Risk factors for biochemical recurrence following radical perineal prostatectomy in a large contemporary series: A detailed assessment of margin extent and location

• Published in: Urologic oncology 2013-11, Vol.31 (8), p.1470-1476
• Main Authors: Sammon, Jesse D., D.O, Trinh, Quoc-Dien, M.D, Sukumar, Shyam, M.D, Ravi, Praful, M.D, Friedman, Ariella, M.D, Sun, Maxine, Ph.D, Schmitges, Jan, M.D, Jeldres, Claudio, M.D, Jeong, Wooju, M.D, Mander, Navneet, M.D, Peabody, James O., M.D, Karakiewicz, Pierre I., M.D, Harris, Michael, M.D
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Neoplasm Grading; Neoplasm Recurrence, Local; Outcome Assessment (Health Care) - statistics & numerical data; Prognosis; Proportional Hazards Models; Prostate - pathology; Prostate - surgery; Prostate-Specific Antigen - blood; Prostatectomy - methods; Prostatic Neoplasms - blood; Prostatic Neoplasms - surgery; Risk Factors; Urology
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2012.03.013

Abstract Objectives The implications of positive surgical margin (PSM) extent and location during radical perineal prostatectomy (RPP) have not been assessed in a contemporary series. We aimed to examine the incidence, location, and extent of PSM as well as their impact on biochemical recurrence (BCR) following RPP. Materials and methods A total of 794 patients underwent RPP by a single surgeon between June 1993 and August 2010. Covariates included age, pathologic T stage, pathologic Gleason sum, preoperative PSA, prostate volume, PSM extent, and location. Life table, Kaplan-Meier, and Cox regression analyses assessed predictors of BCR following RPP. Results PSM were recorded in 162 patients (20.4%); of these, 83 (51.2%) were focal (≤1 mm) whereas 79 (48.8%) were broad (>1 mm). Location of PSM was anterior 10.5%, posterior or lateral 14.8%, bladder neck 23.5%, apical 32.1%, and multifocal 19.1%. At a median follow-up of 54 months, the 5-year BCR-free probability was 90.8% in patients with negative margins, 77.5% in patients with focal PSM, and 47.5% in patients with broad PSM. On multivariable analyses adjusted for age, pathologic T stage, pathologic Gleason sum, preoperative PSA, and prostate volume, broad PSM, (HR = 3.49, P < 0.001) as well as anterior (HR = 3.77, P = 0.003), bladder neck (HR = 2.25, P = 0.01) and multifocal (HR = 3.55, P < 0.001) PSM were independent predictors of BCR. Conclusions In this study, we present oncologic outcomes following RPP in a large contemporary cohort of patients undergoing RPP. In adjusted analyses, broad and anterior PSM carried the highest risk of recurrence after RPP.