Biochemical recurrence rate in patients with positive surgical margins at radical prostatectomy with further negative resected tissue.
OBJECTIVE
To determine the biochemical recurrence (BCR) rate in patients with positive surgical margins (PSMs) on the prostate specimen who have additional negative tissue resected from that site (M+ -), compared to patients with negative margins (M-) and those with persistent PSM (M+), as those with PSM at radical prostatectomy (RP) are at greater risk of BCR, and in some instances where suspicious tissue is noted in the prostate bed or when frozen-section analysis shows PSM, additional tissue is resected from the suspect site of the PSM.


METHODS
Between January 1999 and June 2007, 4217 consecutive patients underwent open or laparoscopic RP with no previous radiotherapy or hormonal therapy. The median (interquartile range) follow-up was 37.4 (21.1-60.7) months.


RESULTS
Pathological organ-confined (OC) cancer was present in 2901 men, of whom 2659 had M-, 216 had M+, and 26 had M+-. Extracapsular extension (ECE) alone with no seminal vesicle or lymph node involvement was present in 843 men, of whom 657 had M-, 174 had M+ and 12 had M+-. For patients with OC cancer, the 36-month actuarial BCR-free probability was 97.9% (95% confidence interval 97.3-98.5) for M-, vs 89.0 (84.1-93.9)% for M+ vs 100% for M+-. For patients with ECE, the 36-month actuarial BCR-free probability was 83.7 (80.0-87.4)% for M- vs 73.7 (66.1-81.3)% for M+ vs 90.0 (71.4-100)% for M+-. The main limitation of the study was its retrospective nature, with the reason for resection of additional tissue not always well documented.


CONCLUSIONS
While the few patients with PSMs and further negative resected tissue limited the statistical analysis, it would appear that in these patients the disease behaves as in those with negative margins.
Rabbani
Farhang
F
Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA. rabbanif@mskcc.org
Vora
Kinjal C
KC
Yunis
Luis Herran
LH
Eastham
James A
JA
Guillonneau
Bertrand
B
Scardino
Peter T
PT
Touijer
Karim
K
D004812:Epidemiologic Methods; D005629:Frozen Sections; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery; D018365:Neoplasm, Residual; D011379:Prognosis; D011467:Prostate / Q000473:pathology* / Q000601:surgery; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery
D017430:Prostate-Specific Antigen