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Radical prostatectomy and the effect of close surgical margins: results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database.

Publication ,  Journal Article
Herforth, C; Stroup, SP; Chen, Z; Howard, LE; Freedland, SJ; Moreira, DM; Terris, MK; Aronson, WJ; Cooperberg, MR; Amling, CL; Kane, CJ
Published in: BJU international
October 2018

To evaluate biochemical recurrence (BCR) patterns amongst men undergoing radical prostatectomy (RP) with specimens having negative (NSM), positive (PSM), and close surgical margins (CSM) from the Shared Equal Access Regional Cancer Hospital (SEARCH) cohort, as PSM after RP are a significant predictor of biochemical failure and possible disease progression, with CSM representing a diagnostic challenge for surgeons.Men undergoing RP between 1988 and 2015 with known final pathological margin status were evaluated. The cohort was divided into three groups based on margin status; NSM, PSM, and CSM. CSM were defined by distance of tumour ≤1 mm from the surgical margin. BCR was defined as a prostate-specific antigen (PSA) level of >0.2 ng/mL, two values at 0.2 ng/mL, or secondary treatment for an elevated PSA level. Predictors of BCR, metastases, and mortality were analysed using Cox proportional hazard models.Of 5515 men in the SEARCH database, 4337 (79%) men met criteria for inclusion in the analysis. Of these, 2063 (48%) had NSM, 1902 (44%) had PSM, and 372 (8%) had CSM. On multivariable analysis, relative to NSM, men with CSM had a higher risk of BCR (hazard ratio [HR] 1.51, 95% confidence interval [CI] 1.25-1.82; P < 0.001) but a decreased risk of BCR when compared to those men with PSM (HR 2.09, 95% CI 1.86-2.36; P < 0.001). Metastases, prostate cancer-specific mortality and all-cause mortality did not differ based on margin status alone.Management of men with CSM is a diagnostic challenge, with a disease course that is not entirely benign. The evaluation of other known risk factors probably provides greater prognostic value for these men and may ultimately better select those who may benefit from adjuvant therapy.

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Published In

BJU international

DOI

EISSN

1464-410X

ISSN

1464-4096

Publication Date

October 2018

Volume

122

Issue

4

Start / End Page

592 / 598

Related Subject Headings

  • Urology & Nephrology
  • Retrospective Studies
  • Prostatic Neoplasms
  • Prostatectomy
  • Prostate-Specific Antigen
  • Prognosis
  • Neoplasm Recurrence, Local
  • Middle Aged
  • Margins of Excision
  • Male
 

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Herforth, C., Stroup, S. P., Chen, Z., Howard, L. E., Freedland, S. J., Moreira, D. M., … Kane, C. J. (2018). Radical prostatectomy and the effect of close surgical margins: results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database. BJU International, 122(4), 592–598. https://doi.org/10.1111/bju.14178
Herforth, Christine, Sean P. Stroup, Zinan Chen, Lauren E. Howard, Stephen J. Freedland, Daniel M. Moreira, Martha K. Terris, et al. “Radical prostatectomy and the effect of close surgical margins: results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database.BJU International 122, no. 4 (October 2018): 592–98. https://doi.org/10.1111/bju.14178.
Herforth C, Stroup SP, Chen Z, Howard LE, Freedland SJ, Moreira DM, et al. Radical prostatectomy and the effect of close surgical margins: results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database. BJU international. 2018 Oct;122(4):592–8.
Herforth, Christine, et al. “Radical prostatectomy and the effect of close surgical margins: results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database.BJU International, vol. 122, no. 4, Oct. 2018, pp. 592–98. Epmc, doi:10.1111/bju.14178.
Herforth C, Stroup SP, Chen Z, Howard LE, Freedland SJ, Moreira DM, Terris MK, Aronson WJ, Cooperberg MR, Amling CL, Kane CJ. Radical prostatectomy and the effect of close surgical margins: results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database. BJU international. 2018 Oct;122(4):592–598.
Journal cover image

Published In

BJU international

DOI

EISSN

1464-410X

ISSN

1464-4096

Publication Date

October 2018

Volume

122

Issue

4

Start / End Page

592 / 598

Related Subject Headings

  • Urology & Nephrology
  • Retrospective Studies
  • Prostatic Neoplasms
  • Prostatectomy
  • Prostate-Specific Antigen
  • Prognosis
  • Neoplasm Recurrence, Local
  • Middle Aged
  • Margins of Excision
  • Male