Evaluating the effectiveness of adjuvant therapy on biochemical recurrence in prostate cancer patients with positive surgical margins after radical prostatectomy

Abstract

BACKGROUND: This study investigates the correlations between positive surgical margins (PSMs) and biochemical recurrence (BCR) in patients undergoing radical prostatectomy (RP). METHODS: A cohort of 111 patients who underwent RP between 2011 and 2020 was subjected to comprehensive analysis. Clinicopathological and laboratory data were collected to evaluate the influence of Gleason score (GS) and different PSM sites on BCR-free survival following RP. Various statistical analyses, including the Chi-square test, student's t-test, Cox regression models, and the Inverse Probability of Treatment Weighting (IPTW) model, were employed to examine the impact of these factors on patient outcomes. RESULTS: The IPTW model revealed a consistent reduction in the risk of BCR among patients who received adjuvant therapy, irrespective of age, pre-biopsy prostate-specific antigen (PSA) levels, or the presence of lymphatic vascular invasion (LVI). Within the subgroup receiving adjuvant therapy, factors such as pathological GS≥8 (p<0.0001), pathological tumor stage (pT stage) beyond T3 (p<0.0001), presence of perineural invasion (PNI) (p<0.0001), utilization of a robotic-assisted radical prostatectomy (RaRP) surgical approach (p<0.0001), and involvement of apical or multifocal PSM sites (p=0.0042 and 0.0054) were identified as significantly associated with the observed protective effect of adjuvant therapy. CONCLUSIONS: This study underscores the importance of identifying apical PSMs, as their presence is associated with an elevated risk of BCR. Administering timely adjuvant therapy to patients with apical PSMs emerges as a potential strategy to improve outcomes. Nevertheless, further research is warranted to refine clinical decision-making and treatment approaches in light of these findings.