Organ-confined prostate cancer with negative surgical margins in an entirely-embedded radical prostatectomy is essentially non-lethal-a retrospective single-institutional study of 520 patients

Purpose: There is no risk-based stratification in serum PSA monitoring in prostate cancer (PCa) patients following radical prostatectomy (RP). Those patients with minimal risk of recurrence may be subjected to unnecessarily rigorous monitoring as well as to increased anxiety disproportionate to their actual prognosis. This study aimed to investigate outcomes in PCa patients with favorable pathologic parameters to see whether they can be followed less rigorously than current practice recommendations dictate.

Methods: 520 consecutive entirely embedded organ-confined RPs with negative margins and undetectable initial postoperative serum PSA at the University of Chicago Medical Center between 2005 and 2017 were retrospectively identified. Clinicopathologic parameters and follow-up data including serum PSA were analyzed.

Results: No patients, regardless of their grade group (GG), developed metastasis or succumbed to a PCa-specific death. These patients had a median postoperative follow-up of 109 months. 2.2% (22/520) of the patients developed biochemical recurrence (BCR). There were 163, 279, 69, 4, and 5 RPs from GG 1 to 5, respectively. Of these, 0% (0/163), 1.8% (5/279), 18.8% (13/69), 0% (0/4), and 60% (3/5) developed BCR, sequentially.

Conclusion: In this study, organ-confined PCa with negative margins in an entirely embedded RP carried no mortality risk. In particular, the patients with GG 1-2 disease may have benefited from less rigorous monitoring. Additionally, enhanced patient reassurance could play a role in reducing anxiety in this subset of patients.