PSM Site Predicts PSA Relapse Risk

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The risk of biochemical recurrence (BCR) after radical prostatectomy for prostate cancer depends on the site of positive surgical margins (PSMs) in the biopsy[?]specimen, according to researchers.

“Men with PSMs at the base and anterior margins of the prostate have a worse prognosis and should be considered candidates for adjuvant treatment due to their very high likelihood of BCR,” the investigators concluded in BJU International (2009; published online ahead of print).

In a study of 1,308 men who underwent radical surgery for prostate cancer, Herbert Lepor, MD, and colleagues at New York University School of Medicine, in New York City, examined the relationship between the location of PSMs and biochemical recurrence. The researchers defined BCR as three consecutive rises in PSA level, with a peak level of at least 0.15 ng/mL. The researchers had more than five years of follow-up data for 246 patients.

Overall, 128 men (9.8%) had one or more PSMs. The site, but not the number, of PSMs, influenced the five-year actuarial BCR rates. Solitary PSMs at the base, anterior, posterolateral, apex, and posterior margins were associated with a 100%, 80%, 49.7%, 41.5%, and 38.3% probability of BCR at five years. Baseline PSA level, Gleason score and perineural invasion independently predicted PSMs.

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