Close Surgical Margins Raise Prostate Cancer Recurrence Risk

SAN DIEGO—Patients found to have close surgical margins after radical prostatectomy (RP) are at higher risk of biochemical recurrence of prostate cancer compared with men with negative surgical margins, researchers reported at the American Urological Association annual meeting.

In a study of 3,499 men who underwent RP from 1988-2009, Sean Stroup, MD, of the University of California San Diego School of Medicine in La Jolla, and colleagues found that close margins were associated with a significant 51% increased risk of biochemical recurrence compared with patients who had negative margins, after adjusting for multiple variables. In addition, the close margin group had a 26% decreased risk of biochemical recurrence compared with men who had positive margins.

The investigators defined close margins as a 1 mm or less distance from the tumor to surgical margin or by pathologic description from reports. They defined biochemical recurrence as a PSA level greater than 0.2 ng/mL, two values at 0.2 ng/mL, or secondary treatment for an elevated PSA.

“Management of men with close surgical margins is a diagnostic challenge, with a disease course that is not entirely benign,” the authors concluded in their study abstract. “Evaluation of other risk factors in these patients, including Gleason score, seminal vesicle involvement, perineural invasion, and tumor burden may provide further insight for patient management. Ultimately these factors will help better select patients who may benefit from adjuvant therapies.”

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