Predictive Value of Positive Surgical Margins Defined

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CHICAGO—Positive surgical margins predict biochemical failure in patients who have had a radical prostatectomy for pT2 prostate cancer, but not pT3a disease, data suggest.

Sarah P. Psutka, MD, a urology resident at Massachusetts General Hospital in Boston, and colleagues retrospectively studied 322 men, of whom 256 had pT2 disease and 66 had pT3 disease. The positive surgical margin rate was 30% for the group as a whole, 25% for the pT2 patients, and 50% for the pT3 patients.

After a mean follow-up of 10 years, positive surgical margins in men with pT2 disease were associated with a significant 2.29 times increased risk of biochemical failure, after controlling for preoperative PSA level, pathologic stage, Gleason score, seminal vesicle involvement, perineural invasion, and disease volume. Researchers did not find an association between positive surgical margins and recurrence in patients with pT3 disease.

In addition, among men with pT2 disease and positive margins, margin length did not correlate with biochemical failure, Dr. Psutka reported here at the American Urological Association annual meeting.

Study findings may raise questions about the value of using adjuvant therapy for patients with pT3 prostate cancer and positive surgical margins, Dr. Psutka said.
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