Prognostic significance of positive surgical margins in patients with extraprostatic carcinoma after radical prostatectomy

Sankar J. Kausik, Michael L. Blute, Thomas J. Sebo, Bradley C. Leibovich, Erik J. Bergstralh, Jeff Slezak, Horst Zincke

Research output: Contribution to journalArticle

89 Citations (Scopus)

Abstract

BACKGROUND. A significant number of prostate adenocarcinoma patients undergoing radical prostatectomy are found to have microscopic extraprostatic disease extension. A majority of these patients have focal extraprostatic extension limited to one or both sides of the prostate. In addition, positive surgical margins are a common pathologic finding in this patient subgroup. In the current study, the authors evaluated the impact of positive surgical margins as an independent predictive factor for prostate specific antigen (PSA) progression in patients with pT3a/b N0M0 carcinoma. METHODS. The Mayo Clinic prostate cancer registry list provided 1202 patients with pT3a/b NO prostate carcinoma (no seminal vesicle or regional lymph node involvement) who underwent a radical prostatectomy between 1987-1995. To reduce confounding variables, patients who received preoperative therapy or adjuvant therapy were excluded, resulting in 842 patients who were eligible for analysis. RESULTS. A total of 354 patients (42%) had ≥ 1 positive surgical margins whereas 488 patients (58%) demonstrated no margin involvement. The sites of margin positivity were as follows: apex (n = 163), base (n = 47), posterior prostate (n = 227), and anterior prostate (n = 11). A total of 111 patients had ≥ 2 positive surgical margins. The 5-year survival free of clinical recurrence and/or biochemical failure (postoperative PSA level > 0.2 ng/mL) for patients with no positive surgical margins was 76% and was 65% for patients with 1 positive surgical margin (P = 0.0001). There was no significant difference in biochemical disease progression between patients with 1 versus those with ≥ 2 surgical margins (65% vs. 62%). Multivariate analysis revealed that positive surgical margins were a significant predictor (P = 0.0017) of clinical disease recurrence and biochemical failure (relative risk, 1.55; 95% confidence interval, 1.18-2.04) after controlling for preoperative PSA, Gleason score, and DNA ploidy. CONCLUSIONS. In the current study, positive surgical margins were found to be a significant predictor of disease recurrence in patients with pT3a/b NO prostate carcinoma, a finding that is independent of PSA, Gleason score, and DNA ploidy. The benefit of adjuvant therapy in optimizing recurrence-free survival remains to be tested.

Original languageEnglish (US)
Pages (from-to)1215-1219
Number of pages5
JournalCancer
Volume95
Issue number6
DOIs
StatePublished - Sep 15 2002

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Prostatectomy
Carcinoma
Prostate
Prostate-Specific Antigen
Recurrence
Neoplasm Grading
Ploidies
Margins of Excision
Confounding Factors (Epidemiology)
Survival
Seminal Vesicles
DNA
Registries
Disease Progression
Prostatic Neoplasms
Adenocarcinoma
Therapeutics
Multivariate Analysis
Lymph Nodes

Keywords

  • Extraprostatic extension
  • Neoplasm
  • Prostatic neoplasms
  • Recurrence
  • Staging

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Kausik, S. J., Blute, M. L., Sebo, T. J., Leibovich, B. C., Bergstralh, E. J., Slezak, J., & Zincke, H. (2002). Prognostic significance of positive surgical margins in patients with extraprostatic carcinoma after radical prostatectomy. Cancer, 95(6), 1215-1219. https://doi.org/10.1002/cncr.10871

Prognostic significance of positive surgical margins in patients with extraprostatic carcinoma after radical prostatectomy. / Kausik, Sankar J.; Blute, Michael L.; Sebo, Thomas J.; Leibovich, Bradley C.; Bergstralh, Erik J.; Slezak, Jeff; Zincke, Horst.

In: Cancer, Vol. 95, No. 6, 15.09.2002, p. 1215-1219.

Research output: Contribution to journalArticle

Kausik, SJ, Blute, ML, Sebo, TJ, Leibovich, BC, Bergstralh, EJ, Slezak, J & Zincke, H 2002, 'Prognostic significance of positive surgical margins in patients with extraprostatic carcinoma after radical prostatectomy', Cancer, vol. 95, no. 6, pp. 1215-1219. https://doi.org/10.1002/cncr.10871
Kausik SJ, Blute ML, Sebo TJ, Leibovich BC, Bergstralh EJ, Slezak J et al. Prognostic significance of positive surgical margins in patients with extraprostatic carcinoma after radical prostatectomy. Cancer. 2002 Sep 15;95(6):1215-1219. https://doi.org/10.1002/cncr.10871
Kausik, Sankar J. ; Blute, Michael L. ; Sebo, Thomas J. ; Leibovich, Bradley C. ; Bergstralh, Erik J. ; Slezak, Jeff ; Zincke, Horst. / Prognostic significance of positive surgical margins in patients with extraprostatic carcinoma after radical prostatectomy. In: Cancer. 2002 ; Vol. 95, No. 6. pp. 1215-1219.
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abstract = "BACKGROUND. A significant number of prostate adenocarcinoma patients undergoing radical prostatectomy are found to have microscopic extraprostatic disease extension. A majority of these patients have focal extraprostatic extension limited to one or both sides of the prostate. In addition, positive surgical margins are a common pathologic finding in this patient subgroup. In the current study, the authors evaluated the impact of positive surgical margins as an independent predictive factor for prostate specific antigen (PSA) progression in patients with pT3a/b N0M0 carcinoma. METHODS. The Mayo Clinic prostate cancer registry list provided 1202 patients with pT3a/b NO prostate carcinoma (no seminal vesicle or regional lymph node involvement) who underwent a radical prostatectomy between 1987-1995. To reduce confounding variables, patients who received preoperative therapy or adjuvant therapy were excluded, resulting in 842 patients who were eligible for analysis. RESULTS. A total of 354 patients (42{\%}) had ≥ 1 positive surgical margins whereas 488 patients (58{\%}) demonstrated no margin involvement. The sites of margin positivity were as follows: apex (n = 163), base (n = 47), posterior prostate (n = 227), and anterior prostate (n = 11). A total of 111 patients had ≥ 2 positive surgical margins. The 5-year survival free of clinical recurrence and/or biochemical failure (postoperative PSA level > 0.2 ng/mL) for patients with no positive surgical margins was 76{\%} and was 65{\%} for patients with 1 positive surgical margin (P = 0.0001). There was no significant difference in biochemical disease progression between patients with 1 versus those with ≥ 2 surgical margins (65{\%} vs. 62{\%}). Multivariate analysis revealed that positive surgical margins were a significant predictor (P = 0.0017) of clinical disease recurrence and biochemical failure (relative risk, 1.55; 95{\%} confidence interval, 1.18-2.04) after controlling for preoperative PSA, Gleason score, and DNA ploidy. CONCLUSIONS. In the current study, positive surgical margins were found to be a significant predictor of disease recurrence in patients with pT3a/b NO prostate carcinoma, a finding that is independent of PSA, Gleason score, and DNA ploidy. The benefit of adjuvant therapy in optimizing recurrence-free survival remains to be tested.",
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AU - Kausik, Sankar J.

AU - Blute, Michael L.

AU - Sebo, Thomas J.

AU - Leibovich, Bradley C.

AU - Bergstralh, Erik J.

AU - Slezak, Jeff

AU - Zincke, Horst

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N2 - BACKGROUND. A significant number of prostate adenocarcinoma patients undergoing radical prostatectomy are found to have microscopic extraprostatic disease extension. A majority of these patients have focal extraprostatic extension limited to one or both sides of the prostate. In addition, positive surgical margins are a common pathologic finding in this patient subgroup. In the current study, the authors evaluated the impact of positive surgical margins as an independent predictive factor for prostate specific antigen (PSA) progression in patients with pT3a/b N0M0 carcinoma. METHODS. The Mayo Clinic prostate cancer registry list provided 1202 patients with pT3a/b NO prostate carcinoma (no seminal vesicle or regional lymph node involvement) who underwent a radical prostatectomy between 1987-1995. To reduce confounding variables, patients who received preoperative therapy or adjuvant therapy were excluded, resulting in 842 patients who were eligible for analysis. RESULTS. A total of 354 patients (42%) had ≥ 1 positive surgical margins whereas 488 patients (58%) demonstrated no margin involvement. The sites of margin positivity were as follows: apex (n = 163), base (n = 47), posterior prostate (n = 227), and anterior prostate (n = 11). A total of 111 patients had ≥ 2 positive surgical margins. The 5-year survival free of clinical recurrence and/or biochemical failure (postoperative PSA level > 0.2 ng/mL) for patients with no positive surgical margins was 76% and was 65% for patients with 1 positive surgical margin (P = 0.0001). There was no significant difference in biochemical disease progression between patients with 1 versus those with ≥ 2 surgical margins (65% vs. 62%). Multivariate analysis revealed that positive surgical margins were a significant predictor (P = 0.0017) of clinical disease recurrence and biochemical failure (relative risk, 1.55; 95% confidence interval, 1.18-2.04) after controlling for preoperative PSA, Gleason score, and DNA ploidy. CONCLUSIONS. In the current study, positive surgical margins were found to be a significant predictor of disease recurrence in patients with pT3a/b NO prostate carcinoma, a finding that is independent of PSA, Gleason score, and DNA ploidy. The benefit of adjuvant therapy in optimizing recurrence-free survival remains to be tested.

AB - BACKGROUND. A significant number of prostate adenocarcinoma patients undergoing radical prostatectomy are found to have microscopic extraprostatic disease extension. A majority of these patients have focal extraprostatic extension limited to one or both sides of the prostate. In addition, positive surgical margins are a common pathologic finding in this patient subgroup. In the current study, the authors evaluated the impact of positive surgical margins as an independent predictive factor for prostate specific antigen (PSA) progression in patients with pT3a/b N0M0 carcinoma. METHODS. The Mayo Clinic prostate cancer registry list provided 1202 patients with pT3a/b NO prostate carcinoma (no seminal vesicle or regional lymph node involvement) who underwent a radical prostatectomy between 1987-1995. To reduce confounding variables, patients who received preoperative therapy or adjuvant therapy were excluded, resulting in 842 patients who were eligible for analysis. RESULTS. A total of 354 patients (42%) had ≥ 1 positive surgical margins whereas 488 patients (58%) demonstrated no margin involvement. The sites of margin positivity were as follows: apex (n = 163), base (n = 47), posterior prostate (n = 227), and anterior prostate (n = 11). A total of 111 patients had ≥ 2 positive surgical margins. The 5-year survival free of clinical recurrence and/or biochemical failure (postoperative PSA level > 0.2 ng/mL) for patients with no positive surgical margins was 76% and was 65% for patients with 1 positive surgical margin (P = 0.0001). There was no significant difference in biochemical disease progression between patients with 1 versus those with ≥ 2 surgical margins (65% vs. 62%). Multivariate analysis revealed that positive surgical margins were a significant predictor (P = 0.0017) of clinical disease recurrence and biochemical failure (relative risk, 1.55; 95% confidence interval, 1.18-2.04) after controlling for preoperative PSA, Gleason score, and DNA ploidy. CONCLUSIONS. In the current study, positive surgical margins were found to be a significant predictor of disease recurrence in patients with pT3a/b NO prostate carcinoma, a finding that is independent of PSA, Gleason score, and DNA ploidy. The benefit of adjuvant therapy in optimizing recurrence-free survival remains to be tested.

KW - Extraprostatic extension

KW - Neoplasm

KW - Prostatic neoplasms

KW - Recurrence

KW - Staging

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