Is a Positive Bladder Neck Margin Truly a T4 Lesion in the Prostate Specific Antigen Era? Results From the SEARCH Database

W. Cooper Buschemeyer, Robert J. Hamilton, William J. Aronson, Joseph C. Presti, Martha Kennedy Terris, Christopher J. Kane, Christopher L. Amling, Stephen J. Freedland

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Purpose: Positive bladder neck margins after radical prostatectomy are currently designated as pT4 lesions. However, to our knowledge the prognostic significance of a positive bladder neck margin in the prostate specific antigen era is unknown. We examined the association between positive bladder neck margins and prostate specific antigen recurrence relative to other pathological findings. Materials and Methods: We examined 1,722 men from the Shared Equal Access Research Cancer Hospital Database who were treated with radical prostatectomy without lymph node metastases. Time to prostate specific antigen recurrence was compared in men with positive vs negative bladder neck margins using Cox proportional hazards models adjusted for multiple clinical and pathological features. Results: A positive bladder neck margin in 79 patients (5%) was significantly associated with other poor prognostic features, including higher prostate specific antigen, higher pathological Gleason sum, extracapsular extension, seminal vesicle invasion and other positive margins. After adjusting for clinical and pathological characteristics positive bladder neck margins were associated with an increased risk of prostate specific antigen recurrence (HR 1.52, 95% CI 1.06-2.19, p = 0.02). Relative to organ confined margin negative disease a positive bladder neck margin associated with other positive margins showed a recurrence risk that was similar to that of seminal vesicle invasion (HR 4.14, 95% CI 2.55-6.73 and HR 4.22, 95% CI 3.08-5.78, respectively, each p <0.001). An isolated positive bladder neck margin was a rare event, noted in 15 patients (0.7%). In these men the recurrence risk was difficult to estimate due to the small number. However, the HR was similar to that in men with nonbladder neck positive margins or extracapsular extension (HR 2.65, 95% CI 0.97-7.25, p = 0.06 and HR 2.19, 95% CI 1.71-2.82, p <0.001, respectively). Conclusions: In the current study a positive bladder neck margin was frequently associated with other adverse features. When it was concomitant with other positive margins, a positive bladder neck margin was associated with a progression risk similar to that of seminal vesicle invasion (T3b disease). Although men with an isolated positive bladder neck margin had a more favorable pathological profile, there were too few of them to assess outcome reliably. However, the limited data suggest that they may best be categorized as having pT3a disease.

Original languageEnglish (US)
Pages (from-to)124-129
Number of pages6
JournalJournal of Urology
Volume179
Issue number1
DOIs
StatePublished - Jan 1 2008
Externally publishedYes

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Prostate-Specific Antigen
Urinary Bladder
Databases
Seminal Vesicles
Recurrence
Prostatectomy
Cancer Care Facilities
Proportional Hazards Models
Neck
Lymph Nodes
Neoplasm Metastasis

Keywords

  • bladder
  • neoplasm staging
  • prostate
  • prostatectomy
  • prostatic neoplasms

ASJC Scopus subject areas

  • Urology

Cite this

Is a Positive Bladder Neck Margin Truly a T4 Lesion in the Prostate Specific Antigen Era? Results From the SEARCH Database. / Buschemeyer, W. Cooper; Hamilton, Robert J.; Aronson, William J.; Presti, Joseph C.; Terris, Martha Kennedy; Kane, Christopher J.; Amling, Christopher L.; Freedland, Stephen J.

In: Journal of Urology, Vol. 179, No. 1, 01.01.2008, p. 124-129.

Research output: Contribution to journalArticle

Buschemeyer, WC, Hamilton, RJ, Aronson, WJ, Presti, JC, Terris, MK, Kane, CJ, Amling, CL & Freedland, SJ 2008, 'Is a Positive Bladder Neck Margin Truly a T4 Lesion in the Prostate Specific Antigen Era? Results From the SEARCH Database', Journal of Urology, vol. 179, no. 1, pp. 124-129. https://doi.org/10.1016/j.juro.2007.08.130
Buschemeyer, W. Cooper ; Hamilton, Robert J. ; Aronson, William J. ; Presti, Joseph C. ; Terris, Martha Kennedy ; Kane, Christopher J. ; Amling, Christopher L. ; Freedland, Stephen J. / Is a Positive Bladder Neck Margin Truly a T4 Lesion in the Prostate Specific Antigen Era? Results From the SEARCH Database. In: Journal of Urology. 2008 ; Vol. 179, No. 1. pp. 124-129.
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abstract = "Purpose: Positive bladder neck margins after radical prostatectomy are currently designated as pT4 lesions. However, to our knowledge the prognostic significance of a positive bladder neck margin in the prostate specific antigen era is unknown. We examined the association between positive bladder neck margins and prostate specific antigen recurrence relative to other pathological findings. Materials and Methods: We examined 1,722 men from the Shared Equal Access Research Cancer Hospital Database who were treated with radical prostatectomy without lymph node metastases. Time to prostate specific antigen recurrence was compared in men with positive vs negative bladder neck margins using Cox proportional hazards models adjusted for multiple clinical and pathological features. Results: A positive bladder neck margin in 79 patients (5{\%}) was significantly associated with other poor prognostic features, including higher prostate specific antigen, higher pathological Gleason sum, extracapsular extension, seminal vesicle invasion and other positive margins. After adjusting for clinical and pathological characteristics positive bladder neck margins were associated with an increased risk of prostate specific antigen recurrence (HR 1.52, 95{\%} CI 1.06-2.19, p = 0.02). Relative to organ confined margin negative disease a positive bladder neck margin associated with other positive margins showed a recurrence risk that was similar to that of seminal vesicle invasion (HR 4.14, 95{\%} CI 2.55-6.73 and HR 4.22, 95{\%} CI 3.08-5.78, respectively, each p <0.001). An isolated positive bladder neck margin was a rare event, noted in 15 patients (0.7{\%}). In these men the recurrence risk was difficult to estimate due to the small number. However, the HR was similar to that in men with nonbladder neck positive margins or extracapsular extension (HR 2.65, 95{\%} CI 0.97-7.25, p = 0.06 and HR 2.19, 95{\%} CI 1.71-2.82, p <0.001, respectively). Conclusions: In the current study a positive bladder neck margin was frequently associated with other adverse features. When it was concomitant with other positive margins, a positive bladder neck margin was associated with a progression risk similar to that of seminal vesicle invasion (T3b disease). Although men with an isolated positive bladder neck margin had a more favorable pathological profile, there were too few of them to assess outcome reliably. However, the limited data suggest that they may best be categorized as having pT3a disease.",
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AU - Buschemeyer, W. Cooper

AU - Hamilton, Robert J.

AU - Aronson, William J.

AU - Presti, Joseph C.

AU - Terris, Martha Kennedy

AU - Kane, Christopher J.

AU - Amling, Christopher L.

AU - Freedland, Stephen J.

PY - 2008/1/1

Y1 - 2008/1/1

N2 - Purpose: Positive bladder neck margins after radical prostatectomy are currently designated as pT4 lesions. However, to our knowledge the prognostic significance of a positive bladder neck margin in the prostate specific antigen era is unknown. We examined the association between positive bladder neck margins and prostate specific antigen recurrence relative to other pathological findings. Materials and Methods: We examined 1,722 men from the Shared Equal Access Research Cancer Hospital Database who were treated with radical prostatectomy without lymph node metastases. Time to prostate specific antigen recurrence was compared in men with positive vs negative bladder neck margins using Cox proportional hazards models adjusted for multiple clinical and pathological features. Results: A positive bladder neck margin in 79 patients (5%) was significantly associated with other poor prognostic features, including higher prostate specific antigen, higher pathological Gleason sum, extracapsular extension, seminal vesicle invasion and other positive margins. After adjusting for clinical and pathological characteristics positive bladder neck margins were associated with an increased risk of prostate specific antigen recurrence (HR 1.52, 95% CI 1.06-2.19, p = 0.02). Relative to organ confined margin negative disease a positive bladder neck margin associated with other positive margins showed a recurrence risk that was similar to that of seminal vesicle invasion (HR 4.14, 95% CI 2.55-6.73 and HR 4.22, 95% CI 3.08-5.78, respectively, each p <0.001). An isolated positive bladder neck margin was a rare event, noted in 15 patients (0.7%). In these men the recurrence risk was difficult to estimate due to the small number. However, the HR was similar to that in men with nonbladder neck positive margins or extracapsular extension (HR 2.65, 95% CI 0.97-7.25, p = 0.06 and HR 2.19, 95% CI 1.71-2.82, p <0.001, respectively). Conclusions: In the current study a positive bladder neck margin was frequently associated with other adverse features. When it was concomitant with other positive margins, a positive bladder neck margin was associated with a progression risk similar to that of seminal vesicle invasion (T3b disease). Although men with an isolated positive bladder neck margin had a more favorable pathological profile, there were too few of them to assess outcome reliably. However, the limited data suggest that they may best be categorized as having pT3a disease.

AB - Purpose: Positive bladder neck margins after radical prostatectomy are currently designated as pT4 lesions. However, to our knowledge the prognostic significance of a positive bladder neck margin in the prostate specific antigen era is unknown. We examined the association between positive bladder neck margins and prostate specific antigen recurrence relative to other pathological findings. Materials and Methods: We examined 1,722 men from the Shared Equal Access Research Cancer Hospital Database who were treated with radical prostatectomy without lymph node metastases. Time to prostate specific antigen recurrence was compared in men with positive vs negative bladder neck margins using Cox proportional hazards models adjusted for multiple clinical and pathological features. Results: A positive bladder neck margin in 79 patients (5%) was significantly associated with other poor prognostic features, including higher prostate specific antigen, higher pathological Gleason sum, extracapsular extension, seminal vesicle invasion and other positive margins. After adjusting for clinical and pathological characteristics positive bladder neck margins were associated with an increased risk of prostate specific antigen recurrence (HR 1.52, 95% CI 1.06-2.19, p = 0.02). Relative to organ confined margin negative disease a positive bladder neck margin associated with other positive margins showed a recurrence risk that was similar to that of seminal vesicle invasion (HR 4.14, 95% CI 2.55-6.73 and HR 4.22, 95% CI 3.08-5.78, respectively, each p <0.001). An isolated positive bladder neck margin was a rare event, noted in 15 patients (0.7%). In these men the recurrence risk was difficult to estimate due to the small number. However, the HR was similar to that in men with nonbladder neck positive margins or extracapsular extension (HR 2.65, 95% CI 0.97-7.25, p = 0.06 and HR 2.19, 95% CI 1.71-2.82, p <0.001, respectively). Conclusions: In the current study a positive bladder neck margin was frequently associated with other adverse features. When it was concomitant with other positive margins, a positive bladder neck margin was associated with a progression risk similar to that of seminal vesicle invasion (T3b disease). Although men with an isolated positive bladder neck margin had a more favorable pathological profile, there were too few of them to assess outcome reliably. However, the limited data suggest that they may best be categorized as having pT3a disease.

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