MP53-12 LONG TERM ONCOLOGICAL OUTCOMES OF APICAL POSITIVE SURGICAL MARGINS AT RADICAL PROSTATECTOMY IN THE SHARED EQUAL ACCESS REGIONAL CANCER HOSPITAL (SEARCH) COHORT

Abstract

You have accessJournal of UrologyProstate Cancer: Staging I1 Apr 2015MP53-12 LONG TERM ONCOLOGICAL OUTCOMES OF APICAL POSITIVE SURGICAL MARGINS AT RADICAL PROSTATECTOMY IN THE SHARED EQUAL ACCESS REGIONAL CANCER HOSPITAL (SEARCH) COHORT Harpreet Wadhwa, Martha Terris, William Aronson, Christopher Kane, Christopher Amling, Matthew Cooperberg, Stephen Freedland, and Michael Abern Harpreet WadhwaHarpreet Wadhwa More articles by this author , Martha TerrisMartha Terris More articles by this author , William AronsonWilliam Aronson More articles by this author , Christopher KaneChristopher Kane More articles by this author , Christopher AmlingChristopher Amling More articles by this author , Matthew CooperbergMatthew Cooperberg More articles by this author , Stephen FreedlandStephen Freedland More articles by this author , and Michael AbernMichael Abern More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1706AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Approximately 29-38% of all positive surgical margins (PSM) at radical prostatectomy (RP) involve the apex. The prognostic significance of positive margins at the apex remains unclear. We therefore compared the long term the oncologic outcomes of men with only apical PSM to those with negative and non-apical PSM at RP. METHODS The SEARCH database was used to identify 2,625 men with prostate cancer (PCa) managed with RP and pelvic lymphadenectomy with complete pathologic grade and stage data. Men with positive lymph nodes were excluded. Margin status was categorized as negative, apex only, or other positive. Multivariable Cox regression models adjusted for pathologic stage and Gleason sum were developed to test the relationship between margin status and long-term oncologic outcomes (biochemical recurrence [BCR], metastases, PCa death). RESULTS In the final cohort 35.5% had PSM (6.0% apex only and 29.5% PSM at other locations) while 64.5% had negative surgical margins. At 78 months of median follow-up 891 men (33.9%) had BCR, 109 men (4.15%) developed metastases, and 64 men (2.44%) died of PCa. Univariable analysis showed that compared to negative margins, apex only PSM was associated with BCR (HR 1.52; 95% CI, 1.15-2.01), but not metastases or PCa death, while PSM at other locations were associated with increased likelihood for BCR (HR, 2.9; 95% CI, 2.53-3.32), metastases (HR 1.6; 95% CI, 1.11-2.43) and death (HR 1.9; 95% CI, 1.14-3.15). On multivariable analysis, apex only (HR 1.46; 95% CI, 1.11-1.93) and other positive margins (HR 2.1; 95% CI, 0.41-0.91) were associated with BCR but margin status was not associated with metastases or PCa death. CONCLUSIONS In multivariate analysis of large cohort of men undergoing RP, those with PSM at the prostatic apex were less likely to suffer BCR, metastases, or PCa death compared to those with PSM at other locations. When adjusted for pathologic stage and grade, however, PSM at any location were associated with BCR but not long term oncologic outcomes. These data suggest that men with apex only PSM may not be ideal candidates for adjuvant therapy after RP. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e640 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Harpreet Wadhwa More articles by this author Martha Terris More articles by this author William Aronson More articles by this author Christopher Kane More articles by this author Christopher Amling More articles by this author Matthew Cooperberg More articles by this author Stephen Freedland More articles by this author Michael Abern More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...