357 RADICAL PROSTATECTOMY AND THE EFFECT OF CLOSE SURGICAL MARGINS: ANALYSIS FROM THE SEARCH DATABASE

Abstract

You have accessJournal of UrologyProstate Cancer: Localized (I)1 Apr 2013357 RADICAL PROSTATECTOMY AND THE EFFECT OF CLOSE SURGICAL MARGINS: ANALYSIS FROM THE SEARCH DATABASE Sean Stroup, Daniel Moreira, Stephen Freedland, Fred Millard, Martha Terris, William Aronson, Joseph Presti, Christopher Amling, and Christopher Kane Sean StroupSean Stroup San Diego, CA More articles by this author , Daniel MoreiraDaniel Moreira New Hyde Park, NY More articles by this author , Stephen FreedlandStephen Freedland Durham, NC More articles by this author , Fred MillardFred Millard La Jolla, CA More articles by this author , Martha TerrisMartha Terris Augusta, GA More articles by this author , William AronsonWilliam Aronson Los Angeles, CA More articles by this author , Joseph PrestiJoseph Presti Palo Alto, CA More articles by this author , Christopher AmlingChristopher Amling Portland, OR More articles by this author , and Christopher KaneChristopher Kane La Jolla, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1744AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Positive surgical margins after radical prostatectomy are a significant predictor for biochemical failure, disease progression, and cancer mortality. Close surgical margins however represent a diagnostic challenge for surgeons. We sought to evaluate the biochemical recurrence patterns among men with radical prostatectomy specimens having negative, positive, and close surgical margins from the Shared Equal Access Regional Cancer Hospital (SEARCH) cohort. METHODS Men undergoing radical prostatectomy between 1988 and 2009 with known final pathologic margin status were evaluated. The cohort was divided into 3 groups based on margin status; negative, positive, and close. Close margins were defined by distance of tumor ≤1mm from the surgical margin or by pathologic description from reports. Biochemical recurrence was defined as PSA >0.2ng/ml, 2 values at 0.2ng/ml, or secondary treatment for an elevated PSA. Predictors of PSA recurrence and prostate cancer specific death were analyzed using Cox-proportional Hazard models. RESULTS Of 3499 men in the SEARCH database, 2468 (70%) men met criteria for inclusion in the analysis. Of these, 1188 (48%) had negative margins, 1058 (43%) had positive margins, and 222 (9%) had close margins. On multivariate analysis, relative to negative margins, men with close margins had a higher risk of biochemical recurrence (HR=1.51, 95%CI=1.18-1.92, P=0.001) and a decreased risk of biochemical recurrence when compared to those men with positive margins (HR=0.74, 95%CI=0.59-0.94, P=0.013). CONCLUSIONS Management of men with close surgical margins is a diagnostic challenge, with a disease course that is not entirely benign. Evaluation of other risk factors in these patients, including Gleason score, seminal vesicle involvement, perineural invasion, and tumor burden may provide further insight for patient management. Ultimately these factors will help better select patients who may benefit from adjuvant therapies. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e144-e145 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sean Stroup San Diego, CA More articles by this author Daniel Moreira New Hyde Park, NY More articles by this author Stephen Freedland Durham, NC More articles by this author Fred Millard La Jolla, CA More articles by this author Martha Terris Augusta, GA More articles by this author William Aronson Los Angeles, CA More articles by this author Joseph Presti Palo Alto, CA More articles by this author Christopher Amling Portland, OR More articles by this author Christopher Kane La Jolla, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...