1474 PT3-PROSTATE CANCER-POSITIVE SURGICAL MARGIN AT BLADDER NECK IS AN INDEPENDANT PREDICTOR OF LOCAL FAILURE AND PROSTATE CANCER MORTALITY: RESULTS OF A PROSPECTIVE SINGLE INSTITUTION SERIES

Abstract

You have accessJournal of UrologyProstate Cancer: Localized1 Apr 20111474 PT3-PROSTATE CANCER-POSITIVE SURGICAL MARGIN AT BLADDER NECK IS AN INDEPENDANT PREDICTOR OF LOCAL FAILURE AND PROSTATE CANCER MORTALITY: RESULTS OF A PROSPECTIVE SINGLE INSTITUTION SERIES Martin Spahn, Alberto Briganti, Umberto Capitanio, Paolo Gontero, Burkhard Kneitz, Pia Bader, Hein Van Poppel, Detlef Frohneberg, and Steven Joniau Martin SpahnMartin Spahn Würzburg, Germany More articles by this author , Alberto BrigantiAlberto Briganti Milan, Italy More articles by this author , Umberto CapitanioUmberto Capitanio Milan, Italy More articles by this author , Paolo GonteroPaolo Gontero Turin, Italy More articles by this author , Burkhard KneitzBurkhard Kneitz Würzburg, Germany More articles by this author , Pia BaderPia Bader Karlsruhe, Germany More articles by this author , Hein Van PoppelHein Van Poppel Leuven, Belgium More articles by this author , Detlef FrohnebergDetlef Frohneberg Karlsruhe, Germany More articles by this author , and Steven JoniauSteven Joniau Leuven, Belgium More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1409AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previous studies have shown a positive correlation between presence of positive surgical margin (SM) and cancer recurrence and mortality. Only few addressed the importance of the location of positive SM.We hypothesized that the outcome of pts. with positive SMs (PSM) varies significantly according to their location in a large pT3 PCa series. METHODS The study included 550 consecutive pts. with high risk pPCa (PSA>20 ng/ml, cT3/cT4, bx Gleason 8–10) treated with RP+ PLND at a single institution. Of these,187 (34%) had pT3a/b disease and did not receive adjuvant radiation therapy.These pts. represented the study cohort. All pts.had detailed pathological data (presence and number of PSM (namely 1,2 or 3) that were collected prospectively. Location of PSM was recorded for all pts. and categorized as apical, posterolateral, urethral,posterior,seminal and bladder. A PSM was defined as presence of tumor cells at the inked margin of resection. Kaplan-Meier curves assessed the time to local failure and cancer specific survival (CSS) according to the number and location of PSM.The association between location of PSM was confirmed at multivariable Cox regression analyses after accounting for pathol. Gleason sum,PSA and use of adjuvant hormonal therapy. RESULTS Overall, 5,8 and 10-year CSS rates were 88, 86 and 86%, respectively, while local recurrence free rate was 82, 80 and 71% at 5–8 and 10-year follow-up, respectively. At Kaplan Meier analysis, only the presence of PSM at bladder neck was associated with both local failure and CSS (all p< 0.001). At 5 and 10 year follow-up, patients with PSM at bladder neck had significantly worse local failure (63 and 63% vs 87 and 74%; all p=0.001) and CSS rate (68 and 68% vs 94 and 91%; p<0.001) as compared to patients with negative margin at bladder neck. Conversely, no association was association between all other PSM location and CSS locations (all p=0.3). These results were confirmed at multivariable Cox regression analysis where the presence of PSM at bladder neck was the only independent predictor of both local failure (p=0.001; HR3.94) 0 and CSS (p=0.001; HR 5.61) even after accounting for all predictors. CONCLUSIONS Our study demonstrated that PSM at bladder neck is a significant predictor of local recurrence and cancer specific mortality in patients with pT3 disease even after accounting for pathological characteristics and use of adjuvant hormonal therapy. Patients with PSM at bladder neck should be thus considered for a combined, multimodal approach. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e591 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Martin Spahn Würzburg, Germany More articles by this author Alberto Briganti Milan, Italy More articles by this author Umberto Capitanio Milan, Italy More articles by this author Paolo Gontero Turin, Italy More articles by this author Burkhard Kneitz Würzburg, Germany More articles by this author Pia Bader Karlsruhe, Germany More articles by this author Hein Van Poppel Leuven, Belgium More articles by this author Detlef Frohneberg Karlsruhe, Germany More articles by this author Steven Joniau Leuven, Belgium More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...