Positive surgical margins after radical prostatectomy: What should we care about?
OBJECTIVE
Positive surgical margins (PSMs) after radical prostatectomy (RP) are a known factor associated with biochemical recurrence (BCR) and raise the issue of adjuvant treatment by radiotherapy versus salvage treatment at recurrence. To help this choice, our study aimed to analyze BCR-free survival and factors associated with BCR in patients with PSM and undetectable postoperative prostate-specific antigen (PSA).


METHODS
Between 2005 and 2008, 630 patients had RP for localized prostate cancer in our center. We included patients with PSM, uninvaded nods, undetectable postoperative PSA and no adjuvant treatment. The 5-year BCR-free survival was calculated using Kaplan-Meier method. Logistic regression models were used to determine the factors associated with BCR in univariate and multivariate analyses (Cox model).


RESULTS
The PSM rate was 32.7 % (n = 206 patients), and 110 patients corresponded to the inclusion criteria. The median follow-up was 72 months. The BCR rate was 30 % with a 5-year BCR-free survival of 83.9 %. The factors significantly associated with BCR were preoperative PSA, predominance and percentage of Gleason 4, tumor volume, PSM length and predominance of Gleason 4 at the margin. In the multivariate analysis, the remaining two significant factors were PSM length [OR 4.35, 95 % CI (1.011-1.421), p = 0.037] and tumor volume [OR 4.29, 95 % CI (1.011-1.483), p = 0.038].


CONCLUSIONS
Over a 5-year follow-up, only one-third of patients experienced BCR. It might be reasonable to postpone adjuvant radiotherapy for patients with PSM and undetectable PSA after RP. Tumor volume and PSM length were associated with BCR and should be taken into account in the postoperative treatment management.
Department of Urology and Pathology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines (UVSQ), 40 rue Worth, 92151, Suresnes, France. pettenati.c@gmail.com.
Caroline
C
Pettenati
Department of Urology and Pathology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines (UVSQ), 40 rue Worth, 92151, Suresnes, France.
Yann
Y
Neuzillet
Department of Urology and Pathology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines (UVSQ), 40 rue Worth, 92151, Suresnes, France.
Camelia
C
Radulescu
Department of Urology and Pathology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines (UVSQ), 40 rue Worth, 92151, Suresnes, France.
Jean-Marie
JM
Hervé
Department of Pathology, Fort de France University Hospital, Fort de France, France.
Vincent
V
Molinié
Department of Urology and Pathology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines (UVSQ), 40 rue Worth, 92151, Suresnes, France.
Thierry
T
Lebret
D000368:Aged; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D017430:Prostate-Specific Antigen
Adjuvant radiotherapy; Biochemical recurrence; Margin; Prostate cancer; Radical prostatectomy