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Should a Positive Surgical Margin Following Radical Prostatectomy be Pathological Stage T2 or T3? Results From the SEARCH Database

2003; Lippincott Williams & Wilkins; Volume: 169; Issue: 6 Linguagem: Inglês

10.1097/01.ju.0000061760.23169.be

1527-3792

Stephen J. Freedland, William J. Aronson, Joseph C. Presti, Christopher J. Kane, Martha K. Terris, DAVID ELASHOFF, Christopher L. Amling,

Urologic and reproductive health conditions

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Jun 2003Should a Positive Surgical Margin Following Radical Prostatectomy be Pathological Stage T2 or T3? Results From the SEARCH Database THE SEARCH DATABASE STUDY GROUP:, STEPHEN J. FREEDLAND, WILLIAM J. ARONSON, JOSEPH C. PRESTI, CHRISTOPHER J. KANE, MARTHA K. TERRIS, DAVID ELASHOFF, and CHRISTOPHER L. AMLING THE SEARCH DATABASE STUDY GROUP: More articles by this author , STEPHEN J. FREEDLANDSTEPHEN J. FREEDLAND More articles by this author , WILLIAM J. ARONSONWILLIAM J. ARONSON More articles by this author , JOSEPH C. PRESTIJOSEPH C. PRESTI Financial interest and/or other relationship with Astra Zeneca. More articles by this author , CHRISTOPHER J. KANECHRISTOPHER J. KANE Financial interest and/or other relationship with AMS, Astra Zeneca, Merck and TAP. More articles by this author , MARTHA K. TERRISMARTHA K. TERRIS More articles by this author , DAVID ELASHOFFDAVID ELASHOFF More articles by this author , and CHRISTOPHER L. AMLINGCHRISTOPHER L. AMLING Financial interest and/or other relationship with TAP and Astra Zeneca. More articles by this author View All Author Informationhttps://doi.org/10.1097/01.ju.0000061760.23169.beAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The finding of a positive surgical margin associated with extracapsular extension at radical prostatectomy is a poor prognostic factor. However, whether a positive surgical margin with no documented extracapsular extension portends a similarly poor prognosis is unclear. We examined the significance of the pathological features of positive surgical margin and extracapsular extension for predicting biochemical failure following radical prostatectomy. Materials and Methods: We examined data on 1,621 men from the SEARCH Database of patients treated with radical prostatectomy without lymph node metastasis. Patients were separated into 5 groups based on the pathological findings of positive surgical margin, extracapsular extension, and/or seminal vesicle invasion. Preoperative clinical variables were compared across the groups and the groups were compared for time to biochemical recurrence using Cox proportional hazards analysis. Results: Men with seminal vesicle invasion had the highest prostate specific antigen (PSA) recurrence rates, while men with a negative surgical margin and no extracapsular extension had the lowest PSA recurrence rates. There were no differences in PSA failure rates between men with a positive surgical margin and no extracapsular extension versus men with a negative surgical margin and extracapsular extension versus men with extracapsular extension and a positive surgical margin. In this subset of patients with a positive surgical margin and/or extracapsular extension but no seminal vesicle invasion only serum PSA was a significant independent predictor of biochemical recurrence. Conclusions: Men with a positive surgical margin but no extracapsular extension had PSA recurrence rates similar to those in men with extracapsular extension with or without positive margins. Men with extracapsular extension had similar biochemical recurrence rates whether the surgical margin was positive or negative. If confirmed at other institutions, consideration should be given to modifying the current TNM staging system to reflect these findings. References 1 : American Joint Committee on Cancer Manual for Staging of Cancer. Philadelphia: J. B. Lippincott Co.1992. Google Scholar 2 : Correlation of margin status and extraprostatic extension with progression of prostate carcinoma. Cancer1999; 86: 1775. 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Link, Google Scholar From the Departments of Urology and Biostatistics, University of California-Los Angeles and Department of Surgery, Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, Department of Urology, Stanford University School of Medicine, Palo Alto, Department of Urology, University of California San Francisco, San Francisco and Department of Urology, Naval Medical Center, San Diego, California, and Division of Urology, Medical College of Georgia, Augusta, Georgia© 2003 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 169Issue 6June 2003Page: 2142-2146 Advertisement Copyright & Permissions© 2003 by American Urological Association, Inc.Keywordsprostatectomyprostate-specific antigenneoplasm stagingprostatic neoplasmsprostateMetricsAuthor Information THE SEARCH DATABASE STUDY GROUP: More articles by this author STEPHEN J. FREEDLAND More articles by this author WILLIAM J. ARONSON More articles by this author JOSEPH C. PRESTI Financial interest and/or other relationship with Astra Zeneca. More articles by this author CHRISTOPHER J. KANE Financial interest and/or other relationship with AMS, Astra Zeneca, Merck and TAP. More articles by this author MARTHA K. TERRIS More articles by this author DAVID ELASHOFF More articles by this author CHRISTOPHER L. AMLING Financial interest and/or other relationship with TAP and Astra Zeneca. More articles by this author Expand All Advertisement PDF DownloadLoading ...