Presentation Authors: Felix Preisser*, Frankfurt, Germany, Gilberto Coxilha, Alexander Heinze, Raisa Pompe, Hamburg, Germany, Felix Chun, Frankfurt, Germany, Markus Graefen, Hartwig Huland, Derya Tilki, Hamburg, Germany
Introduction: Positive surgical margins (PSM) represent a poor prognostic factor at radical prostatectomy (RP). To investigate the impact of PSM, its length, the focality and the PSM Gleason, on biochemical recurrence (BCR) in organ-confined RP patients.
Methods: Within a high-volume center database we identified patients who harbored organ-confined PCa at RP between 2010 and 2016. Only patients without lymph node invasion and without adjuvant or neoadjuvant treatment were included. Kaplan-Meier analyses and multivariable Cox regression models were used to test the effect of the PSM on the BCR risk.
Results: Overall, 8,770 patients were identified. Of those, 6.6% (n=579) harbored PSM. Patients with PSM had higher median PSA values (8.0 vs. 6.5ng/ml, p < 0.001), higher proportion of primary Gleason â‰¥4 (15.0 vs. 11.5%, p=0.01) and BCR (10.2 vs. 4.3%, p < 0.001). BCR-free survival at 72 months after RP was 77.7 vs. 89.0% for patients with vs. without PSM (p < 0.001). BCR-free survival rates at 72 months were 77.4 vs. 73.6% (p=0.1) for unifocal vs. multifocal PSM, 77.2 vs. 71.8% (p=0.03) for Gleason pattern 3 vs. â‰¥4 at the margin and 88.4 vs. 66.3% (p < 0.001) for < 3mm vs. â‰¥3mm length of margin. In multivariable Cox models PSM was an independent predictor for BCR (HR: 2.62, p < 0.001). However, in subgroups with PSM, only â‰¥3mm PSM represented an independent predictor (HR: 1.93, p=0.04), while focality and Gleason at the margin were no significant predictors.
Conclusions: PSM represents an independent predictor for BCR in organ-confined PCa at RP. Moreover, Gleason â‰¥4 at the margin and â‰¥3mm PSM length were associated with worse BCR-free survival. Closer surveillance of patients with organ-confined PCa at RP and PSM can help to identify those who qualify for early salvage radiotherapy.