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Positive apical surgical margins after radical retropubic prostatectomy, truth or artefact?
Stephen S Connolly1, Gary C O'Toole, Kiaran J O'Malley
1Department of Urology, University College Dublin, St Vincent's University Hospital, Dublin, Ireland.
Objective:
The significance of a positive apical surgical margin following radical retropubic prostatectomy has been the subject of controversy. We examined the hypothesis that a positive apical margin alone is not associated with an increased probability of biochemical relapse.
Material And Methods:
A total of 162 men underwent radical prostatectomy for clinically organ-confined disease between May 1990 and December 1998. The mean follow-up period was 55 months (minimum 24 months). The mean patient age was 60.8 years. Clinical staging was 67.9% T1 and 32.1% T2. The mean preoperative prostate-specific antigen level was 11.5 ng/ml, and the mean Gleason score was 5.8.
Results:
Overall, 5/64 patients (7.8%) with negative surgical margins and 42/98 (42.9%) with at least one positive surgical margin had biochemical recurrence (p < 0.001). Seven of 25 patients (28%) with a solitary positive apical margin relapsed. A solitary apical positive margin was associated with a statistically significant higher risk of recurrence versus controls (p < 0.05).
Conclusion:
All patients with a positive surgical margin, including those with a solitary apical margin alone, are at significantly increased risk of biochemical failure.