You have accessJournal of UrologyProstate Cancer: Localized1 Apr 20111097 PROGNOSTIC IMPACT OF HISTOPATHOLOGIC CHARACTERISTICS OF POSITIVE APICAL MARGINS IN PATIENTS WITH CLINICALLY LOCALIZED PROSTATE CANCER Ryan Dorin, Peter Nichols, Jie Cai, Donald Skinner, and Gary Lieskovsky Ryan DorinRyan Dorin Los Angeles, CA More articles by this author , Peter NicholsPeter Nichols Los Angeles, CA More articles by this author , Jie CaiJie Cai Los Angeles, CA More articles by this author , Donald SkinnerDonald Skinner Los Angeles, CA More articles by this author , and Gary LieskovskyGary Lieskovsky Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2600AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previous studies on radical prostatectomy (RP) patients have reported that the length of a positive surgical margin may be predictive of disease recurrence, but it is unknown if this finding is applicable to patients with a positive apical margin (AM+) only. We analyzed the impact on outcomes of several specific histopathologic characteristics of AM+ specimens in patients with clinically localized (cT1 / cT2) prostate cancer who underwent RP, with the aim of improving risk stratification for this patient population. METHODS Utilizing an IRB approved prospectively maintained database, we identified 1663 patients with clinically localized prostate cancer who underwent RP between 1988 and 2003 at our institution. There were 188 patients with an apical-only positive surgical margin, of whom 174 had apical margin (AM) sections available for detailed microscopic re-examination by a single urologic pathologist. Histopathologic characteristics of the AM sections were measured and recorded, including length and estimated area of margin involvement, primary Gleason grade of tumor at the margin, and the extent of tumor in the apical section. The risk of disease recurrence (biochemical or clinical) was calculated for each variable using a log rank test, and multivariate analyses were conducted to control for adjuvant radiation, pathologic tumor stage and Gleason grade. RESULTS Median follow up was 10.2 years and the estimated 10 year biochemical recurrence (BCR) free survival was 85%. AM tissue was sectioned using the “shave” technique in 151 specimens, and using the “cone” technique in 23 specimens. On univariate and multivariate analyses, primary Gleason grade at the AM (hazard ratio (HR)=1.7 for Gleason 4 vs. 3, HR=7.3 for Gleason 5 vs. 4, p= 0.018), and the area of tumor in contact with the AM (HR=12.4 for >27mm2, p<0.001) were significant predictors of BCR. In patients who did not receive adjuvant radiation (N=85), percent of the AM involved by tumor was also predictive of disease recurrence (HR=5.2 for >15%, p=0.024). However, length of the AM in contact with tumor was not predictive of recurrence on univariate or multivariate analyses. CONCLUSIONS In patients with clinically organ confined prostate cancer undergoing RP who have an isolated positive AM, the primary Gleason grade and area of tumor in contact with the margin may be useful in identifying patients at a higher risk of recurrence. The length of an isolated positive AM does not appear to be a significant predictive factor for disease progression. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e441 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ryan Dorin Los Angeles, CA More articles by this author Peter Nichols Los Angeles, CA More articles by this author Jie Cai Los Angeles, CA More articles by this author Donald Skinner Los Angeles, CA More articles by this author Gary Lieskovsky Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
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