Extent of positive surgical margins following radical prostatectomy: impact on biochemical recurrence with long-term follow-up

Yoann Koskas,Nicolas Guibert,Jochen Walz,Géraldine Pignot,Cyrille Bastide,Sophie Giusiano,François Lannes,Dominique Rossi,Nicolas Branger

doi:10.1186/s12894-019-0470-8

Abstract

BackgroundTo assess the prognostic value of the extent of positive surgical margins (PSM) following radical prostatectomy (RP) on biochemical recurrence (BR) with long-term follow-up.MethodsThis retrospective study analyzed 1275 RPs performed between January 1992 and December 2013 in two university centers in Marseille (France). The inclusion criteria were: follow-up > 24 months, undetectable postoperative prostate-specific antigen (PSA), no seminal vesicle (SV) invasion, no lymph node invasion confirmed by surgery (pN0) or imaging (pNx), and no neoadjuvant or adjuvant treatment. BR was defined by PSA level ≥ 0.2 ng/mL on two successive samples. We included 189 patients, divided into two groups:- Focal PSM (fPSM): single PSM (sPSM) ≤3 mm;- Extensive PSM (ePSM): sPSM with linear length > 3 mm or several margins regardless of the length.ResultsThe median follow-up was 101 months (18–283) and the median age was 63 years (46–76). BR occurred in only 12.1% (14/115) of cases involving fPSM and in 54.1% (40/74) of cases involving ePSM. In the multivariate model, ePSM patients were significantly associated with increased BR compared to fPSM (hazard ratio [HR] = 6.11; 95% confidence interval [CI] = 3.25–11.49). The ePSM significantly decreased BR-free survival (p < 0.001) for every patient and every subgroup (pT2, pT3a, pG ≤6, and pG ≥7). The median BR time following RP was significantly shorter for ePSM patients than fPSM (57.2 vs. 89.2 months p < 0.001).ConclusionWith a median 8-year follow-up, ePSM was strongly associated with BR compared to fPSM. Therefore, it seems legitimate to monitor patients with fPSM. In cases of ePSM, adjuvant treatment appears effective.

Highlights

To assess the prognostic value of the extent of positive surgical margins (PSM) following radical prostatectomy (RP) on biochemical recurrence (BR) with long-term follow-up
To our knowledge, this is the first study with a median follow-up of 8 years that found no association between Focal PSM (fPSM) and BR in patients who had received no neoadjuvant or adjuvant treatment and exhibited slightly locally-advanced disease (
Our study strongly suggests that the PSM extent should be taken into account in therapeutic decisions following radical prostatectomy

Summary

Introduction

To assess the prognostic value of the extent of positive surgical margins (PSM) following radical prostatectomy (RP) on biochemical recurrence (BR) with long-term follow-up. The presence of positive surgical margins (PSM) following radical prostatectomy (RP) is a worrying for surgeons and patients alike as it represents an independent biochemical recurrence (BR) risk factor [1,2,3,4,5,6,7,8]. A PSM means incomplete cancer resection and may lead to additional treatment, such as either adjuvant radiotherapy (AR) or chemical or surgical castration. These remedial treatments display side effects and affect patient quality of life [12]. The strategy eventually employed varies according to institution, while often left to the surgeon’s discretion or following each team’s habitual practice

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Conclusion