title: Risk factors for biochemical recurrence following radical perineal prostatectomy in a large contemporary series: a detailed assessment of margin extent and location.
abstract: OBJECTIVE
  The implications of positive surgical margin (PSM) extent and location during radical perineal prostatectomy (RPP) have not been assessed in a contemporary series. We aimed to examine the incidence, location, and extent of PSM as well as their impact on biochemical recurrence (BCR) following RPP.
  
  
  METHODS
  A total of 794 patients underwent RPP by a single surgeon between June 1993 and August 2010. Covariates included age, pathologic T stage, pathologic Gleason sum, preoperative PSA, prostate volume, PSM extent, and location. Life table, Kaplan-Meier, and Cox regression analyses assessed predictors of BCR following RPP.
  
  
  RESULTS
  PSM were recorded in 162 patients (20.4%); of these, 83 (51.2%) were focal (≤ 1 mm) whereas 79 (48.8%) were broad (>1 mm). Location of PSM was anterior 10.5%, posterior or lateral 14.8%, bladder neck 23.5%, apical 32.1%, and multifocal 19.1%. At a median follow-up of 54 months, the 5-year BCR-free probability was 90.8% in patients with negative margins, 77.5% in patients with focal PSM, and 47.5% in patients with broad PSM. On multivariable analyses adjusted for age, pathologic T stage, pathologic Gleason sum, preoperative PSA, and prostate volume, broad PSM, (HR = 3.49, P < 0.001) as well as anterior (HR = 3.77, P = 0.003), bladder neck (HR = 2.25, P = 0.01) and multifocal (HR = 3.55, P < 0.001) PSM were independent predictors of BCR.
  
  
  CONCLUSIONS
  In this study, we present oncologic outcomes following RPP in a large contemporary cohort of patients undergoing RPP. In adjusted analyses, broad and anterior PSM carried the highest risk of recurrence after RPP.
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI 48202, USA. Electronic address: jsammon79@gmail.com.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Sammon
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.forename: Shyam
authors.initials: S
authors.lastname: Sukumar
authors.forename: Praful
authors.initials: P
authors.lastname: Ravi
authors.forename: Ariella
authors.initials: A
authors.lastname: Friedman
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Jan
authors.initials: J
authors.lastname: Schmitges
authors.forename: Claudio
authors.initials: C
authors.lastname: Jeldres
authors.forename: Wooju
authors.initials: W
authors.lastname: Jeong
authors.forename: Navneet
authors.initials: N
authors.lastname: Mander
authors.forename: James O
authors.initials: JO
authors.lastname: Peabody
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Michael
authors.initials: M
authors.lastname: Harris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D011467:Prostate / Q000473:pathology / Q000601:surgery*; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood / Q000601:surgery*; D012307:Risk Factors
chemical_list: D017430:Prostate-Specific Antigen