OBJECTIVE: To determine the impact of surgical margin status on the risk of significant biochemical recurrence (prostate-specific antigen [PSA] doubling time < 3, < 6 or < 9 months) after prostatectomy.
MATERIALS AND METHODS: Patients undergoing radical prostatectomy with complete clinical and pathological data and detailed PSA follow-up were identified from two prospectively recorded databases. Patients were stratified according to their risk of occult systemic disease (low risk: PSA < 10 ng/dL, pT2 stage and Gleason score ≤ 6; intermediate risk: PSA 10-20 ng/dL, pT2 stage and/or Gleason score 7; high: PSA > 20 ng/dL or pT3-4 stage or Gleason score 8-10) and the impact of a positive surgical margin (PSM) within each stratum determined by univariable and multivariable analysis.
RESULTS: Of 1514 patients identified, 276 (18.2%), 761 (50.3%) and 477 (31.5%) were classified as having low-, intermediate- and high-risk disease respectively. A total of 370 (24.4%) patients had a PSM and with a median follow-up of 22.2 months, and 165 (7%) patients had a biochemical recurrence. Sufficient PSA data was available to calculate PSA doubling times in 151/165 patients (91.5%). The PSM rate rose significantly, from 11% in low-risk to 43% in high-risk disease (P < 0.001), with similar positive associations noted with tumour grade, stage and serum PSA (P < 0.001). Patients with low-risk disease had essentially identical risks of significant biochemical recurrence over the study period, regardless of surgical margin status. By contrast, in patients with both intermediate- and high-risk disease, a PSM was a strong predictor of significant biochemical recurrence on univariable analysis. On multivariable analysis, howver, PSM predicted significant disease recurrence in intermediate-risk disease only.
CONCLUSIONS: PSM is a risk factor for significant biochemical recurrence only in intermediate risk disease.
Corcoran NM, Hovens CM, Metcalfe C, Hong MK, Pedersen J, Casey RG, Peters J, Harewood L, Goldenberg SL, Costello AJ, Gleave ME. Are you the author?
Department of Urological Sciences and Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada; Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Parkville; and the Australian Prostate Cancer Research Centre@Epworth, Richmond TissuPath Pty Ltd, Hawthorn, Vic., Australia.
Reference: BJU Int. 2012 Jan 18. Epub ahead of print.