Introduction & Objectives: The presence of positive surgical margins (PSM) in radical prostatectomy (RP) specimens has been repeatedly associated with an increased risk of biochemical recurrence (BCR) in disease follow-up. We aimed to evaluate outcomes in patients submitted to RP in our department and with detectable PSM.
Materials & Methods: Clinical data was gathered on the radical prostatectomies (RP) performed between January 2012 and December 2016 in our department. Considered variables were age, initial PSA, surgical access (open/laparoscopic), RP pathology data, adjuvant radiotherapy. Analyzed outcomes were biochemical recurrence (BCR), time to BCR, metastasis-free survival (MFS) and cancer specific survival (CSS). Statistical analysis was performed using SPSS v20.
Results: Two hundred and nine (n=209) radical prostatectomies were performed. Mean age was 65.1 ± 5.9 years old, and initial PSA was 10.34 ± 6.53 ng/mL. Patients were divided in two groups: group 1 with detected PSM (n = 79), and group 2 without PSM (n=130). The prevalence of PSM was higher in more advanced tumours (pT2 20.1% in pT2, 63.4% in pT3a and 78.8% in pT3b/T4). Tumours in group 1 had a higher Gleason score (RP ISUP grade ≥ 4 in 29.1% vs. 7.7%, p=0.03) and were more frequently extraprostatic (≥pT3a disease in 65.8% (52) vs. 17.1% (22), p<0.001) comparing to group 2. There was no difference in PSM prevalence between open and laparoscopic access. After a mean follow-up of 56.9 ± 12.7 months, BCR prevalence was 26.6% (n=21) in group 1 and 13.1% (n=17) in group 2 (p=0.02), occurring 21.9 ± 11.1 and 24.7 ± 16.5 months after RP (p=0.80), respectively. In a multivariate analysis among group 1 patients, none of the studied variables correlated to BCR (p>0.05). Distante metastasis were detected during follow-up in two patients in each group: MFS was 2.2% in group 1 and 1.5% in group 2 (p=0.33). CSS was 98.7% in group 1 and 100% in group 2 (p=0.13).
Conclusions: Our series’ prevalence of PSM was superior to most reports in literature, which can in part be explained by the highly superior prevalence of extraprostatic disease (65.8%) among our cohort of patients with PSM. The presence of PSM had a significant effect on BCR (p=0.02) and time to its occurrence (p=0.80), but no individual predictors of BCR were identified among this group. PSM had no impact on CSS or prevalence of metastatic disease.
