UroToday - Pathologic variables following radical prostatectomy (RP) for prostate cancer (CaP) that might suggest benefit from adjuvant radiotherapy include a positive surgical margin (PSM), seminal vesicle invasion (pT3B disease), and extracapsular extension (pT3a disease). In practice, many urologists don't send patients for adjuvant radiotherapy in the face of a single PSM that is not too extensive, although that practice pattern is not based upon any defined length. In the journal Histopathology, the group from Nijmegen University in the Netherlands correlates the risk of CaP biochemical recurrence and the length of PSM.

The study cohort included 267 patients with a PSM in the RP specimen who underwent surgery between 1995 and 2005. Ninety-three patients were excluded from the analysis; 34 never reached an undetectable PSA level postoperatively and 59 received adjuvant hormonal or radiotherapy. The remaining 174 patients were studied. RP specimens were examined at 4mm thick slices. The dominant or index Gleason score was used for study analysis. The length of the total amount of PSM was determined (summed if more than one area of PSM).

The length of PSMs ranged from 0.4 to 174.5mm with a median of 11.2mm and a mean of 21.9mm. PSM locations were posterior in 43%, anterior in 35%, apical in 33%, posterolateral in 21%, basal in 20%, and at the seminal vesicles in 5%. The length of PSA correlated with preoperative PSA, pathological stage, tumor volume, number of PSM sites, Gleason sum at the PSM and Gleason score. The mean follow-up was 43 months and the 5-year risk of a biochemical recurrence (BCR) was 29%. For men with a PSM < 10mm, the 5-year risk of BCR was 21% compared to 39% for men with >10mm of PSM. Multivariable analysis demonstrated that risk of BCR was associated with increasing length of PSM; < 10mm vs. >10mm, HR 2.15. However, preoperative PSA, pathological stage, Gleason score, tumor volume, and location of the PSM or Gleason pattern at the PSM site were not predictive.

van Oort IM, Bruins HM, Kiemeney LA, Knipscheer BC, Witjes JA, Hulsbergen-van de Kaa CA
Histopathology. 2010 Mar;56(4):464-71
doi: 10.1111/j.1365-2559.2010.03497.x

Written by UroToday Contributing Editor Christopher P. Evans, MD, FACS

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