title: Impact of positive surgical margins and their locations after radical prostatectomy: comparison of biochemical recurrence according to risk stratification and surgical modality.
abstract: OBJECTIVE
  We investigated the influence of positive surgical margins (PSMs) and their locations on biochemical recurrence (BCR) according to risk stratification and surgical modality.
  
  
  METHODS
  A total of 1,874 post-radical-prostatectomy (RP) patients of pT2-T3a between 2000 and 2010 at three tertiary centers, and who did not receive neoadjuvant/adjuvant therapy, were included in this study. Patients were stratified according to BCR risk: low risk (PSA <10, pT2a-b, and pGS ≤6), intermediate risk (PSA 10-20 and/or pT2c and/or pGS 7), and high risk (PSA >20 or pT3a or pGS 8-10). The median follow-up was 43 months.
  
  
  RESULTS
  PSMs were a significant predictor of BCR in both the intermediate- and high-risk-disease groups (P = .001, HR 2.1, 95 % CI 1.3-3.4; P < .001, HR 2.8, 95 % CI 2.0-4.1). Positive apical margin was a significant risk factor for BCR in high-risk disease (P = .003, HR 2.0, 95 % CI 1.2-3.3), but not in intermediate-risk disease (P = .06, HR 1.7, 95 % CI 0.9-3.1). Positive bladder neck margin was a significant risk factor for BCR in both intermediate- and high-risk disease (P < .001, HR 5.4, 95 % CI 2.1-13.8; P = .001, HR 4.5, 95 % CI 1.8-11.4). In subgroup analyses, robotic RP provided comparable BCR-free survival regardless of risk stratification. Patients with PSMs showed similar BCR-free survival between open and robotic RP (log-rank, P = .897).
  
  
  CONCLUSIONS
  Post-RP PSMs were a significantly independent predictor of disease progression in high-risk disease as well as intermediate-risk disease. Both positive apical and bladder neck margins are also significant risk factors of BCR in high-risk disease. Patients with PSMs showed similar BCR-free survival between open and robotic surgery.
authors.affiliation: Department of Urology, Seoul National University Hospital, 28, Yongon-dong, Chongno-gu, Seoul, 110-744, Korea.
authors.forename: Min Soo
authors.initials: MS
authors.lastname: Choo
authors.forename: Sung Yong
authors.initials: SY
authors.lastname: Cho
authors.forename: Kyungtae
authors.initials: K
authors.lastname: Ko
authors.forename: Chang Wook
authors.initials: CW
authors.lastname: Jeong
authors.forename: Seung Bae
authors.initials: SB
authors.lastname: Lee
authors.forename: Ja Hyeon
authors.initials: JH
authors.lastname: Ku
authors.forename: Sung Kyu
authors.initials: SK
authors.lastname: Hong
authors.forename: Seok-Soo
authors.initials: SS
authors.lastname: Byun
authors.forename: Cheol
authors.initials: C
authors.lastname: Kwak
authors.forename: Hyeon Hoe
authors.initials: HH
authors.lastname: Kim
authors.forename: Sang Eun
authors.initials: SE
authors.lastname: Lee
authors.forename: Hyeon
authors.initials: H
authors.lastname: Jeong
mesh_terms: D000368:Aged; D015331:Cohort Studies; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood* / Q000175:diagnosis; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D012306:Risk
chemical_list: D017430:Prostate-Specific Antigen