preoperative predictors for positive surgical margins and their locations after radical prostatectomy in Korean men.

Abstract

Introduction: Positive surgical margins (PSMs) after radical prostatectomy (RP) are well known independent predictive risk factors of disease progression such as biochemical or local disease recurrence. In the present study, the preoperative predictors of PSMs and their locations after RP were evaluated. Materials and Methods: The cases of 2404 patients who had undergone RP for clinically localized prostate cancer at three centers between 1999 and 2010, and who had not received any prior hormonal therapy, were analyzed. PSMs, defined as the presence of cancer cells at the inked margins, were categorized into four groups according to the apical, basal, posterolateral and multifocal locations. Results: PSMs were observed in 802 cases (33.4%). The preoperative PSA, prostate volume and biopsy Gleason scores were significantly associated with increased PSM risk. The distribution of PSM locations was 9.7% (234 of 2404 cases) apex, 3.3% (79) base, 9.4% (225) posterolateral (PL) and 10.9% (264) multifocal locations. The predictive variables for apical PSM were small prostate volume and positive apical biopsy. There were no statistically significant predictors for PL or basal PSM. As correlated with the type of surgery, positive apical biopsy was the predictor of apical PSM in open RP (ORP) (OR=1.7, p=0.009) and robot-assisted laparoscopic radical prostatectomy (RALP) (OR=2.2, p=0.041). Small prostate volume (less than 40ml) was the predictor of apical PSM in ORP (OR=1.6, p=0.012), but for basal PSM in RALP (OR=4.5, p<0.001). There were no statistically significant predictors for the laparoscopic RP patients. Conclusions: High PSA and small prostate volume were predictive factors of PSM. Small prostate volume and positive apical biopsy were the predictive factors of apical PSM. Small prostate volume was associated with PSM at the apex in ORP, but at the base in RALP.