Prognostic significance of positive surgical margins in radical prostatectomy specimens.

Overview

PURPOSE: The prognostic significance of positive surgical margins in radical prostatectomy specimens was assessed. MATERIALS AND METHODS: The interval to progression (increasing prostate specific antigen level) was measured in 478 patients by status of the surgical margins. RESULTS: At 5 years, the nonprogression rate was 64% for patients with and 83% for those without positive surgical margins. With a high grade cancer, seminal vesicle invasion or lymph node metastases, positive surgical margins had no effect on prognosis; with extracapsular extension and a Gleason score of 6 or less positive surgical margins were associated with a higher progression rate. CONCLUSIONS: Prognosis was adversely affected by positive surgical margins only in moderately differentiated cancers with extracapsular extension alone. If the cancer is otherwise confined, positive surgical margins are associated with an excellent prognosis unlikely to be improved by adjuvant therapy.