Anatomic site-specific positive margins in organ-confined prostate cancer and its impact on outcome after radical prostatectomy

Michael L. Blute, David G. Bostwick, Erik J. Bergstralh, Jeff M. Slezak, Sandra K. Martin, Christopher Amling, Horst Zincke

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Abstract

Objectives. The impact of a positive surgical margin in otherwise confined prostate cancer after radical prostatectomy remains unclear. We analyzed the outcome of a large number of patients with organ-confined prostate cancer according to the presence and anatomic site of margin positivity. Methods. We evaluated 2712 prostatectomy patients with Stage pT2N0 cancer (ie, no evidence of extraprostatic disease, seminal vesicle or regional node involvement) and no prior therapy who were treated by radical prostatectomy between 1987 and 1995 at Mayo Clinic. A total of 697 patients (26%) had positive margins. To assess the effect of margin status in the absence of treatment, 378 patients with postoperative adjuvant therapy were not considered for the study group; the final group consisted of 2334 patients. Results. Overall, 253 (58%) tumors were positive at the apex and/or urethra, 85 (19%) at the prostate base, 11 (2.5%) at the anterior prostate, and 174 (40%) at the posterior prostate; 89 (20%) had at least two margins involved and 21 (8.3%) had more than two involved. The apex/urethra was the only positive anatomic site in 183 (42%). Five-year survival free of clinical recurrence or prostate-specific antigen (PSA) biochemical failure (postoperative serum PSA of 0.2 ng/mL or more) for patients with a single positive margin was 79% for apex or urethra, 78% for anterior/posterior, and 56% for prostate base. Five-year survival free of clinical recurrence or PSA (biochemical) failure was slightly higher for those with one versus two margin-positive regions (77% versus 68%, respectively). Multivariate analysis revealed that positive surgical margins were a significant predictor of clinical recurrence and PSA (biochemical) failure (relative risk [95% confidence interval]: 1.65 [1.24, 2.18]) after controlling for Gleason grade, preoperative PSA, and deoxyribonucleic acid (DNA) ploidy. The effect of margin positivity on recurrence at a specific anatomic site (versus negative margins or positive at a different anatomic site) revealed the prostate base to be the only significant anatomic site when adjusted for grade, PSA, and ploidy. Five-year survival free of the combined clinical or PSA failure end point for those with versus those without positive margins at the prostate base was 56% versus 85%, respectively (P

Original languageEnglish (US)
Pages (from-to)733-739
Number of pages7
JournalUrology
Volume50
Issue number5
DOIs
StatePublished - Nov 1997
Externally publishedYes

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Prostate-Specific Antigen
Prostatectomy
Prostatic Neoplasms
Prostate
Urethra
Recurrence
Ploidies
Survival
Seminal Vesicles
Status Epilepticus
Neoplasms
Therapeutics
Multivariate Analysis
Confidence Intervals
DNA
Serum

ASJC Scopus subject areas

  • Urology

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Anatomic site-specific positive margins in organ-confined prostate cancer and its impact on outcome after radical prostatectomy. / Blute, Michael L.; Bostwick, David G.; Bergstralh, Erik J.; Slezak, Jeff M.; Martin, Sandra K.; Amling, Christopher; Zincke, Horst.

In: Urology, Vol. 50, No. 5, 11.1997, p. 733-739.

Research output: Contribution to journalArticle

Blute, Michael L. ; Bostwick, David G. ; Bergstralh, Erik J. ; Slezak, Jeff M. ; Martin, Sandra K. ; Amling, Christopher ; Zincke, Horst. / Anatomic site-specific positive margins in organ-confined prostate cancer and its impact on outcome after radical prostatectomy. In: Urology. 1997 ; Vol. 50, No. 5. pp. 733-739.
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abstract = "Objectives. The impact of a positive surgical margin in otherwise confined prostate cancer after radical prostatectomy remains unclear. We analyzed the outcome of a large number of patients with organ-confined prostate cancer according to the presence and anatomic site of margin positivity. Methods. We evaluated 2712 prostatectomy patients with Stage pT2N0 cancer (ie, no evidence of extraprostatic disease, seminal vesicle or regional node involvement) and no prior therapy who were treated by radical prostatectomy between 1987 and 1995 at Mayo Clinic. A total of 697 patients (26{\%}) had positive margins. To assess the effect of margin status in the absence of treatment, 378 patients with postoperative adjuvant therapy were not considered for the study group; the final group consisted of 2334 patients. Results. Overall, 253 (58{\%}) tumors were positive at the apex and/or urethra, 85 (19{\%}) at the prostate base, 11 (2.5{\%}) at the anterior prostate, and 174 (40{\%}) at the posterior prostate; 89 (20{\%}) had at least two margins involved and 21 (8.3{\%}) had more than two involved. The apex/urethra was the only positive anatomic site in 183 (42{\%}). Five-year survival free of clinical recurrence or prostate-specific antigen (PSA) biochemical failure (postoperative serum PSA of 0.2 ng/mL or more) for patients with a single positive margin was 79{\%} for apex or urethra, 78{\%} for anterior/posterior, and 56{\%} for prostate base. Five-year survival free of clinical recurrence or PSA (biochemical) failure was slightly higher for those with one versus two margin-positive regions (77{\%} versus 68{\%}, respectively). Multivariate analysis revealed that positive surgical margins were a significant predictor of clinical recurrence and PSA (biochemical) failure (relative risk [95{\%} confidence interval]: 1.65 [1.24, 2.18]) after controlling for Gleason grade, preoperative PSA, and deoxyribonucleic acid (DNA) ploidy. The effect of margin positivity on recurrence at a specific anatomic site (versus negative margins or positive at a different anatomic site) revealed the prostate base to be the only significant anatomic site when adjusted for grade, PSA, and ploidy. Five-year survival free of the combined clinical or PSA failure end point for those with versus those without positive margins at the prostate base was 56{\%} versus 85{\%}, respectively (P",
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T1 - Anatomic site-specific positive margins in organ-confined prostate cancer and its impact on outcome after radical prostatectomy

AU - Blute, Michael L.

AU - Bostwick, David G.

AU - Bergstralh, Erik J.

AU - Slezak, Jeff M.

AU - Martin, Sandra K.

AU - Amling, Christopher

AU - Zincke, Horst

PY - 1997/11

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N2 - Objectives. The impact of a positive surgical margin in otherwise confined prostate cancer after radical prostatectomy remains unclear. We analyzed the outcome of a large number of patients with organ-confined prostate cancer according to the presence and anatomic site of margin positivity. Methods. We evaluated 2712 prostatectomy patients with Stage pT2N0 cancer (ie, no evidence of extraprostatic disease, seminal vesicle or regional node involvement) and no prior therapy who were treated by radical prostatectomy between 1987 and 1995 at Mayo Clinic. A total of 697 patients (26%) had positive margins. To assess the effect of margin status in the absence of treatment, 378 patients with postoperative adjuvant therapy were not considered for the study group; the final group consisted of 2334 patients. Results. Overall, 253 (58%) tumors were positive at the apex and/or urethra, 85 (19%) at the prostate base, 11 (2.5%) at the anterior prostate, and 174 (40%) at the posterior prostate; 89 (20%) had at least two margins involved and 21 (8.3%) had more than two involved. The apex/urethra was the only positive anatomic site in 183 (42%). Five-year survival free of clinical recurrence or prostate-specific antigen (PSA) biochemical failure (postoperative serum PSA of 0.2 ng/mL or more) for patients with a single positive margin was 79% for apex or urethra, 78% for anterior/posterior, and 56% for prostate base. Five-year survival free of clinical recurrence or PSA (biochemical) failure was slightly higher for those with one versus two margin-positive regions (77% versus 68%, respectively). Multivariate analysis revealed that positive surgical margins were a significant predictor of clinical recurrence and PSA (biochemical) failure (relative risk [95% confidence interval]: 1.65 [1.24, 2.18]) after controlling for Gleason grade, preoperative PSA, and deoxyribonucleic acid (DNA) ploidy. The effect of margin positivity on recurrence at a specific anatomic site (versus negative margins or positive at a different anatomic site) revealed the prostate base to be the only significant anatomic site when adjusted for grade, PSA, and ploidy. Five-year survival free of the combined clinical or PSA failure end point for those with versus those without positive margins at the prostate base was 56% versus 85%, respectively (P

AB - Objectives. The impact of a positive surgical margin in otherwise confined prostate cancer after radical prostatectomy remains unclear. We analyzed the outcome of a large number of patients with organ-confined prostate cancer according to the presence and anatomic site of margin positivity. Methods. We evaluated 2712 prostatectomy patients with Stage pT2N0 cancer (ie, no evidence of extraprostatic disease, seminal vesicle or regional node involvement) and no prior therapy who were treated by radical prostatectomy between 1987 and 1995 at Mayo Clinic. A total of 697 patients (26%) had positive margins. To assess the effect of margin status in the absence of treatment, 378 patients with postoperative adjuvant therapy were not considered for the study group; the final group consisted of 2334 patients. Results. Overall, 253 (58%) tumors were positive at the apex and/or urethra, 85 (19%) at the prostate base, 11 (2.5%) at the anterior prostate, and 174 (40%) at the posterior prostate; 89 (20%) had at least two margins involved and 21 (8.3%) had more than two involved. The apex/urethra was the only positive anatomic site in 183 (42%). Five-year survival free of clinical recurrence or prostate-specific antigen (PSA) biochemical failure (postoperative serum PSA of 0.2 ng/mL or more) for patients with a single positive margin was 79% for apex or urethra, 78% for anterior/posterior, and 56% for prostate base. Five-year survival free of clinical recurrence or PSA (biochemical) failure was slightly higher for those with one versus two margin-positive regions (77% versus 68%, respectively). Multivariate analysis revealed that positive surgical margins were a significant predictor of clinical recurrence and PSA (biochemical) failure (relative risk [95% confidence interval]: 1.65 [1.24, 2.18]) after controlling for Gleason grade, preoperative PSA, and deoxyribonucleic acid (DNA) ploidy. The effect of margin positivity on recurrence at a specific anatomic site (versus negative margins or positive at a different anatomic site) revealed the prostate base to be the only significant anatomic site when adjusted for grade, PSA, and ploidy. Five-year survival free of the combined clinical or PSA failure end point for those with versus those without positive margins at the prostate base was 56% versus 85%, respectively (P

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