Bulbul M., Abou Diab N., Hout Y., Hujeij A., Darwish O., Tawil A., Geara F.

Presented on March, 21 2007

INTRODUCTION & OBJECTIVES: Positive surgical margins following radical retropubic prostatectomy (RRP) is not uncommon. Protocols of adjuvant therapy or conservative follow-up have evolved yet specific selection criteria have not been widely adopted. We evaluated the outcome of patients (pts) treated with immediate post-op radiation therapy (XRT) – Hormonal therapy (HT) vs active follow-up employing specific selection criteria.

MATERIAL & METHODS: Sixty pts with positive surgical margins following RRP performed between January 1998 and December 2004 were examined. Surgically, after removal of the prostate, urethral stump, bladder neck and prostatic bed. biopsies were separately taken before performing the anastomosis.  27/60 pts were immediately started post-op on H.T (total 6 months) while XRT to prostatic bed was started 3 months post-op. Selection criteria for immediate therapy included, positive seminal vesicles Gleason score greater than or equal to 8, multiple significant margins and positive prostatic bed biopsy. 33/60 pts were followed up conservatively. Follow-up for both groups included periodic PSA, DRE.  Biochemical recurrence was defined as PSA > 0.2 ng/ml.

RESULTS: On the observation protocol 27/33 pts (82%) continue to be NED 2-8 years (median 4 years) post-op. while 6/33 pts (18%) recurred 2-6 years (median 2 years) Post-op.  All six patients received XRT or HT and all six are still alive. Of pts receiving immediate adjuvant therapy 22/27 pts (81%) are NED 2-8 years (median 5) while 5/27 pts (19%) recurred 6-18 months post completion of treatment. Of those 5 pts one patient died of disease, two are on intermittent HT therapy and two are on chemotherapy. 

CONCLUSIONS: The majority (80%) of pts with positive surgical margins after RRP with or without adjuvant therapy are free of disease 4-5 years post-op. Appropriate selection criteria could identify patients who would benefit from immediate adjuvant therapy; positive seminal vesicles, Gleason score greater than or equal to 8, multiple significant margins and positive prostatic bed biopsy.

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