1000 PROGNOSTIC SIGNIFICANCE OF LENGTH OF POSITIVE SURGICAL MARGINS ON BIOCHEMICAL RECURRENCE AFTER ROBOTIC-ASSISTED RADICAL PROSTATECTOMY IN A SINGLE CENTER WITH MINIMUM FOLLOW-UP OF FIVE YEARS

Abstract

You have accessJournal of UrologyProstate Cancer: Localized (IV)1 Apr 20131000 PROGNOSTIC SIGNIFICANCE OF LENGTH OF POSITIVE SURGICAL MARGINS ON BIOCHEMICAL RECURRENCE AFTER ROBOTIC-ASSISTED RADICAL PROSTATECTOMY IN A SINGLE CENTER WITH MINIMUM FOLLOW-UP OF FIVE YEARS Achilles Ploumidis, Prasanna Sooriakumaran, Leif Haendler, Tommy Nyberg, Mats Olsson, Stefan Carlsson, Gunnar Steineck, and Peter Wiklund Achilles PloumidisAchilles Ploumidis Stockholm, Sweden More articles by this author , Prasanna SooriakumaranPrasanna Sooriakumaran Stockholm, Sweden More articles by this author , Leif HaendlerLeif Haendler Stockholm, Sweden More articles by this author , Tommy NybergTommy Nyberg Stockholm, Sweden More articles by this author , Mats OlssonMats Olsson Stockholm, Sweden More articles by this author , Stefan CarlssonStefan Carlsson Stockholm, Sweden More articles by this author , Gunnar SteineckGunnar Steineck Stockholm, Sweden More articles by this author , and Peter WiklundPeter Wiklund Stockholm, Sweden More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.584AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES It is well established that PSM is a risk factor for BCR, and in our own series, PSM was associated with a 2-3 fold increase in the risk of BCR. In this study we aim to assess the impact of length of PSM as a predictive variable for BCR. METHODS From Jan 2002 to Dec 2006, 944 men with clinically localized or locally advanced (cT1-3) prostate cancer underwent RARP at our institution. Data were prospectively collected and included: age, BMI, preoperative PSA, prostate volume, clinical stage, biopsy Gleason score, pathological stage, specimen Gleason score (GS), margin status (positive, negative), number of PSM (single, multiple) and extent of PSM (mm) and were associated with BCR rate. Margin status and length were measured by seven uropathologists. BCR was defined as PSA ≥0.2 ng/ml on two consecutive measurements. Kaplan-Meier survival plots with log-rank tests and Cox univariable and multivariable regression analysis were used to determine biochemical recurrence-free survival and identify predictors of BCR. RESULTS The overall median follow-up was 6.3 (IQR: 5.6-7.2) years. In total, 194 (21.6%) patients were found to have PSM of which, 104 (16.0%) were pT2, 64 (33.3%) were pT3a and 22 (57.9%) were pT3b. The location of PSM was in 66 (7.4%) patients at the apex, in 87 (9.8%) patients posterolateral, in 33 (3.7%) patients anterior and in 20 (2.2%) patients at the base of the prostate. PSM in multiple locations was noted in 38 patients. In multivariable regression analysis: PSA >10 (HR: 1.86, 95%CI: 1.27-2.72, p=0.0013), pT3a stage (HR: 1.62, 95%CI: 1.07-2.46, p=0.0221), pT3b stage (HR: 3.09, 95%CI: 1.69-5.67, p=0.0003), GS: 3+4 (HR: 2.20, 95%CI: 1.34-3.60, p=0.0017), GS: 4+3 (HR: 5.08, 95%CI: 2.95-8.74, p<0.0001), GS: ≥8 (HR: 3.89, 95%CI: 1.90-7.93, p<0.0002) and PSM length ≥ 3mm or multifocality (HR: 2.84, 95%CI: 1.76-4.58, p<0.0001) remained independent predictors of BCR. CONCLUSIONS In a large RARP series with median follow-up of 6.3 years, PSM length ≥3mm was an independent predictor of BCR. Patients with PSM <3mm had similar BCR outcomes to those with negative surgical margins. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e410-e411 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Achilles Ploumidis Stockholm, Sweden More articles by this author Prasanna Sooriakumaran Stockholm, Sweden More articles by this author Leif Haendler Stockholm, Sweden More articles by this author Tommy Nyberg Stockholm, Sweden More articles by this author Mats Olsson Stockholm, Sweden More articles by this author Stefan Carlsson Stockholm