However, many believe that a focal PSM (FPSM) is less likely to recur compared with an extensive PSM (EPSM). This study cohort was comprised of all the patients operated from 2000 to 2009 who had PSM on RP specimen. Patients with positive lymph nodes and failure for the PSA to reach <0.1µg/L following RP were excluded. They defined focal PSM as tumor touching the inked margin at a single anatomical location with <2mm of surface area involvement. An EPSM was defined as tumor touching the inked margin at ≥2 anatomical locations or with ≥2mm of surface area involvement. BCR was defined as a PSA value ≥0.2µg/L (early if BCR occurred in ≤12 months and late BCR if occurred after 12 months).
There were 424 patients who had RP and 107 (25.3%) had a PSM. Lymph nodes (LN) were positive in 3 (2.8%). Treatment failure occurred in 13 (12.5%) with majority having pT3 disease. There were 91 patients who fulfilled the study criteria and median PSA, age and follow-up were 9µg/L, 63 years and 36 months, respectively. There were 41 (45%) with FPSM and 50 (55%) with EPSM. Median time to BCR was 24 months in FPSM vs. 12 months in EPSM. BCR occurred in 8 (19.6%) with a FPSM vs. 21 (42%) with a EPSM. The incidence of BCR was higher in both groups with pT3 disease (FPSM 5 (31.3%) and EPSM 14 (44%)). During the mean study period of 48.3 months, BCR free survival was 80.4% and 58% in FPSM & EPSM, respectively. Radiotherapy treatment for BCR had success rate of 100% and 94% in FPSM and EPSM groups, respectively.
They concluded that observation is a reasonable option for patients with a FPSM, particularly those with organ-confined disease. Adjuvant radiotherapy can be given to patients with EPSM and pT3 disease.
Presented by Sanjai K. Addla, et al. at the 26th Annual European Association of Urology (EAU) Congress - March 18 - 21, 2011 - Austria Centre Vienna, Vienna, Austria