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A Recursive Partitioning Analysis Demonstrating Risk Subsets for 8-Year Biochemical Relapse After Margin-Positive

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Patients with positive surgical margins after prostate cancer surgery have varying risks of recurrence. Low-grade tumors with minimal margin extent have a low risk, while high-grade tumors with extensive margins have a high risk.

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Area of Science:

  • Urology
  • Oncology
  • Pathology

Background:

  • Locally advanced prostate cancer (PC) after radical prostatectomy (RP) with positive surgical margins presents a challenge in determining the need for further treatment.
  • Identifying patients who will benefit from salvage or adjuvant therapy is crucial for optimizing outcomes.

Purpose of the Study:

  • To examine the risk of prostate-specific antigen (PSA) relapse in a large cohort of men with PC following margin-positive RP.
  • To identify clinical and pathological factors that predict PSA relapse after RP.

Main Methods:

  • Retrospective analysis of a multi-institutional database of patients who underwent RP between 2002 and 2010.
  • Exclusion of patients with seminal vesicle/lymph node involvement, metastatic disease, high pre-RP PSA, or prior adjuvant therapy.
  • Kaplan-Meier analysis for biochemical relapse-free survival (bRFS) and recursive partitioning analysis (RPA) using margin extent (ME) and Gleason grade (GG).

Main Results:

  • Analysis included 210 patients with positive margins; 89 experienced PSA relapse at a median follow-up of 105 months.
  • RPA identified 5 distinct risk groups based on GG and ME.
  • The lowest risk group (GG1, ≤ 2 mm ME) had an 8-year bRFS of 92%, while the highest risk group (GG3-5, ≥ 3 mm ME) had an 8-year bRFS of 11%.

Conclusions:

  • Risk stratification of patients with margin-positive RP is feasible using pre-operative and post-operative variables.
  • Patients with low-grade disease and minimal margin involvement have a low recurrence risk and may avoid post-prostatectomy radiation.
  • Patients with higher-grade disease and greater margin involvement may benefit from adjuvant or early salvage radiation therapy.