Prognostic consequences of the location of positive surgical margins in organ-confined prostate cancer.
BACKGROUND
The purpose of the present study was to evaluate and compare the risk of progression in organ-confined prostate cancers (stage pT2), according to the location of positive surgical margins.


METHODS
Between 1988 and 2001, 538 consecutive men underwent radical prostatectomy for localized prostate cancer. All patients had preoperative physical examinations, serum PSA assays (Hybritech assay, N.l. <4 ng/ml) and ultrasound-guided sextant biopsies to confirm diagnosis. Radical prostatectomy specimens were analyzed according to the Stanford protocol. Positive margins were classified as single or multiple and main locations (apex, bladder neck and posterolateral) were noted. Postoperative follow-up data were obtained through routine serum PSA assays. Biochemical recurrence was defined as a single postoperative PSA level >0.2 ng/ml. Biochemical progression was studied in patients with organ-confined tumors (stage pT2) according to the location of the single positive margin. Kaplan-Meier analysis was performed to determine the actuarial biochemical recurrence-free likelihood and the log-rank test was used for statistical analysis. Differences were considered significant when the p value was <0.05.


RESULTS
371 patients had organ-confined tumors, and 60 patients (16.1%) had solitary positive margins (apex 26, bladder neck 14, posterolaterally 20). Eleven patients (18.3%) had biochemical progression. 5-year biochemical free progression was 54.5, 76.9 and 87.9% for apex, bladder and the posterolateral location, respectively (p < 0.05).


CONCLUSIONS
In the present study, a positive surgical margin at the apex was associated with worse clinical prognosis compared to the bladder neck and posterolateral locations.
Department of Urology, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA. laurent.salomon@hmn.ap-hop-paris.fr
Laurent
L
Salomon
Aristotelis G
AG
Anastasiadis
Patrick
P
Antiphon
Olivier
O
Levrel
Fabien
F
Saint
Alexandre
A
De La Taille
Antony
A
Cicco
Dimitri
D
Vordos
Andras
A
Hoznek
Dominique
D
Chopin
Clément-Claude
CC
Abbou
D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*