Positive surgical margins at radical prostatectomy: Population-based averages within PSA and Gleason strata

Authors

  • Jason P. Izard Department of Urology, University of Washington, Seattle, WA
  • Marco A. Salazar Department of Urology, University of Washington, Seattle, WA
  • Suman Chatterjee Department of Urology, University of Washington, Seattle, WA
  • Daniel W. Lin Department of Urology, University of Washington, Seattle, WA
  • Jonathan L. Wright

DOI:

https://doi.org/10.5489/cuaj.315

Abstract

Background: Positive surgical margins (PSM) are an important determinant of biochemical recurrence after radical prostatectomy (RP). We use a population-based cancer registry to evaluate PSM by stage, Gleason and prostate-specific antigen (PSA).

Methods: We identified men undergoing RP from the Surveillance, Epidemiology and End Results (SEER) database between 2004 and 2007. Differences between those with and without PSM were compared with chi-squared tests. The proportion of cases with PSM were stratified by PSA and Gleason sum for both pT2 and pT3a tumours. Factors associated with PSM were analyzed using chi-square and multivariate logistic regression analysis. A composite variable was used in a second multivariate analysis to display the odds ratio (OR) for a PSM for each discrete combination of PSA, Gleason score and pT stage.

Results: In total, 28 461 RP patients were identified and a PSM was present in 19.5%. PSM were 42% in pT3a and 16% in pT2 cases. Higher PSAs (<4.0, 4-9.9, >10) were associated with higher proportions of PSM (12%, 20% and 28%, p < 0.001). Similarly, higher Gleason scores (≤6, 3+4, 4+3, ≥8) were associated with higher PSM (12%, 22%, 27% and 33%, p < 0.001). For pT2 tumours, the proportion of PSM ranged from 8% (Gleason ≤6, PSA <4.0) to 28% (Gleason 8-10, PSA ≥10). For pT3a tumours, the PSM was higher in each Gleason/PSA strata compared to those with pT2 tumours, reaching 63% for those with pT3a, Gleason 8-10, PSA >10 disease. On multivariate analysis, stage was the largest predictor for PSM (OR 3.05, 95% confidence interval 2.81-3.30), although Gleason score and PSA remained statistically significant.

Conclusion: In this population-based study of PSM after RP, the proportion of PSM vary significantly within different PSA and Gleason strata for organ-confined and extracapsular disease. These data can be used as a reference for urologist self-assessment.

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Published

2013-09-10

How to Cite

Izard, J. P., Salazar, M. A., Chatterjee, S., Lin, D. W., & Wright, J. L. (2013). Positive surgical margins at radical prostatectomy: Population-based averages within PSA and Gleason strata. Canadian Urological Association Journal, 7(9-10), e561–6. https://doi.org/10.5489/cuaj.315

Issue

Vol. 7 No. 9-10 (2013): CUAJ September

Section

Original Research

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