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Keywords:

  • prostatic neoplasm;
  • biochemical recurrence;
  • minimally invasive;
  • prostatectomy;
  • positive surgical margins

Objective

  • To assess the prognostic significance of positive surgical margins (PSMs) after minimally invasive radical prostatectomy (MIRP) in interaction with other established prognosis factors.

Patients and Methods

  • We retrospectively analysed data prospectively collected between 1998 and 2010 for 4628 consecutive patients who underwent MIRP for clinically localized prostate cancer.
  • The impact of PSM on biochemical recurrence (BCR), defined as prostate-specific antigen (PSA) >0.2 ng/mL, was evaluated using multivariable Cox proportional hazards regression.
  • Estimates of BCR-free survival were generated using the Kaplan–Meier method and compared among groups using the log-rank test.

Results

  • The median follow-up was 55 months.
  • On multivariable analysis, PSM was an independent prognostic factor for BCR (adjusted hazard ratio: 2.14 for PSMs vs negative surgical margins (NSMs); 95% confidence interval [CI]: 1.86–2.45; P < 0.001). Other independent predictors for BCR were preoperative PSA, date of surgery, pT stage, Gleason score and lymph node involvement (all P < 0.001).
  • The 5-year BCR-free probability was 80.6% (95% CI: 79–82.2) for NSMs vs 51% (95% CI: 47–55) for PSMs (log-rank P < 0.001).
  • Patients with pT2 and pT3a PSMs had a similar prognosis to those with pT3a and pT3b NSMs, respectively (log-rank P ≥ 0.05).

Conclusion

  • A PSM after MIRP is associated with 2.14-fold increased risk of BCR. In patients with pT2 and pT3a disease, a PSM could be considered a pathological upstaging.