title: Close surgical margins after radical prostatectomy mimic biochemical recurrence rates of positive margins.
abstract: BACKGROUND
  The significance of a "close" but negative surgical margin after radical prostatectomy (RP) is controversial. We evaluated the effect of a close surgical margin (CSM) on biochemical recurrence (BCR) compared to a negative margin after RP.
  
  
  METHODS
  Pathologic records of men who underwent RP from 2005-2011 were retrospectively reviewed. Margin status was classified as "positive" (PSM), "negative" (NSM), or "close" (<1mm from margin). BCR was defined as 2 consecutive postoperative prostate specific antigen measurements >0.2ng/ml. Probability of BCR was estimated using the Kaplan-Meier method and stratified by margin status. Univariable and multivariable Cox proportional hazards models were used to determine whether close margin status was associated with an increased rate of BCR.
  
  
  RESULTS
  A total of 609 consecutive patients underwent RP (93% robotic) and had complete pathologic data. A total of 126 (20.7%) had PSM, 453 (74.4%) had NSM, and 30 (4.9%) had CSM (mean<0.44mm). The 3-year BCR-free survival for patients with CSM was similar to those with PSM (70.4% vs. 74.5%, log rank P = 0.66) and significantly worse than those with NSM (90%, log rank P<0.001). On multivariable regression, positive margin status (HR = 3.26, P<0.001) was significantly associated with a higher risk of BCR, along with close margins (HR = 2.7, P = 0.04).
  
  
  CONCLUSIONS
  BCR for patients with CSM at RP is tantamount to PSM patients. CSM <1mm should be explicitly noted on pathology reports. Patients with this finding should be followed up closely and offered adjuvant therapy.
authors.affiliation: Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY. Electronic address: mjw2117@gmail.com.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Whalen
authors.affiliation: Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Edan Y
authors.initials: EY
authors.lastname: Shapiro
authors.affiliation: Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Rothberg
authors.affiliation: Department of Pathology, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Turk
authors.affiliation: Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Solomon L
authors.initials: SL
authors.lastname: Woldu
authors.affiliation: Department of Biostatistics, Columbia University, Mailman School of Public Health, New York, NY.
authors.forename: Arindam
authors.initials: A
authors.lastname: Roy Choudhury
authors.affiliation: Department of Urology, Morsani College of Medicine, University of South Florida, Tampa, FL.
authors.forename: Trushar
authors.initials: T
authors.lastname: Patel
authors.affiliation: Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY.
authors.forename: Ketan K
authors.initials: KK
authors.lastname: Badani
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000209:etiology*; D009367:Neoplasm Staging; D011379:Prognosis; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment
keywords: Biochemical recurrence; Close margins; Outcomes; Radical prostatectomy; Surgical margins