1557 ROLE OF POSITIVE SURGICAL MARGINS IN PATIENTS WITH ORGAN CONFINED PROSTATE CANCER. IMPLICATIONS FOR ADJUVANT TREATMENTS

Abstract

You have accessJournal of UrologyProstate Cancer: Localized VI1 Apr 20101557 ROLE OF POSITIVE SURGICAL MARGINS IN PATIENTS WITH ORGAN CONFINED PROSTATE CANCER. IMPLICATIONS FOR ADJUVANT TREATMENTS Alberto Briganti, Nazareno Suardi, Umberto Capitanio, Umberto Capitanio, Andrea Salonia, Andrea Russo, Lorenzo Rocchini, Claudio Doglioni, Cesare Cozzarini, Giorgio Guazzoni, Patrizio Rigatti, and Francesco Montorsi Alberto BrigantiAlberto Briganti More articles by this author , Nazareno SuardiNazareno Suardi More articles by this author , Umberto CapitanioUmberto Capitanio More articles by this author , Umberto CapitanioUmberto Capitanio More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Andrea RussoAndrea Russo More articles by this author , Lorenzo RocchiniLorenzo Rocchini More articles by this author , Claudio DoglioniClaudio Doglioni More articles by this author , Cesare CozzariniCesare Cozzarini More articles by this author , Giorgio GuazzoniGiorgio Guazzoni More articles by this author , Patrizio RigattiPatrizio Rigatti More articles by this author , and Francesco MontorsiFrancesco Montorsi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1322AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent prospective, randomized trials have shown a positive impact of adjuvant radiation therapy (RT) in patients (pts) with Gleason 6-10 and positive surgical margins (SM+). However, despite a trend toward significance even in pts with organ confined (pT2) disease, these studies enrolled only few patients with pT2 SM+. We hypothesized that the outcome of patients with pT2 and SM+ have heterogeneous outcome which differ according to other cancer characteristics. METHODS The study included 1637 ps with node-negative, pT2 disease treated with radical prostatectomy (RP) and pelvic lymph node dissection (PLND) for clinically localized prostate cancer between 1986 and 2007 at a single European tertiary referral center. All pts had complete clinical and pathological data. Pts were divided into 4 groups according to pathological characteristics: pT2 Gleason 6 and negative SM (SM-; group 1; n=861, 52.6%), pT2 Gleason 6 and SM+ (n=123, 7.5%; group 2), pT2 Gleason 7-10 SM- (n=429; 30.1%; group 3), pT2 Gleason 7-10 SM+ (n=161;9.8%; group 4). No pts received any adjuvant treatment after surgery. The Kaplan Meier method assessed the rate of biochemical recurrence (BCR) defined as two consecutive PSA values >0.2 ng/ml. Multivariable Cox regression models tested the association between SM+ and BCR in each category after accounting for pre-op PSA and pathological Gleason sum RESULTS Mean PSA at RP was 7.3 ng/ml (median 6.2 ng/ml; range: 0.4-40 ng/ml). RP Gleason sum was ¡Ü6, 7 and 8-10 in 60.1, 37 and 2.9% pts, respectively. Overall, BCR free survival rates at 2,5 and 8 years were 96,91 and 84%, respectively. Overall, pts with SM+ had significantly lower 2,5 and 8 BCR free survival rates compared to pts with SM- (91, 80 and 76 vs 98,93 and 86% vs respectively; p<0.001). However, when stratified according to Gleason sum, pts with SM+ and Gleason 6 (group 2) had similar 2,5 and 8 year BCR free survival rates as compared to pts with Gleason 6 and SM- (group 1; 95,89 and 89 vs 98,94 and 89%; p=0.2). Conversely, pts with SM+ and high Gleason score (7-10; group 4) had significantly lower 2,5 and 8 year BCR free survival rates as compared to pts with high Gleason but SM- (group 3; 87,71 and 60 vs 96,89 and 76%; p<0.001). At multivariable analyses where presence of SM+ was a significant predictor of BCR only in patients with high Gleason score (HR: 2.6; p=0.01) CONCLUSIONS We demonstrated that SM+ in pT2 disease matters only in presence of high Gleason score. Our results seem to indirectly suggest that, even in presence of SM+, pts with lower Gleason might not be considered candidates for adjuvant treatments Milan, Italy© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e601-e602 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alberto Briganti More articles by this author Nazareno Suardi More articles by this author Umberto Capitanio More articles by this author Umberto Capitanio More articles by this author Andrea Salonia More articles by this author Andrea Russo More articles by this author Lorenzo Rocchini More articles by this author Claudio Doglioni More articles by this author Cesare Cozzarini More articles by this author Giorgio Guazzoni More articles by this author Patrizio Rigatti More articles by this author Francesco Montorsi More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...