407 THE RELATIONSHIP BETWEEN THE LINEAR EXTENT OF POSITIVE SURGICAL MARGIN OR INTIMATE CAPSULAR CONTACT IN PROSTATECTOMY SPECIMENS AND PROGRESSION (2010)

You have accessJournal of UrologyProstate Cancer: Staging III1 Apr 2010407 THE RELATIONSHIP BETWEEN THE LINEAR EXTENT OF POSITIVE SURGICAL MARGIN OR INTIMATE CAPSULAR CONTACT IN PROSTATECTOMY SPECIMENS AND PROGRESSION Kazuma Udo, Angel Cronin, Lauren Carlino, James Eastham, Peter Scardino, Victor Reuter, and Samson Fine Kazuma UdoKazuma Udo More articles by this author , Angel CroninAngel Cronin More articles by this author , Lauren CarlinoLauren Carlino More articles by this author , James EasthamJames Eastham More articles by this author , Peter ScardinoPeter Scardino More articles by this author , Victor ReuterVictor Reuter More articles by this author , and Samson FineSamson Fine More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.476AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Positive surgical margins (PSM) are an adverse prognostic factor in patients who have undergone radical prostatectomy for prostate cancer. Whether the linear extent of PSM influences progression remains unclear. Furthermore, tumor may exhibit intimate capsular contact (ICC) without extending to the margin. We hypothesized that ICC might influence progression in a similar manner as PSM. The aim of this study was to evaluate the relationship between the linear extent of PSM and ICC with progression following radical prostatectomy after detailed pathology review. METHODS We identified 2102 men with pathological stage pT2 or pT3a following radical prostatectomy between January 2004 and December 2007. ICC was defined as 1 or 2 fibroblasts separating cancer cells from an inked margin. In cases with PSM, we evaluated tumor volume, percentage of high grade cancer, as well as the presence of PSM and/or ICC (including PSM/ICC location, number, linear extent, and Gleason grade in the area of PSM/ICC) on whole-mount sections. Gleason grade was stratified as either low (≤3) or high (≥4). RESULTS Cohort: 186 of 2102 (9%) radical prostatectomies had a PSM. 89 cases (48%) were pT2+ (otherwise organ-confined) and 97 (52%) were pT3a. 30 patients with PSM and 83 without PSM progressed, with a median follow up for progression-free patients of 2 years. Linear Extent of and Gleason Grade at PSM: The total length of PSM was ≤ 1mm for 94 (51%), 1.1 to 3mm for 50 (27%), and > 3mm for 42 (23%) cases. The 2-year progression-free probability (PFP) was 91% (81%, 96%) for PSM ≤ 1mm, 86% (71%, 94%) for 1.1 to 3mm, and 64% (47%, 77%) for > 3mm. The total length of PSM was associated with progression overall (p<0.001). In comparison, the 2-year PFP was 96% (95% CI 94%, 97%) for patients with negative surgical margins. Patients with Gleason grade 4 at PSM were significantly more likely to progress compared to those with Gleason grade 3 (p<0.001). Impact of ICC: ICC was present in 168 (90%) patients with PSM. Length of ICC and Gleason grade at ICC also predicted progression (p=0.04 and p<0.001, respectively). There was high correlation between the length of ICC and PSM as well as highest Gleason grade at ICC and PSM. CONCLUSIONS The total length of margin positivity and Gleason grade at a PSM were associated with progression. Given the high correlation of pathologic features between ICC and PSM, ICC does not add independent prognostic information in patients who have a PSM. New York, NY© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e161 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kazuma Udo More articles by this author Angel Cronin More articles by this author Lauren Carlino More articles by this author James Eastham More articles by this author Peter Scardino More articles by this author Victor Reuter More articles by this author Samson Fine More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...