Back to 2011 Program

Introduction: Current guidelines state that close prostatectomy margins (<0.1 mm from the inked margin) should be reported as negative on pathology reports. However, this recommendation remains controversial and relies on little evidence. The aim of this study is to evaluate the impact of close margin status on the long-term risk of biochemical recurrence following radical prostatectomy.
Materials & Methods: Eight-hundred ninety-four consecutive patients who underwent radical prostatectomy for localized prostate cancer at Massachusetts General Hospital between 1993 and 1999 were identified. Associations between margin status, Gleason score, pathological stage, pre-operative PSA, prostate weight, age with the risk of biochemical recurrence were examined.
Results: Negative prostatectomy margins occurred in 644 of 894 cases (72%). Of these patients, 100 (15.5%) had close margins. Overall, median time to recurrence was 3.5 years, median follow-up of patients in remission 9.9 years. Cumulative recurrence-free survival differed significantly among the three types of margins (p<0.001). On multivariate analysis, close margin status constituted a significant independent predictor of recurrence (HR 2.23, 95%CI 1.08 - 4.99). Subgroup analysis showed the same impact on prognosis in low-risk tumors. Gleason score and positive margins were the strongest predictors of recurrence.
Conclusions: In this study, margin closeness constituted an independent prognostic factor. However, it was clearly subordinated to Gleason grade and frank positive margins. Our findings reaffirm the need of regular, long-term postoperative follow-up, in particular of patients otherwise considered to be at low-risk.