TI - Prognostic implications of a positive apical margin in radical prostatectomy specimens [see comments]

TI - Anatomic site-specific positive margins in organ-confined prostate cancer and its impact on outcome after radical prostatectomy.

UI - 98031666
AU - Fesseha T; Sakr W; Grignon D; Banerjee M; Wood DP Jr; Pontes JE
TI - Prognostic implications of a positive apical margin in radical prostatectomy specimens [see comments]
SO - J Urol 1997;158(6):2176-9
AD - Department of Urology, Wayne State University, Detroit, Michigan, USA.
AB - PURPOSE: We evaluated the prognostic implication of a positive
surgical margin at the prostatic apex to define the risk of failure
after radical prostatectomy. MATERIALS AND METHODS: Radical
prostatectomy specimens of 590 patients operated on between 1990 and
1994 were reviewed by 2 uropathologists (D. G. and W. S.) to
determine the percentage of patients with a positive margin at the
apex in the absence of positive margins, extraprostatic extension or
involvement of seminal vesicles and pelvic lymph nodes. In this group
of 33 patients, the significance of a positive apex could be
determined without the influence of any other stage related
prognostic factors. Treatment failure was defined as prostate
specific antigen greater than 0.4. All 33 patients have been followed
between 3.5 and 65.5 months (median 38.7). RESULTS: Among 590
patients 236 (40%) had disease completely confined to the prostate. A
total of 217 patients (37%) had either positive surgical margins (M+)
or extraprostatic extension and of these, only 33 (5.5%) had an
apical positive margin in an otherwise prostate confined tumor. Of 33
apical positive margin patients only 3 in whom surgery failed had
progressively detectable prostate specific antigen 3.5 to 65.5 months
after surgery. CONCLUSIONS: A positive surgical margin at the
prostatic apex in the absence of positive margins or extraprostatic
extension elsewhere does not confer a worse prognosis than organ
confined disease. In this study the recurrence rate for patients with
positive apical margins was the same as for those with confined
disease.

AU - Blute ML; Bostwick DG; Bergstralh EJ; Slezak JM; Martin SK; Amling CL;Zincke H

TI - Anatomic site-specific positive margins in organ-confined prostate cancer and its impact on outcome after radical prostatectomy.
SO - Urology 1997;50(5):733-9
AD - Department of Urology, Mayo Clinic, Rochester, MN 55905, USA.

AB - OBJECTIVES: The impact of a positive surgical margin in otherwise
confined prostate cancer after radical prostatectomy remains unclear.
We analyzed the outcome of a large number of patients with organ-
confined prostate cancer according to the presence and anatomic site
of margin positivity. METHODS: We evaluated 2712 prostatectomy
patients with Stage pT2N0 cancer (ie, no evidence of extra-prostatic
disease, seminal vesicle or regional node involvement) and no prior
therapy who were treated by radical prostatectomy between 1987 and
1995 at Mayo Clinic. A total of 697 patients (26%) had positive
margins. To assess the effect of margin status in the absence of
treatment, 378 patients with postoperative adjuvant therapy were not
considered for the study group: the final group consisted of 2334
patients. RESULTS: Overall, 253 (58%) tumors were positive at the
apex and/or urethra, 85 (19%) at the prostate base, 11 (2.5%) at the
anterior prostate, and 174 (40%) at the posterior prostate; 89 (20%)
had at least two margins involved and 21 (8.3%) had more than two
involved. The apex/urethra was the only positive anatomic site in 183
(42%). Five-year survival free of clinical recurrence or prostate-
specific antigen (PSA) biochemical failure (postoperative serum PSA
of 0.2 ng/mL or more) for patients with a single positive margin was
79% for apex or urethra, 78% for anterior/posterior, and 56% for
prostate base. Five-year survival free of clinical recurrence or PSA
(biochemical) failure was slightly higher for those with one versus
two margin-positive regions (77% versus 68%, respectively).
Multivariate analysis revealed that positive surgical margins were a
significant predictor of clinical recurrence and PSA (biochemical)
failure (relative risk [95% confidence interval]: 1.65 [1.24, 2.18])
after controlling for Gleason grade, preoperative PSA, and deoxyribo-
nucleic acid (DNA) ploidy. The effect of margin positivity on
recurrence at a specific anatomic site (versus negative margins or
positive at a different anatomic site) revealed the prostate base to
be the only significant anatomic site when adjusted for grade, PSA,
and ploidy. Five-year survival free of the combined clinical or PSA
failure end point for those with versus those without positive
margins at the prostate base was 56% versus 85%, respectively (P <
0.0001). CONCLUSIONS: Positive surgical margins are a significant
predictor of recurrence in Stage pT2N0 cancer, which is independent
of grade, PSA, and DNA ploidy. The impact of positive margin status
on recurrence-free survival appears to be anatomic and site-specific,
with prostate base positivity significantly associated with poor
outcome. The benefit of adjuvant therapy based on anatomic site-
specific margin positivity remains to be tested in order to optimize
recurrence-free survival.