WASHINGTON, DC USA (UroToday.com) - This important presentation reports that in a multivariable analysis a positive surgical margin (PSM) is an independent predictor of prostate cancer-specific mortality (PCSM).
It is shown that a PSM is associated with an increased risk of biochemical recurrence following radical prostatectomy (RP). However, the impact of PSM on long-term PCSM following RP has not been clearly elucidated. These investigators studied the impact of a PSM on PCSM in a large retrospective cohort of RP patients. They evaluated 4,228 eligible patients who underwent RP between 1982 and 2009 by a single surgeon. The median age was 58 years and the median PSA was 5.5 ng/ml. They employed Cox proportional hazards models to determine the impact of a PSM on PCSM.
RP Gleason score was 6 or below in 63.9%, 7 in 29.9%, and 8-10 in 6.2%. PSMs were found in 487 (11.5%). With a median follow-up of 9 years, 173 men (4.1%) died of prostate cancer. Compared to patients with negative surgical margin, men with PSM were; 1) more likely to be older and to have undergone RP in the pre-PSA era, 2) more likely to have a higher PSA level, 3) have a Gleason score of 7 or above, 4) have non-organ-confined tumors, and 5) have postoperative adjuvant or salvage therapy (p<0.001 for all). In a univariate model for PCSM, PSM was highly significant, HR=4.23 (95% CI 3.13-5.73), p<0.0001. However, in a multivariable model adjusting for RP Year, RP Gleason, stage, and (as time dependent covariates) adjuvant or salvage treatment, PSM was no longer significant: HR=1.03 (95% CI 0.73- 1.44), p=0.880.
Presented by Michael Dinizo, et al. at the American Urological Association (AUA) Annual Meeting - May 14 - 19, 2011 - Walter E. Washington Convention Center, Washington, DC USA
Reported for UroToday by Christopher P. Evans, MD, FACS, Professor and Chairman, Department of Urology, University of California, Davis, School of Medicine.