Positive apical surgical margins after radical retropubic prostatectomy, truth or artefact?

摘要

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.