AUA 2011 - Implications of surgical margin status on prostate cancer-specific survival - Session Highlights

WASHINGTON, DC USA ( - 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.


The opinions expressed in this article are those of the Contributing Editor and do not necessarily reflect the viewpoints of the American Urological Association.



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