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Predictors of Positive Surgical Margins After Radical Prostatectomy: Analysis of a Contemporary Single Institution Series
Francisco Gelpi, Leonard G Gomella, Costas Lallas, Peter McCue, Chandan Kundavaram, Xiaolong Liu, Edouard J Trabulsi
Thomas Jefferson University Hospital, Philadelphia, PA

Introduction: Positive surgical margins (PSM) after radical prostatectomy (RP) are an important adverse pathologic feature associated with increased risk of disease recurrence. A contemporary single-institution series of RP was examined in order to analyze multiple factors and their relationship with PSM.
Methods: A retrospective review of 1,300 patients in an institutional IRB-approved RP database was performed. Factors assessed included: age, obesity, pre-operative PSA, surgeon, EBL, surgical approach, post-operative stage, post-operative Gleason score, extracapsular extension (ECE), seminal vesical involvement (SVI), perineural invasion (PNI), and prostate weight. Prostate specimens underwent whole mount step sectioned pathologic analysis and confirmatory second level review at a multidisciplinary genitourinary pathology conference. Multivariate logistic regression analysis was performed.
Results: Recognized factors associated with higher PSM included: surgical Gleason score (p=0.002), pathologic stage (pT3/4 vs. pT2) (OR=6.23 p=<0.001), SVI (OR=4.99, p=<0.001), PNI (OR= 4.65, p=<0.001), preoperative PSA (OR=1.11, p= <0.0001), and obesity (OR=1.06, p=0.0002). Younger patient age (OR= 0.98, p< 0.05) and larger prostate weight (OR= 0.98, p=<0.001) were associated with a lower chance of PSM. No statistical difference was appreciated regardless of surgical approach (open, laparoscopic, robotic-assisted, or conversion), surgeon, EBL, or ECE.
Conclusions: PSM after RP are associated with multiple demographic, operative, and pathologic factors. In this series, it was also observed that younger patients and larger prostates had lower PSM. Furthermore, obesity was associated with higher rates of PSM: the cause and implication of this association are unclear, but are consistent with the finding that obesity is related to worse prostate cancer outcomes.


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