The Inpact of Positive Surgical Margins and Their Preoperative Predicting Factors on Biochemical Failure after Radical Retropubic Prostatectomy

Kim, Jin Bum; Kim, Choung Soo; Park, Jong Yeon

Abstract

PURPOSE: To investigate the impact of positive surgical margins and their preoperative predicting factors on PSA failure after radical retropubic prostatectomy.
MATERIALS AND METHODS
From January 1990 to July 2002, 255 patients underwent radical prostatectomy at our hospital. We retrospectively reviewed their medical records and performed univariate and multivariate analyses to correlate preoperative prognostic factors such as serum PSA level, clinical stage, Gleason score, and presence of unilateral or bilateral tumor on biopsy with positive surgical margins on pathologic specimens. Furthermore, we investigated the impact of the margin status and its predicting factors on biochemical recurrence in 214 patients without lymph node metastasis or history of adjuvant hormonal therapy. The median follow-up period was 30 months.
RESULTS
Of the 255 patients, 79(31%) had positive surgical margin. In terms of margin status, clinical stage, Gleason score, and tumor bilaterality on biopsy were independently significant prognostic factors on multivariate analysis. Of the 214 patients without lymph node metastasis or history of adjuvant hormonal therapy, biochemical failure occurred in 39(13.5%). The biochemical failure rate was significantly higher in patients with positive surgical margins than in those with negative margins(35.7% versus 12.0%, p<0.05). Multivariate analysis of pre- and post-operative multiple factors revealed that margin status, pathologic stage, and preoperative PSA were independent prognostic factors for biochemical recurrence. The only significant statistical difference occurred in mean preoperative PSA level between the margin positive subgroups with and without biochemical failure.
CONCLUSIONS
If patients with high preoperative PSA level show positive surgical margin after radical prostatectomy, adjuvant systemic treatment should be considered.