Currently the American Urologic Association is holding their annual conference. Like the ASCO and AACR conferences there are many presentations and posters given that harkens the latest in research findings for general urological topics as well as for prostate cancer. I will be reporting on a number of these findings over the next period of time.

Dinizo et al.; (AUA abstract- 192 see the abstract below), based an analysis on Walsh’s data of over 4,000 men who were treated for prostate cancer at Johns Hopkins between 1982 and 2009. All these men had positive surgical margins. The common thread that ran through the entire group of men was an increased risk for post-surgical biochemical progression. However having positive margins was not an independent predictor of an increased risk for prostate cancer specific mortality. At first glance this seems contradictory, however it is easily explained because these men with positive margins then went on to receive adjuvant or salvage therapy.

The bottom line take home message is important; men with positive surgical margins when given adjuvant or salvage therapy status are at no higher risk for prostate cancer-specific mortality. Do you have positive margins, then by all means you must have adjuvant or salvage therapy.

THE ABSTRACT:


    Sunday, May 15, 2011 8:00 AM-10:00 AM
    Prostate Cancer: Staging
    Podium
    Source of Funding: none
    192: IMPLICATIONS OF SURGICAL MARGIN STATUS ON PROSTATE CANCER-SPECIFIC SURVIVAL
    Michael Dinizo. Heather Chalfin, Bruce Trock, Alan Partin, Patrick Walsh, Elizabeth Humphreys, Misop Han
    Baltimore, MD

    INTRODUCTION AND OBJECTIVES: A positive surgical margin (PSM) status is associated with an increased risk of biochemical recurrence following radical prostatectomy (RP). However, the impact of PSM on long-term prostate cancer-specific mortality (PCSM) following RP has not been well elucidated. We examined the impact of PSM on PCSM in a large retrospective cohort of RP patients. METHODS: Between 1982 and 2009, 4,381 men underwent RP by a single surgeon. The median age was 58 years (range 33-81) and the median PSA was 5.5 ng/ml. Cox proportional hazards models were utilized to determine the impact of a PSM on PCSM.

    RESULTS:
    Of the patient population, 4,228 (96.5%) met complete inclusion criteria. RP Gleason score was 6 or below in 2,701 (63.9%), 7 in 1,263 (29.9%), and 8-10 in 264 (6.2%). PSM was found in 487 (11.5%). With a median follow-up of 9 years (range 1-27), 173 men (4.1%) died of prostate cancer. Compared to those with negative surgical margin, men with PSM were more likely to be older (59.2 vs. 57.1) and to have RP in the pre-PSA era (34.9% vs. 12.5%). Additionally, they were more likely to have higher PSA level (11.6 vs. 6.6), Gleason score of 7 or above (60.4% vs. 33%), non-organ-confined tumor (90.8% vs. 31.6%), and postoperative adjuvant or salvage therapy (35.3% vs. 7.4%) (p< 0.001 for all). In a univariate model for PCSM, PSM was highly significant, HR=4.23 (95% CI 3.13-5.73), p<0.0001. However, in a multivariable model adjusting for RP Year, RP Gleason, stage, and (as time dependent covariates) adjuvant or salvage treatment, PSM was no longer significant: HR=1.03 (95% CI 0.73- 1.44), p=0.880.CONCLUSIONS: Prostate cancer-specific survival following RP is excellent. PSM was associated with increased PCSM in a univariate analysis. However, in a multivariable analysis, a PSM was not an independent predictor of PCSM.

    Joel T. Nowak, M.A., M.S.W.