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Positive surgical margins in radical prostatectomy patients do not predict long‐term oncological outcomes: results from the Shared Equal Access Regional Cancer Hospital ( SEARCH ) cohort
Author(s) -
Mithal Prabhakar,
Howard Lauren E.,
Aronson William J.,
Terris Martha K.,
Cooperberg Matthew R.,
Kane Christopher J.,
Amling Christopher,
Freedland Stephen J.
Publication year - 2016
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.13181
Subject(s) - medicine , prostate cancer , prostatectomy , biochemical recurrence , hazard ratio , interquartile range , proportional hazards model , cohort , oncology , stage (stratigraphy) , cancer , prostate specific antigen , retrospective cohort study , urology , metastasis , pathological , confidence interval , paleontology , biology
Objective To assess the impact of positive surgical margins ( PSM s) on long‐term outcomes after radical prostatectomy ( RP ), including metastasis, castrate‐resistant prostate cancer ( CRPC ), and prostate cancer‐specific mortality ( PCSM ). Patients and Methods Retrospective study of 4 051 men in the Shared Equal Access Regional Cancer Hospital ( SEARCH ) cohort treated by RP from 1988 to 2013. Proportional hazard models were used to estimate hazard ratios ( HR s) of PSM s in predicting biochemical recurrence (BCR), CRPC , metastases, and PCSM . To determine if PSM s were more predictive in certain patients, analyses were stratified by pathological Gleason score, stage, and preoperative prostate‐specific antigen ( PSA ) level. Results The median (interquartile range) follow‐up was 6.6 (3.2–10.6) years and 1 127 patients had >10 years of follow‐up. During this time, 302 (32%) men had BCR , 112 (3%) developed CRPC , 144 (4%) developed metastases, and 83 (2%) died from prostate cancer. There were 1 600 (40%) men with PSM s. In unadjusted models, PSM s were significantly associated with all adverse outcomes: BCR , CRPC , metastases and PCSM (all P ≤ 0.001). After adjusting for demographic and pathological characteristics, PSM s were associated with increased risk of only BCR ( HR 1.98, P < 0.001), and not CRPC , metastases, or PCSM ( HR ≤1.29, P > 0.18). Similar results were seen when stratified by pathological Gleason score, stage, or PSA level, and when patients who underwent adjuvant radiotherapy were excluded. Conclusions PSM s after RP are not an independent risk factor for CRPC , metastasis, or PCSM overall or within any subset. In the absence of other high‐risk features, PSM s alone may not be an indication for adjuvant radiotherapy.