Objective: To evaluate the risk of biochemical recurrence of organ-confined prostate cancer (pT2+) after radical prostatectomy, according to the site of positive resection margins.
Material and methods: 649 radical prostatectomies were performed between 1988 and 2002 for organ-confined tumours in 436 cases (stage pT2). Preoperative (clinical stage, PSA assay and Gleason score on biopsies) and post-operative data (weight of the resection specimen, Gleason score and tumour volume) were recorded as a function of the site of positive resection margins. Biochemical recurrence was defined by a PSA level greater than 0.2 ng/ml. Biochemical progression-free survival was studied according to the Kaplan-Meier method, as a function of the site of positive resection margins.
Results: Sixty-six patients (15.1%) had a single positive margin. With a mean follow-up of 52.9 months (range: 1.1 to 160.4 months), eleven patients (16.6%) developed biochemical recurrence. The mean progression-free survival was 7.8 months. An apical positive resection margin was associated with the most unfavourable prognosis compared to other sites.
Conclusion: Apical positive resection margins appear to be associated with a poorer prognosis than other sites. This study confirms that dissection of the apex is essential to ensure optimal tumour control and prognosis in organ-confined prostate cancer.