Surgical margins are not associated with death from prostate cancer

The authors analysed the effect of positive surgical margins on cancer-specific survival. 

When tumors are removed, typically extra tissue around the tumor is also removed to increase the likelihood of removing all the cancer cells. Estimating surgical margins involves examining this extra tissue after or during surgery to see if cancer cells remain. If there are no cancer cells on the outer edge of the tissue, usually no further surgery is needed. However, if the cancer cells are present right to the edge of the tissue, this is classified as a positive surgical margin and means that more surgery or further therapy may be needed to remove the remaining cancer cells.

Positive surgical margins in radical prostatectomy (removal of the prostate) for treatment of localised (confined to the prostate) prostate cancer has been reported in 11-48% of men. It is associated with a risk of biochemical recurrence (where there is an increase of the protein prostate-specific antigen [PSA] after treatment implying that cancer has returned). However, there is very limited data available on the effect of positive surgical margins on cancer-specific mortality (death from prostate cancer) in patients.

The aim of this article was to determine the influence of positive surgical margins on prostate-cancer specific mortality.

11,521 patients were evaluated in this study. Follow-up was carried out at 3 and 6 month intervals for the first 3-5 years and annually for the remaining 14 years. Of these, 23% had positive surgical margins. 788 men received postoperative radiotherapy (treatment with high-energy rays after surgery), 96% of whom had a detectable PSA level before surgery. 9% of men received androgen deprivation therapy (hormone therapy that targets the main hormone associated with prostate tumor growth) after radical prostatectomy for biochemical recurrence.

Following an average follow-up of 56 months 778 men had died, 157 (1.4% overall) from prostate cancer.

The 15-year prostate cancer-specific mortality rate (percentage of patients who had died from prostate cancer) was 7%. The 15-year cancer-specific mortality rates were 10% for those with positive surgical margins and 6% for those with negative surgical margins.  In analyses, positive surgical margins did not appear to be associated with cancer-specific mortality. Having radiotherapy after surgery was associated with an increased risk of prostate cancer-specific mortality, but this was most likely due to the fact that it was administered to men who had biochemical recurrence.

The authors concluded that positive surgical margins do not seem to increase the chance of dying from prostate cancer within 10-15 years after receiving radical prostatectomy treatment.

The authors analysed the effect of positive surgical margins on cancer-specific survival. 

When tumors are removed, typically extra tissue around the tumor is also removed to increase the likelihood of removing all the cancer cells. Estimating surgical margins involves examining this extra tissue after or during surgery to see if cancer cells remain. If there are no cancer cells on the outer edge of the tissue, usually no further surgery is needed. However, if the cancer cells are present right to the edge of the tissue, this is classified as a positive surgical margin and means that more surgery or further therapy may be needed to remove the remaining cancer cells.

Positive surgical margins in radical prostatectomy (removal of the prostate) for treatment of localised (confined to the prostate) prostate cancer has been reported in 11-48% of men. It is associated with a risk of biochemical recurrence (where there is an increase of the protein prostate-specific antigen [PSA] after treatment implying that cancer has returned). However, there is very limited data available on the effect of positive surgical margins on cancer-specific mortality (death from prostate cancer) in patients.

The aim of this article was to determine the influence of positive surgical margins on prostate-cancer specific mortality.

11,521 patients were evaluated in this study. Follow-up was carried out at 3 and 6 month intervals for the first 3-5 years and annually for the remaining 14 years. Of these, 23% had positive surgical margins. 788 men received postoperative radiotherapy (treatment with high-energy rays after surgery), 96% of whom had a detectable PSA level before surgery. 9% of men received androgen deprivation therapy (hormone therapy that targets the main hormone associated with prostate tumor growth) after radical prostatectomy for biochemical recurrence.

Following an average follow-up of 56 months 778 men had died, 157 (1.4% overall) from prostate cancer.

The 15-year prostate cancer-specific mortality rate (percentage of patients who had died from prostate cancer) was 7%. The 15-year cancer-specific mortality rates were 10% for those with positive surgical margins and 6% for those with negative surgical margins.  In analyses, positive surgical margins did not appear to be associated with cancer-specific mortality. Having radiotherapy after surgery was associated with an increased risk of prostate cancer-specific mortality, but this was most likely due to the fact that it was administered to men who had biochemical recurrence.

The authors concluded that positive surgical margins do not seem to increase the chance of dying from prostate cancer within 10-15 years after receiving radical prostatectomy treatment.