Biochemical recurrence rates are similar for pT2-positive surgical margins and pT3a

Abstract

ARTICLE INFO ______________________________________________________________ ______________________Objective: Histological details of positive surgical margins in radical prostatectomy specimens have been related to outcome after surgery in rare studies recently published. Our objective is to assess whether the status of surgical margins, the extent and the Gleason score of positive margins, and the extent of the extraprostatic extension are predictive of biochemical recurrence post-radical prostatectomy. Materials and Methods:Three hundred sixty-five radical prostatectomy specimens were analyzed. The length of the positive surgical margin and extraprostatic extension and the Gleason score of the margin were recorded. Statistical analyses examined the predictive value of these variables for biochemical recurrence.Results: 236 patients were stage pT2R0, 58 pT2R1, 25 pT3R0 and 46 pT3R1. Biochemical recurrence occurred in 11%, 31%, 20% and 45.7% of pT2R0, pT2R1, pT3R0 and pT3R1, respectively. The extent of the positive surgical margins and the Gleason score of the positive surgical margins were not associated with biochemical recurrence in univariate analysis in a mean follow up period of 35.9 months. In multivariate analyses, only the status of the surgical margins and the global Gleason score were associated with biochemical recurrence, with a risk of recurrence of 3.1 for positive surgical margins and of 3.8 for a Gleason score > 7. Conclusion: Positive surgical margin and the global Gleason score are significant risk factors for biochemical recurrence post-radical prostatectomy, regardless of the extent of the surgical margin, the extent of the extraprostatic extension, or the local Gleason score of the positive surgical margin or extraprostatic tissue. pT2R1 disease behaves as pT3R0 and should be treated similarly.

The impact of single positive surgical margin features on biochemical recurrence after robotic radical prostatectomy

“…Savdie et al reported that the risk of PSA recurrence doubled in patients with Gleason 4 and 5 patterns at a PSM and the risk was similar with the NSM patient group among patients with a Gleason 3 score at a PSM (38). In this present study, no significant difference was found in the mean Gleason scores determined at the PSM areas between the groups with and without recurrence similar with some other study in the literature (39). Also, there was no significant difference between the groups with and without recurrence according to a Gleason 3 or Gleason 4 pattern at the PSM area (chi - square and Fisher - exact test).…”

Aumento da Incidência de Recidiva Bioquímica após Prostatectomia Radical em Centro de Formação em Urologia Oncológica no Brasil: Doenças mais Avançadas estão sendo submetidas à Cirurgia?

“…As taxas de falha de prostatectomia foram de 45% a 55% em pacientes com margens positivas quando comparados a 15% a 25% daqueles com margens livres 16 . Outro estudo com 74 pacientes submetidos à prostatectomia radical e com estadiamento patológico T3a mostrou taxa de margem cirúrgica positiva de 49,3% 17 . Na análise multivariada, presença de ISUP 4 ou maior na margem comprometida, margem comprometida maior do que 3 mm e presença de duas ou mais áreas de margem comprometida foram fortemente relacionadas à recorrência bioquímica 18 .…”

Primary Gleason grade and Gleason grade group at positive surgical margins: a systematic review and meta‐analysis

“…There were several other methodological issues also identified with these studies. Some had a low sample size and/or a short follow-up period [7,21,[25][26][27]. Maxeiner et al [28] also showed GS 8-10 increased risk of BCR in univariable analysis; however, they failed to perform a multivariable analysis due to insufficient sample size.…”