title: Positive apical surgical margins after radical retropubic prostatectomy, truth or artefact?
abstract: OBJECTIVE
  The significance of a positive apical surgical margin following radical retropubic prostatectomy has been the subject of controversy. We examined the hypothesis that a positive apical margin alone is not associated with an increased probability of biochemical relapse.
  
  
  METHODS
  A total of 162 men underwent radical prostatectomy for clinically organ-confined disease between May 1990 and December 1998. The mean follow-up period was 55 months (minimum 24 months). The mean patient age was 60.8 years. Clinical staging was 67.9% T1 and 32.1% T2. The mean preoperative prostate-specific antigen level was 11.5 ng/ml, and the mean Gleason score was 5.8.
  
  
  RESULTS
  Overall, 5/64 patients (7.8%) with negative surgical margins and 42/98 (42.9%) with at least one positive surgical margin had biochemical recurrence (p < 0.001). Seven of 25 patients (28%) with a solitary positive apical margin relapsed. A solitary apical positive margin was associated with a statistically significant higher risk of recurrence versus controls (p < 0.05).
  
  
  CONCLUSIONS
  All patients with a positive surgical margin, including those with a solitary apical margin alone, are at significantly increased risk of biochemical failure.
authors.affiliation: Department of Urology, University College Dublin, St Vincent's University Hospital, Dublin, Ireland.
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Connolly
authors.forename: Gary C
authors.initials: GC
authors.lastname: O'Toole
authors.forename: Kiaran J
authors.initials: KJ
authors.lastname: O'Malley
authors.forename: Rustom
authors.initials: R
authors.lastname: Manecksha
authors.forename: Anne
authors.initials: A
authors.lastname: O'Brien
authors.forename: David W
authors.initials: DW
authors.lastname: Mulvin
authors.forename: David M
authors.initials: DM
authors.lastname: Quinlan
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D001707:Biopsy, Needle; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology*; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000473:pathology*; D011336:Probability; D016016:Proportional Hazards Models; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity