Publications

Abstract

PURPOSE: Positive surgical margins (PSM) post radical prostatectomy increase the risk of biochemical recurrence in prostate cancer. To establish predictors of biochemical recurrence we analysed the pathologic characteristics of PSMs, including Gleason grade of the carcinoma at the involved margin, a factor that has not been previously reported in the literature. PATIENTS AND METHODS: Clinicopathologic and outcome data on 940 patients who underwent radical prostatectomy (RP) between 1997 and 2003 were collected. Of these, 285 (30.3%) patients with positive margins were identified for pathologic review, including assessment of location of margin, linear extent, number of PSM, plane of margin and Gleason grade (3 vs 4 or 5) at the margin. RESULTS: At a median follow-up of 82 months, the biochemical recurrence rate of the PSM cohort was 29%. On univariate analysis, the presence of Gleason grade 4 or 5 at the margin (34.4% cases) was significantly associated with biochemical recurrence (HR 2.80, 95% CI =1.82-4.32, p<0.001) compared with Gleason grade 3. Linear extent of margin involvement was also associated with recurrence (p=0.009). Single vs multiple margin involvement, location, and plane of the involved margin were not significant predictors of recurrence. On multivariate analysis, Gleason grade 4 or 5 at the margin remained an independent predictor of recurrence (HR 2.14, 95% CI =1.29-4.03, p=0.003). CONCLUSION: The Gleason grade at the site of a PSM identifies patients at increased risk of biochemical recurrence and should aid stratification of patients for adjuvant radiation therapy.