Login to Access Video or Poster Abstract: MP64-18
Sources of Funding: none

Introduction

Management of prostate cancer is complicated by positive surgical margins (PSM) after prostatectomy. We present risk factors for and impact of PSM in a large prospective cohort.

Methods

The Heidelberg prospective tumour data base was searched data on PSM including Gleason pattern of PSM, age, BMI, preop.-PSA, Gleason score(GS), Specimen T- and N-stage, PSA up to 10 yrs. after RP etc. RT regime and HT were considered. Recurrence free(RFS) and cancer specific survival(CSS) were evaluated. Analysis was made with the IBM-SPSS software and Chi2-, Students´- t-test and Fischer´s test, Kaplan meier and multivariate analyses.

Results

2383 men were investigated. Approx. 45% had locally advanced disease and 44% had PSM. Significantly higher PSM rates were noted in men with suspicious digital-rectal examination (DRE), pT>2, GS>7 and preop.-PSA>10ng/ml. PSM-rate was also significantly influenced by the surgeon and BMI>25. PT>2, suspicious DRE and preop. PSA>10ng/ml were associated with Gleason-pattern >3 at PSM. Gleason-pattern at PSM did not influence postop. PSA. PSM significantly influenced biochemical recurrence (BCR). Men with PSM had significantly higher PSA at 3, 6, 12, 24, 36, 48 and 60 months. The chance of BCR at 3, 6, 12 and 24 months significantly correlated to preop. PSA. _x000D_ Multivariate analyses revealed significantly higher PSMs only in pT>2 (p<0.001), GS>7(p=0.001), preop. PSA>10ng/ml(p<0.001), BMI>25(p=0.02) and suspicious DRE(p=0.05). Preop. PSA significantly correlated to pT>2 (p<0.001), GS>7(p=0.001), pN+(p=0.001), PSM(p<0.001), and BCR(p=0.05) in the multivariate analysis. _x000D_ 24% received RT; significantly more men with PSM(p<0.001) or GS>7(p<0.001) received RT. pT-stage, GS, PSM and pattern at PSM (à p<0.001) influenced RT-regime significantly. BCR at 12(p<0.001) months was significantly lower after ART; there was no significant correlation between RT-regime and BCR afterwards. RDE(p=0.02), ECOG-Score(p=0.02), pT-stage(p<0.001), GS(p<0.001), PSM (p=0.01) significantly affected CSS. _x000D_ RFS was significantly influenced by pT-stage(p<0.001), PSM(p=0.001), GS (p=0.002), preop. PSA(p<0.001) and suspicious DRE(p=0.001) in the multivariate investigation_x000D_

Conclusions

Aggressive tumour specific characteristics like preop. PSA>10, pT>2 and GS>7 and BMI significantly increased risk for PSM. PSM also considerably influenced BCR. These results underline the importance of early cancer detection enabling prompt therapy. Techniques to reduce PSM-rate especially in advanced prostate cancer should be concurrently explored.

Funding

none