Focal positive surgical margins decrease disease-free survival after radical prostatectomy even in organ-confined disease.
OBJECTIVE
To investigate the significance of focal positive margins (FPM) in prostatectomy patients. The significance of FPM after radical prostatectomy is unclear. The implication is that FPM are surgically induced, may not represent true tumor extension beyond the prostate, and thus would not affect disease-free survival (DFS).


METHODS
Data were retrospectively reviewed from 2468 patients undergoing radical prostatectomy between January 1996 and October 2008. The DFS probabilities were compared among different margin statuses (negative [NM], FPM, and extensively positive [EPM]) with the log-rank test. FPM was defined as less than/equal to 3 mm. EPM was greater than 3 mm. A multivariate Cox analysis was performed to evaluate the significance of FPM in patients with prostate cancer.


RESULTS
Of all patients, 2022 (82%) had NM, 344 (14%) had FPM, and 99 (4%) had EPM. Of the 1997 patients with pT2 disease, 1716 (86%) had NM, 229 (11.5%) had FPM, and 52 (2.6%) had EPM. The 10-year DFS for all patients was 84%, 64%, 38% for NM, FPM, and EPM, respectively (P < .0001). The 10-year DFS for organ-confined disease was 90%, 76%, and 53% for NM, FPM, and EPM, respectively (P < .0001). The risk of biochemical recurrence for all patients increases with worsening margin status. Margin status affects biochemical recurrence and depends on the Gleason grade on surgical pathology for all patients (P = .0005) and patients with pT2 disease (P = .0233).


CONCLUSIONS
FPM and EPM after radical prostatectomy confer a decreased DFS even in patients with otherwise organ-confined disease.
Lake
Alison M
AM
Department of Urology, University of Michigan, Ann Arbor, Michigan 48109, USA. alilake@med.umich.edu
He
Chang
C
Wood
David P
DP
D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011467:Prostate / Q000473:pathology*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery / Q000628:therapy; D016879:Salvage Therapy