Positive apical surgical margins after radical retropubic prostatectomy, truth or artefact?
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.
Connolly
Stephen S
SS
Department of Urology, University College Dublin, St Vincent's University Hospital, Dublin, Ireland.
O'Toole
Gary C
GC
O'Malley
Kiaran J
KJ
Manecksha
Rustom
R
O'Brien
Anne
A
Mulvin
David W
DW
Quinlan
David M
DM
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