Solitary and Small Apical PSM Predict Biochemical Recurrence Post-RP

Solitary apical and small (3 mm or smaller) apical positive surgical margins (PSM) may have a significant impact on biochemical recurrence-free survival in localized stages of prostate cancer (PCa) following radical prostatectomy (RP), according to a study publishing online in the International Journal of Urology.

Matthias May, MD, of St. Elisabeth Clinic in Straubing, Germany, and colleagues evaluated the prognostic value of positive surgical margins (PSM) in RP specimens in relation to multifocality, localization, and size. They evaluated 1,036 patients who underwent RP and clinical stage pT2-3a, pN0, M0. None of the patients had received adjuvant or neoadjuvant therapy. The patients were followed-up for a mean of 60 months (range: 1-156 months).

A total of 267 of the 1,036 patients (26%) had PSM. The PSM rates were 21% in stage pT2 tumors and 48% in stage pT3a tumors. Preoperative PSA levels, Gleason score, and PSM were independent predictors of biochemical recurrence (BCR), according to the researchers. The BCR-free survival rate was 59% for patients with PSM and 80% for those without PSM. The study showed that 64% of solitary PSM were apical. Multifocality, localization and PSM size had no impact on BCR.

In an accompanying editorial, Mark Hsu, MD, of Stanford University in Palo Alto, Calif., and Steven L Change, MD of Brigham and Women's Hospital in Boston, related that they had conducted a study showing that PSM specifically at the anterior fibromuscular region or bladder neck conferred an increased risk of future BCR after RP. They noted that the difference between their findings and those of Dr. May's team may be due to differences in study design and methodology. They wrote that PSM collectively may portend a worse prognosis for disease recurrence, but it is still unknown “which aspects of a positive surgical margin are most influential in terms of predicting which patients are at highest risk for disease recurrence.”