Predictive Significance of Surgical Margin Status After Prostatectomy for Prostate Cancer During PSA Era

• Published in: Urology (Ridgewood, N.J.) Vol. 72; no. 6; pp. 1203 - 1207
• Main Authors: Mann, M.J, DeCastro, G.J, Desai, M, Benson, M.C, McKiernan, J.M
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-12-2008; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Gynecology. Andrology. Obstetrics; Humans; Male; Male genital diseases; Medical Oncology - methods; Medical sciences; Middle Aged; Neoplasm Recurrence, Local - diagnosis; Neoplasm Recurrence, Local - pathology; Nephrology. Urinary tract diseases; Predictive Value of Tests; Prognosis; Prostate-Specific Antigen - analysis; Prostate-Specific Antigen - blood; Prostatectomy - methods; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - surgery; Risk Factors; Treatment Outcome; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland; Urology; Nephrology; Urinary system disease; Prostate disease; Tumoral marker; Malignant tumor; Urology; Prostate specific antigen; Treatment; Surgery; Prostatectomy; Surgical margin; Predictive factor; Male genital diseases; Prostate cancer; Cancer
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2008.04.068

Objectives The presence of positive surgical margins (PSMs) after prostatectomy for prostate cancer has long been an indicator of poor survival outcomes. However, with the downstaging of cancer occurring in the prostate-specific antigen testing era, we sought to determine whether the risk associated with PSMs retains the same effect on prognosis as before the prostate-specific antigen testing era. Methods Of the 3460 patients in the Columbia University Urologic Oncology database, 2215 (64%) were identified who had undergone radical prostatectomy from 1991 to 2005 and had sufficient pathologic data to be analyzed and ≥1 year of follow-up. Three epochs were chosen: 1991-1995, 1996-2000, and 2001-2005. Results The median age, preoperative prostate-specific antigen, and Gleason score was 61.6 years, 6 ng/mL, and 7, respectively, and >50% of patients had pathologic Stage T2 disease. On multivariate analysis, PSMs were a risk factor for biochemical failure for each epoch ( P < .01). The Wald's test indicated that the significance of PSMs had not changed over time ( P = .8). The contribution of PSMs to the accuracy of predicting biochemical failure in a multivariate model was found only for the earliest epoch, because it improved the model by 0.15 (95% confidence interval 0.03-0.27). In the second epoch, it was 0.13 (95% confidence interval −0.01 to 0.27), and it was 0.13 for the third (95% confidence interval −0.06 to 0.32). Conclusions The results of this study suggest that the predictive contribution of PSMs to the accuracy of a multivariate model or nomogram used to predict the outcomes after prostatectomy has decreased during the past 15 years.