Positive surgical margins in radical prostatectomy patients do not predict long-term oncological outcomes: Results from the Shared Equal Access Regional Cancer Hospital (SEARCH) cohort

Prabhakar Mithal, Lauren E. Howard, William J. Aronson, Martha K. Terris, Matthew R. Cooperberg, Christopher J. Kane, Christopher Amling, Stephen J. Freedland

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objective To assess the impact of positive surgical margins (PSMs) on long-term outcomes after radical prostatectomy (RP), including metastasis, castrate-resistant prostate cancer (CRPC), and prostate cancer-specific mortality (PCSM). Patients and Methods Retrospective study of 4 051 men in the Shared Equal Access Regional Cancer Hospital (SEARCH) cohort treated by RP from 1988 to 2013. Proportional hazard models were used to estimate hazard ratios (HRs) of PSMs in predicting biochemical recurrence (BCR), CRPC, metastases, and PCSM. To determine if PSMs were more predictive in certain patients, analyses were stratified by pathological Gleason score, stage, and preoperative prostate-specific antigen (PSA) level. Results The median (interquartile range) follow-up was 6.6 (3.2-10.6) years and 1 127 patients had >10 years of follow-up. During this time, 302 (32%) men had BCR, 112 (3%) developed CRPC, 144 (4%) developed metastases, and 83 (2%) died from prostate cancer. There were 1 600 (40%) men with PSMs. In unadjusted models, PSMs were significantly associated with all adverse outcomes: BCR, CRPC, metastases and PCSM (all P ≤ 0.001). After adjusting for demographic and pathological characteristics, PSMs were associated with increased risk of only BCR (HR 1.98, P < 0.001), and not CRPC, metastases, or PCSM (HR ≤1.29, P > 0.18). Similar results were seen when stratified by pathological Gleason score, stage, or PSA level, and when patients who underwent adjuvant radiotherapy were excluded. Conclusions PSMs after RP are not an independent risk factor for CRPC, metastasis, or PCSM overall or within any subset. In the absence of other high-risk features, PSMs alone may not be an indication for adjuvant radiotherapy.

Original languageEnglish (US)
Pages (from-to)244-248
Number of pages5
JournalBJU International
Volume117
Issue number2
DOIs
StatePublished - Feb 1 2016

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Cancer Care Facilities
Prostatectomy
Prostatic Neoplasms
Neoplasm Metastasis
Recurrence
Adjuvant Radiotherapy
Mortality
Neoplasm Grading
Prostate-Specific Antigen
Margins of Excision
Proportional Hazards Models

Keywords

  • adjuvant radiotherapy
  • disease progression
  • prostate cancer
  • prostatectomy

ASJC Scopus subject areas

  • Urology

Cite this

Positive surgical margins in radical prostatectomy patients do not predict long-term oncological outcomes : Results from the Shared Equal Access Regional Cancer Hospital (SEARCH) cohort. / Mithal, Prabhakar; Howard, Lauren E.; Aronson, William J.; Terris, Martha K.; Cooperberg, Matthew R.; Kane, Christopher J.; Amling, Christopher; Freedland, Stephen J.

In: BJU International, Vol. 117, No. 2, 01.02.2016, p. 244-248.

Research output: Contribution to journalArticle

Mithal, Prabhakar ; Howard, Lauren E. ; Aronson, William J. ; Terris, Martha K. ; Cooperberg, Matthew R. ; Kane, Christopher J. ; Amling, Christopher ; Freedland, Stephen J. / Positive surgical margins in radical prostatectomy patients do not predict long-term oncological outcomes : Results from the Shared Equal Access Regional Cancer Hospital (SEARCH) cohort. In: BJU International. 2016 ; Vol. 117, No. 2. pp. 244-248.
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abstract = "Objective To assess the impact of positive surgical margins (PSMs) on long-term outcomes after radical prostatectomy (RP), including metastasis, castrate-resistant prostate cancer (CRPC), and prostate cancer-specific mortality (PCSM). Patients and Methods Retrospective study of 4 051 men in the Shared Equal Access Regional Cancer Hospital (SEARCH) cohort treated by RP from 1988 to 2013. Proportional hazard models were used to estimate hazard ratios (HRs) of PSMs in predicting biochemical recurrence (BCR), CRPC, metastases, and PCSM. To determine if PSMs were more predictive in certain patients, analyses were stratified by pathological Gleason score, stage, and preoperative prostate-specific antigen (PSA) level. Results The median (interquartile range) follow-up was 6.6 (3.2-10.6) years and 1 127 patients had >10 years of follow-up. During this time, 302 (32{\%}) men had BCR, 112 (3{\%}) developed CRPC, 144 (4{\%}) developed metastases, and 83 (2{\%}) died from prostate cancer. There were 1 600 (40{\%}) men with PSMs. In unadjusted models, PSMs were significantly associated with all adverse outcomes: BCR, CRPC, metastases and PCSM (all P ≤ 0.001). After adjusting for demographic and pathological characteristics, PSMs were associated with increased risk of only BCR (HR 1.98, P < 0.001), and not CRPC, metastases, or PCSM (HR ≤1.29, P > 0.18). Similar results were seen when stratified by pathological Gleason score, stage, or PSA level, and when patients who underwent adjuvant radiotherapy were excluded. Conclusions PSMs after RP are not an independent risk factor for CRPC, metastasis, or PCSM overall or within any subset. In the absence of other high-risk features, PSMs alone may not be an indication for adjuvant radiotherapy.",
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T1 - Positive surgical margins in radical prostatectomy patients do not predict long-term oncological outcomes

T2 - Results from the Shared Equal Access Regional Cancer Hospital (SEARCH) cohort

AU - Mithal, Prabhakar

AU - Howard, Lauren E.

AU - Aronson, William J.

AU - Terris, Martha K.

AU - Cooperberg, Matthew R.

AU - Kane, Christopher J.

AU - Amling, Christopher

AU - Freedland, Stephen J.

PY - 2016/2/1

Y1 - 2016/2/1

N2 - Objective To assess the impact of positive surgical margins (PSMs) on long-term outcomes after radical prostatectomy (RP), including metastasis, castrate-resistant prostate cancer (CRPC), and prostate cancer-specific mortality (PCSM). Patients and Methods Retrospective study of 4 051 men in the Shared Equal Access Regional Cancer Hospital (SEARCH) cohort treated by RP from 1988 to 2013. Proportional hazard models were used to estimate hazard ratios (HRs) of PSMs in predicting biochemical recurrence (BCR), CRPC, metastases, and PCSM. To determine if PSMs were more predictive in certain patients, analyses were stratified by pathological Gleason score, stage, and preoperative prostate-specific antigen (PSA) level. Results The median (interquartile range) follow-up was 6.6 (3.2-10.6) years and 1 127 patients had >10 years of follow-up. During this time, 302 (32%) men had BCR, 112 (3%) developed CRPC, 144 (4%) developed metastases, and 83 (2%) died from prostate cancer. There were 1 600 (40%) men with PSMs. In unadjusted models, PSMs were significantly associated with all adverse outcomes: BCR, CRPC, metastases and PCSM (all P ≤ 0.001). After adjusting for demographic and pathological characteristics, PSMs were associated with increased risk of only BCR (HR 1.98, P < 0.001), and not CRPC, metastases, or PCSM (HR ≤1.29, P > 0.18). Similar results were seen when stratified by pathological Gleason score, stage, or PSA level, and when patients who underwent adjuvant radiotherapy were excluded. Conclusions PSMs after RP are not an independent risk factor for CRPC, metastasis, or PCSM overall or within any subset. In the absence of other high-risk features, PSMs alone may not be an indication for adjuvant radiotherapy.

AB - Objective To assess the impact of positive surgical margins (PSMs) on long-term outcomes after radical prostatectomy (RP), including metastasis, castrate-resistant prostate cancer (CRPC), and prostate cancer-specific mortality (PCSM). Patients and Methods Retrospective study of 4 051 men in the Shared Equal Access Regional Cancer Hospital (SEARCH) cohort treated by RP from 1988 to 2013. Proportional hazard models were used to estimate hazard ratios (HRs) of PSMs in predicting biochemical recurrence (BCR), CRPC, metastases, and PCSM. To determine if PSMs were more predictive in certain patients, analyses were stratified by pathological Gleason score, stage, and preoperative prostate-specific antigen (PSA) level. Results The median (interquartile range) follow-up was 6.6 (3.2-10.6) years and 1 127 patients had >10 years of follow-up. During this time, 302 (32%) men had BCR, 112 (3%) developed CRPC, 144 (4%) developed metastases, and 83 (2%) died from prostate cancer. There were 1 600 (40%) men with PSMs. In unadjusted models, PSMs were significantly associated with all adverse outcomes: BCR, CRPC, metastases and PCSM (all P ≤ 0.001). After adjusting for demographic and pathological characteristics, PSMs were associated with increased risk of only BCR (HR 1.98, P < 0.001), and not CRPC, metastases, or PCSM (HR ≤1.29, P > 0.18). Similar results were seen when stratified by pathological Gleason score, stage, or PSA level, and when patients who underwent adjuvant radiotherapy were excluded. Conclusions PSMs after RP are not an independent risk factor for CRPC, metastasis, or PCSM overall or within any subset. In the absence of other high-risk features, PSMs alone may not be an indication for adjuvant radiotherapy.

KW - adjuvant radiotherapy

KW - disease progression

KW - prostate cancer

KW - prostatectomy

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