title: Solitary and small (≤3 mm) apical positive surgical margins are related to biochemical recurrence after radical prostatectomy.
abstract: OBJECTIVE
  To evaluate the prognostic value of positive surgical margins (PSM) in radical prostatectomy (RPE) specimens in relation to multifocality, localization and size.
  
  
  METHODS
  A total of 1036 patients who underwent RPE and staged pT2-3a,pN0,M0 were evaluated. None had received adjuvant or neoadjuvant therapy. All specimens were routinely processed by complete whole mount sectioning. Exact number, localization and size of PSM were reassessed, and patients were followed up for a mean of 60 months.
  
  
  RESULTS
  A total of 267 patients (26%) showed PSM (20% pT2, 48% pT3a). Preoperative prostate-specific antigen, Gleason score (GS) and PSM were independent predictors of biochemical recurrence (BCR). BCR-free survival rates for patients with and without PSM were 59% and 80%, respectively (HR 2.1; P < 0.001). PSM were related to biochemical failure in pT2 and pT3a tumors (P = 0.001 and P = 0.015). A total of 64% of solitary PSM were apical. Multifocality, localization and size of PSM had no significant impact on BCR.
  
  
  CONCLUSIONS
  Solitary apical and small PSM in RPE have a significant impact on BCR-free survival in localized stages.
authors.affiliation: Department of Urology, St. Elisabeth Clinic Straubing, StraubingDepartment of Urology, Caritas-Hospital St. JosefInstitute of Pathology, University of Regensburg, RegensburgStiftung MännergesundheitInstitute of Pathology, Area South/West from the Vivantes GmbHInstitute of Pathology, Area North/East from the Vivantes GmbH, BerlinDepartment of Urology, Vivantes Clinic Friedrichshain and Am Urban, Berlin, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: May
authors.forename: Sabine
authors.initials: S
authors.lastname: Brookman-May
authors.forename: Lothar
authors.initials: L
authors.lastname: Weißbach
authors.forename: Hermann
authors.initials: H
authors.lastname: Herbst
authors.forename: Christian
authors.initials: C
authors.lastname: Gilfrich
authors.forename: Thomas
authors.initials: T
authors.lastname: Papadopoulos
authors.forename: Jan
authors.initials: J
authors.lastname: Roigas
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Hofstädter
authors.forename: Wolf F
authors.initials: WF
authors.lastname: Wieland
authors.forename: Maximilian
authors.initials: M
authors.lastname: Burger
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000453:epidemiology*; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies
chemical_list: D017430:Prostate-Specific Antigen