Positive surgical margins at radical prostatectomy: Population-based averages within PSA and Gleason strata

Abstract

Background: Positive surgical margins (PSM) are an important determinant of biochemical recurrence after radical prostatectomy (RP). We use a population-based cancer registry to evaluate PSM by stage, Gleason and prostate-specific antigen (PSA). Methods: We identified men undergoing RP from the Surveillance, Epidemiology and End Results (SEER) database between 2004 and 2007. Differences between those with and without PSM were compared with chi-squared tests. The proportion of cases with PSM were stratified by PSA and Gleason sum for both pT2 and pT3a tumours. Factors associated with PSM were analyzed using chi square and multivariate logistic regression analysis. A composite variable was used in a second multivariate analysis to display the odds ratio (OR) for a PSM for each discrete combination of PSA, Gleason score and pT stage Results: In total, 28 461 RP patients were identified and a PSM was present in 19.5%. PSM were 42% in pT3a and 16% in pT2 cases. Higher PSAs (<4.0, 4-9.9, >10) were associated with higher proportions of PSM (12%, 20% and 28%, p < 0.001). Similarly, higher Gleason scores (≤6, 3+4, 4+3, ≥8) were associated with higher PSM (12%, 22%, 27% and 33%, p < 0.001). For pT2 tumours, the proportion of PSM ranged from 8% (Gleason ≤6, PSA <4.0) to 28% (Gleason 8-10, PSA ≥10). For pT3a tumours, the PSM was higher in each Gleason/PSA strata compared to those with pT2 tumours, reaching 63% for those with pT3a, Gleason 8-10, PSA >10 disease. On multivariate analysis, stage was the largest predictor for PSM (OR 3.05, 95% confidence interval 2.81-3.30), although Gleason score and PSA remained statistically significant. Conclusion: In this population-based study of PSM after RP, the proportion of PSM vary significantly within different PSA and Gleason strata for organ-confined and extracapsular disease. These data can be used as a reference for urologist self-assessment.

The association between nerve sparing and a positive surgical margin during radical prostatectomy

“…The point estimate increases from univariable to multivariable analysis (RR = 1.33 to RR = 1.52) suggesting that significance might be attained with a larger sample size or if additional variables such as tumor volume or margin length were included in the model. In this study, the overall risk of a prostate incision into tumor (pT2R1) was low (5.9%), and within the range of other reported studies (1.3-33%) [13,[19][20][21][22][23][24]. Prostate incision into tumor (pT2R1) has been shown to have a detrimental effect on biochemical recurrence-free survival and potentially, cancer-specific survival [13,14,19-21, 25,26].…”

Construction and validation of web-based nomograms for detecting and prognosticating in prostate adenocarcinoma with bone metastasis

“…The PA patients for this study were obtained from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015.The inclusion criteria were as follows: (1) patients were diagnosed according to the International Classification site for the prostate (C61.9) and ICD-O-3 histology codes for prostate carcinoma (8140) 21 ; (2) patients were diagnosed between 2010 and 2015 based on their applicability to the 7th edition of the AJCC staging system; (3) the patient's gender was confined to male only. Initially, we included 308,332 PA patients, of whom 13,647 (4.43%) had concurrent BM.…”

Effect of positive surgical margins at radical prostatectomy on cancer‐specific mortality in high/very high‐risk prostate cancer patients with Gleason Grade Group 4–5

“…2 PSM were shown to be particularly predictive of worse cancer control rates, especially when combined with high Gleason Grade Group (GGG). [3][4][5] Specifically, the interaction between high GGG and PSM confers higher risk of biochemical recurrence (BCR) than expected from additive effects of both variables. 3 The effect of PSM on the most important and definitive cancer control outcome, namely cancer specific mortality (CSM), is not well established.…”

“…Indeed, in high/very high‐risk (HR/VHR) prostate cancer (PCa), PSM rates are higher and range from 22% to 48% 2 . PSM were shown to be particularly predictive of worse cancer control rates, especially when combined with high Gleason Grade Group (GGG) 3–5 . Specifically, the interaction between high GGG and PSM confers higher risk of biochemical recurrence (BCR) than expected from additive effects of both variables 3 …”