title: Positive surgical margins in radical prostatectomy patients do not predict long-term oncological outcomes: results from the Shared Equal Access Regional Cancer Hospital (SEARCH) cohort.
abstract: OBJECTIVE
  To assess the impact of positive surgical margins (PSMs) on long-term outcomes after radical prostatectomy (RP), including metastasis, castrate-resistant prostate cancer (CRPC), and prostate cancer-specific mortality (PCSM).
  
  
  METHODS
  Retrospective study of 4,051 men in the Shared Equal Access Regional Cancer Hospital (SEARCH) cohort treated by RP from 1988 to 2013. Proportional hazard models were used to estimate hazard ratios (HRs) of PSMs in predicting biochemical recurrence (BCR), CRPC, metastases, and PCSM. To determine if PSMs were more predictive in certain patients, analyses were stratified by pathological Gleason score, stage, and preoperative prostate-specific antigen (PSA) level.
  
  
  RESULTS
  The median (interquartile range) follow-up was 6.6 (3.2-10.6) years and 1 127 patients had >10 years of follow-up. During this time, 302 (32%) men had BCR, 112 (3%) developed CRPC, 144 (4%) developed metastases, and 83 (2%) died from prostate cancer. There were 1,600 (40%) men with PSMs. In unadjusted models, PSMs were significantly associated with all adverse outcomes: BCR, CRPC, metastases and PCSM (all P ≤ 0.001). After adjusting for demographic and pathological characteristics, PSMs were associated with increased risk of only BCR (HR 1.98, P < 0.001), and not CRPC, metastases, or PCSM (HR ≤1.29, P > 0.18). Similar results were seen when stratified by pathological Gleason score, stage, or PSA level, and when patients who underwent adjuvant radiotherapy were excluded.
  
  
  CONCLUSIONS
  PSMs after RP are not an independent risk factor for CRPC, metastasis, or PCSM overall or within any subset. In the absence of other high-risk features, PSMs alone may not be an indication for adjuvant radiotherapy.
authors.affiliation: Department of Urology, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Prabhakar
authors.initials: P
authors.lastname: Mithal
authors.affiliation: Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA.|Division of Urology, Veterans Affairs Medical Center, Durham, NC, USA.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Howard
authors.affiliation: Urology Section, Department of Surgery, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.|Department of Urology, UCLA School of Medicine, Los Angeles, CA, USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Aronson
authors.affiliation: Section of Urology, Veterans Affairs Medical Center, Augusta, GA, USA.|Section of Urology, Medical College of Georgia, Augusta, GA, USA.
authors.forename: Martha K
authors.initials: MK
authors.lastname: Terris
authors.affiliation: Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Cooperberg
authors.affiliation: Urology Department, University of California San Diego Health System, San Diego, CA, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Kane
authors.affiliation: Division of Urology, Department of Surgery, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Amling
authors.affiliation: Division of Urology, Veterans Affairs Medical Center, Durham, NC, USA.|Division of Urology, Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Freedland
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D002173:Cancer Care Facilities; D017024:Chemotherapy, Adjuvant; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods / Q000401:mortality; D064129:Prostatic Neoplasms, Castration-Resistant / Q000097:blood / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen
keywords: adjuvant radiotherapy; disease progression; prostate cancer; prostatectomy