[Prognostic value of the localization of positive resection margins after radical prostatectomy for intraprostatic tumors].
OBJECTIVE
To evaluate the risk of biochemical recurrence of organ-confined prostate cancer (pT2+) after radical prostatectomy, according to the site of positive resection margins.


METHODS
649 radical prostatectomies were performed between 1988 and 2002 for organ-confined tumours in 436 cases (stage pT2). Preoperative (clinical stage, PSA assay and Gleason score on biopsies) and post-operative data (weight of the resection specimen, Gleason score and tumour volume) were recorded as a function of the site of positive resection margins. Biochemical recurrence was defined by a PSA level greater than 0.2 ng/ml. Biochemical progression-free survival was studied according to the Kaplan-Meier method, as a function of the site of positive resection margins.


RESULTS
Sixty-six patients (15.1%) had a single positive margin. With a mean follow-up of 52.9 months (range: 1.1 to 160.4 months), eleven patients (16.6%) developed biochemical recurrence. The mean progression-free survival was 7.8 months. An apical positive resection margin was associated with the most unfavourable prognosis compared to other sites.


CONCLUSIONS
Apical positive resection margins appear to be associated with a poorer prognosis than other sites. This study confirms that dissection of the apex is essential to ensure optimal tumour control and prognosis in organ-confined prostate cancer.
Sebe
Philippe
P
Service d'Urologie, Hôpital Henri Mondor, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil.
Makhoul
Bernard
B
Audet
Jean-François
JF
Chopin
Dominique
D
Abbou
Clément Claude
CC
Salomon
Laurent
L
D006801:Humans; D008297:Male; D011379:Prognosis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*