The effect of surgical margin positivity on oncologic outcomes after radical prostatectomy

Purpose: To evaluate the effects of positive surgical margin (PSM) and additional surgical margin (SM) characteristics on oncologic outcomes in patients who underwent radical prostatectomy (RP). Material and Methods: 319 patients who underwent radical prostatectomy (RP) between February 2011 and December 2019 in the Urology Department of Çukurova University Faculty of Medicine were included in the study. Patients who received neoadjuvant and adjuvant hormonal therapy, chemotherapy, who receiving radiotherapy, PSA ≥50 ng/ml, metastatic, who has T4 disease and PSA unfollow-up were excluded from the study. We evaluated the effect of surgical margin positivity (SMP) on biochemical recurrence (BCR)-free survival and overall survival, the association of additional surgical margin (SM) features with BCR-free survival, and the effect of SMP on progression-free survival as secondary endpoints. In patients with SMP, SM length, highest Gleason grade (GG), localization, unifocality or multifocality were examined and its relationship with BCR was evaluated. Results: SMP was observed in 57 (17,9 %) patients and BCR was observed in 27 (8,5 %) patients. The mean follow-up period was 59±29,1 (2-128) months. The 5-year survival without BCR was 95,1 % in SM (-) patients and 76,2 % in SM (+) patients (p<0,001). Additional SM parameters were surgical margin Gleason grade (SMGD) (p=0,317), length (p=0,251), number of positive SM (p=0.509), apex from localizations (p=0,166), posterolateral (p=0,286) and bladder neck (p=0,389) did not affect BCR-free survival. While the overall survival time decreased as the pathologic stage increased in SM (-) patients (p=0,004), the pathologic stage did not affect overall survival in SM (+) patients (p=0,876). SMP was found to negatively affect progression-free survival at T2 stage (p=0,014). At T3 stage, BCR-free (p=0,112), overall (p=0,168), and progression-free survival (p=0,931) were unaffected by SMP. Conclusion: The presence of SMP in localized disease was found to be a determining factor for BCR and progression. These patients should be followed closely in terms of oncology and personalized treatment should be planned as soon as needed. In locally advanced stage disease, oncological outcomes are adversely affected regardless of SMP. KeyWords: biochemical recurrence, positive surgical margin, prostate cancer, radical prostatectomy, survival