Prognostic Value of Focal Positive Surgical Margins After Radical Prostatectomy

Abstract

We present a comparison of the prognostic significance of focal positive margins (FPMs) among patients with clinically localized prostate cancer after radical prostatectomy (RP). FPMs after RP did not significantly affect biochemical recurrence-free survival in all patients or patients with pathologic T2 disease. Background: The significance of focal positive margins (FPMs) after radical prostatectomy (RP) is unclear. Our objective was to investigate the prognostic value of FPMs in patients undergoing RP. Materials and Methods: The data were analyzed retrospectively for 1733 patients with clinically localized prostate cancer who had undergone RP at our institution from December 2003 to March 2014 without neoadjuvant or adjuvant therapy. Positive surgical margins were characterized as FPMs (<= 3 mm long) or non-FPMs (> 3 mm long). Multivariate analysis of the clinicopathologic factors, including FPMs, was performed with respect to biochemical recurrence (BCR)-free survival. Results: Of the 1733 patients, 1260 (72.7%) had negative margins, 114 (6.6%) had a FPM, 218 (12.6%) had a nonfocal single positive margin (NFSPM), and 141 (8.1%) had nonfocal multiple positive margins (NFMPMs). Of the patients with pathologic T2 prostate cancer, 1065 (84.3%) had negative margins, 62 (4.9%) had 1 FPM, 104 (8.2%) had 1 NFSPM, and 33 (2.6%) had NFMPMs. The 5-year BCR-free survival for patients with negative margins and FPMs was 90% and 83.4%, respectively. On multivariate analysis, the presence of a FPM was not a significant prognostic factor for BCR-free survival in all the patients or in the patients with pathologic T2 disease (P = .458 and P = .512, respectively). Conclusions: FPMs after RP do not significantly affect BCR-free survival in patients with prostate cancer.