Risk factors of positive surgical margin and biochemical recurrence of patients treated with radical prostatectomy: a single-center 10-year report

Background  Many studies have shown that positive surgical margin and biochemical recurrence could impact the life of patients with prostate cancer treated with radical prostatectomy. With more and more patients with prostate cancer appeared in recent 20 years in China, it is necessary to investigate the risk of positive surgical margin and biochemical recurrence, and their possible impact on the prognosis of patients treated with radical prostatectomy. In this study, we analyzed the characteristics of patients with prostate cancer who had undergone radical prostatectomy in Macau area and tried to find any risk factor of positive surgical margin and biochemical recurrence and their relationship with the prognosis of these patients.

Methods  From 2000 to 2009, 149 patients with prostate cancer received radical prostatectomy and were followed up. Among these patients, 111 received retropubic radical prostatectomies, 38 received laparoscopic radical prostatectomies. All patients were followed-up on in the 3rd month, 6th month and from that point on every 6 months after operation. At each follow-up a detailed record of any complaint, serum prostate-specific antigen (PSA), full biochemical test and uroflowmetry was acquired.

Results  The average age was (69.0±6.1) years, preoperative average serum PSA was (10.1±12.1) ng/ml and average Gleason score was 6.4±1.3. The incidence of total complications was about 47.7%, the incidence of the most common complication, bladder outlet obstruction, was about 26.8%, and that of the second most common complication, urinary stress incontinence, was about 16.1% (mild 9.4% and severe 6.7%). The incidence of positive surgical margin was about 38.3%. The preoperative serum PSA ((13.4±17.6) ng/ml), average Gleason score (7.1±1.3) and pathological T stage score (7.0±1.4) were higher in patients with positive surgical margins than those with negative margins ((8.0±5.8) ng/ml, 6.0±1.2 and 5.4±1.4, respectively) (P=0.004, P=0.001 and P=0.001, respectively). A univariate analysis showed that positive surgical margin had a positive statistical association with serum PSA (P=0.007), Gleason score (P <0.001), pathological T stage score (P <0.001) and biochemical recurrence (BCR) (P=0.035). The most common location of a positive surgical margin was in the apex of the prostate, which was about 63% (36/57). Sixty-four percent (23/36) of patients with positive surgical margin in apex were also involved in prostate lobe; other locations were prostate lobe (23%, 13/57), seminal vesicle (9%, 5/57). The multivariate analysis showed that positive surgical margin had a positive statistical association with Gleason score (P=0.03) and pathological T stage score (P=0.02). Neither univariate analysis or multivariate analysis showed any statistical relationship between BCR and any other risk factors covered in this study.

Conclusions  Positive surgical margin is associated with pre-operative PSA, Gleason score, pathological T stage and biochemical recurrence. Earlier diagnosis and improved techniques of dissection of prostate apex could decrease the incidence of positive surgical margins.

Risk factors of positive surgical margin and biochemical recurrence of patients treated with radical prostatectomy: a single-center 10-year report

Background Many studies have shown that positive surgical margin and biochemical recurrence could impact the life of patients with prostate cancer treated with radical prostatectomy. With more and more patients with prostate cancer appeared in recent 20 years in China,it is necessary to investigate the risk of positive surgical margin and biochemical recurrence,and their possible impact on the prognosis of patients treated with radical prostatectomy. In this study,we analyzed the characteristics of patients with prostate cancer who had undergone radical prostatectomy in Macau area and tried to find any risk factor of positive surgical margin and biochemical recurrence and their relationship with the prognosis of these patients.Methods From 2000 to 2009,149 patients with prostate cancer received radical prostatectomy and were followed up.Among these patients,111 received retropubic radical prostatectomies,38 received laparoscopic radical prostatectomies.All patients were followed-up on in the 3rd month,6th month and from that point on every 6 months after operation. At each follow-up a detailed record of any complaint,serum prostate-specific antigen (PSA),full biochemical test and uroflowmetry was acquired.Results The average age was (69.0±6.1) years,preoperative average serum PSA was (10.1 ±12.1) ng/ml and average Gleason score was 6.4±1.3. The incidence of total complications was about 47.7%,the incidence of the most common complication,bladder outlet obstruction,was about 26.8%,and that of the second most common complication,urinary stress incontinence,was about 16.1% (mild 9.4% and severe 6.7%). The incidence of positive surgical margin was about 38.3%. The preoperative serum PSA ((13.4±17.6) ng/ml),average Gleason score (7.1±1.3) and pathological T stage score (7.0±1.4) were higher in patients with positive surgical margins than those with negative margins ((8.0±5.8) ng/ml,6.0±1.2 and 5.4±1.4,respectively) (P=0.004,P=0.001 and P=0.001,respectively). A univariate analysis showed that positive surgical margin had a positive statistical association with serum PSA (P=0.007),Gleason score (P ＜0.001),pathological T stage score (P ＜0.001) and biochemical recurrence (BCR) (P=0.035). The most common location of a positive surgical margin was in the apex of the prostate,which was about 63% (36/57). Sixty-four percent (23/36) of patients with positive surgical margin in apex were also involved in prostate lobe;other locations were prostate lobe (23%,13/57),seminal vesicle (9%,5/57). The multivariate analysis showed that positive surgical margin had a positive statistical association with Gleason score (P=0.03) and pathological T stage score (P=0.02). Neither univariate analysis or multivariate analysis showed any statistical relationship between BCR and any other risk factors covered in this study.Conclusions Positive surgical margin is associated with pre-operative PSA,Gleason score,pathological T stage and biochemical recurrence. Earlier diagnosis and improved techniques of dissection of prostate apex could decrease the incidence of positive surgical margins.