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Positive surgical margins after radical prostatectomy: What should we care about?

  • Original Article
  • Published:
World Journal of Urology Aims and scope

Abstract

Purpose

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].

Conclusion

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.

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Conflict of interest

None.

Ethical statement

The study was approved by the local ethics committee, and all patients gave their informed consent before the study.

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Authors and Affiliations

  1. Department of Urology and Pathology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines (UVSQ), 40 rue Worth, 92151, Suresnes, France

    Caroline Pettenati, Yann Neuzillet, Camelia Radulescu, Jean-Marie Hervé & Thierry Lebret

  2. Department of Pathology, Fort de France University Hospital, Fort de France, France

    Vincent Molinié

Authors
  1. Caroline Pettenati
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  2. Yann Neuzillet
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  3. Camelia Radulescu
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  4. Jean-Marie Hervé
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  5. Vincent Molinié
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  6. Thierry Lebret
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Correspondence to Caroline Pettenati.

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Pettenati, C., Neuzillet, Y., Radulescu, C. et al. Positive surgical margins after radical prostatectomy: What should we care about?. World J Urol 33, 1973–1978 (2015). https://doi.org/10.1007/s00345-015-1580-x

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  • DOI: https://doi.org/10.1007/s00345-015-1580-x

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