2 Biochemical recurrence-free survival curve stratified by the surgical margin status (solitary PSM group vs. multiple PSMs group). Solitary PSM, positive surgical margin on a single site; Multiple PSMs, positive surgical margins on two or more sites; SE, standard error.

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