title: Does the distance between tumor and margin in radical prostatectomy specimens correlate with prognosis: relation to tumor location.
abstract: The posterior half of the prostate has a smooth well-defined edge unlike anteriorly. Often, tumor extends close to the posterior margin, where it is controversial whether pathologists should measure the distance between the tumor and the margin. There are no published data regarding the significance of a close margin factoring in the anatomical location within the radical prostatectomy (RP). We identified 158 RPs with 39 anterior-predominant carcinomas and 119 cases with posterior-predominant cancer. Distances between the tumor and inked margin were measured with an ocular micrometer. Eighty-seven cases had no progression with a minimum 6-year follow-up (median, 8; range, 6-9). Eighteen cases had progression with a median time to progression of 2 years with all men progressing within 6 years after RP. There was no statistically significant difference in the risk of progression relative to distance of tumor to the posterior margin (P=.09). The mean distance of tumor to the anterior margin for the cases that progressed was 0.6 mm (median, 0.5 mm; range, 0.05-1.18) compared to 1.9 mm (median, 1.1; range, 0.02-4) for the cases that did not progress (P=.02). Of 7 cases with anterior-predominant tumors that progressed, 5 had tumor located less than 1 mm from the anterior margin. In conclusion, if cancer is present less than 1 mm from the anterior margin, there is an increased tendency to recur, and this finding should be included in pathology reports. However, close margins posteriorly are not clinically significant and should not be reported.
authors.affiliation: Department of Pathology, The Johns Hopkins Medical Institution, Baltimore, MD 21231. Electronic address: spaluru1@jhmi.edu.
authors.forename: Swetha
authors.initials: S
authors.lastname: Paluru
authors.affiliation: Department of Pathology, The Johns Hopkins Medical Institution, Baltimore, MD 21231; Department of Urology, The Johns Hopkins Medical Institution, Baltimore, MD 21231; Department of Oncology, The Johns Hopkins Medical Institution, Baltimore, MD 21231. Electronic address: jepstein@jhmi.edu.
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Epstein
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000473:pathology* / Q000556:secondary / Q000601:surgery*; D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D007610:Kallikreins / Q000097:blood; D008297:Male; D000072662:Margins of Excision; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D018365:Neoplasm, Residual; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen
keywords: Anterior margin; Location of tumor; Margins; Posterior margin; Prostatic adenocarcinoma; Radical prostatectomy