Positive surgical margins (PSM) after radical prostatectomy (RP) are a significant predictor of biochemical failure and possible disease progression. Close surgical margins (CSM) however represent a diagnostic challenge for surgeons. We sought to evaluate the biochemical recurrence (BCR) patterns among men undergoing RP with specimens having negative, positive, and close surgical margins from the Shared Equal Access Regional Cancer Hospital (SEARCH) cohort.
Men undergoing RP between 1988 and 2015 with known final pathologic margin status were evaluated. The cohort was divided into 3 groups based on margin status; negative, positive, and close. Close margins were defined by distance of tumor ≤1mm from the surgical margin. BCR was defined as PSA >0.2ng/ml, 2 values at 0.2ng/ml, or secondary treatment for an elevated PSA. Predictors of BCR, metastases, and mortality were analyzed using Cox-proportional Hazard models.
Of 5,515 men in the SEARCH database, 4,337 (79%) men met criteria for inclusion in the analysis. Of these, 2,063 (48%) had negative margins, 1902 (44%) had positive margins, and 372 (8%) had close margins. On multivariable analysis, relative to negative margins, men with close margins had a higher risk of BCR (HR=1.51, 95%CI=1.25-1.82, P<0.001) but a decreased risk of BCR when compared to those men with positive margins (HR=2.09, 95%CI=1.86-2.36, P<0.001). Metastases, prostate cancer specific mortality (PCSM) and all-cause mortality did not differ based on margin status alone.
Management of men with close surgical margins is a diagnostic challenge, with a disease course that is not entirely benign. Evaluation of other known risk factors likely provide greater prognostic value for these men and may ultimately better select those who may benefit from adjuvant therapy. This article is protected by copyright. All rights reserved.
BJU international. 2018 Feb 23 [Epub ahead of print]
Christine Herforth, Sean P Stroup, Zinan Chen, Lauren E Howard, Stephen J Freedland, Daniel M Moreira, Martha K Terris, William J Aronson, Matthew R Cooperberg, Christopher L Amling, Christopher J Kane
Department of Urology, Naval Medical Center San Diego, San Diego, CA., Duke University, Durham, NC., Veterans Affairs Durham Medical Center, Durham, NC., The Mayo Clinic, Rochester, MN., University of California, Los Angeles, CA., University of California, San Francisco, CA., Oregon Health & Science University, Portland, OR., Department of Urology, University of California, San Diego, San Diego, CA.