Is a PSM an independent predictor of risk for disease progression?

A study just published by Sæther et al. appears to suggest that the clinical finding of a positive surgical margin (PSM) is not an important independent predictor for risk of progression when compared to other data available at the time of surgery.

PSMs are commonly considered to be an adverse prognostic indicator in patients undergoing radical prostatectomy (RP). However, there are discrepancies among studies concerning the effect of PSM on prognosis. In addition, the significance of PSM location and extent is uncertain. This study was designed to examine the impact of surgical margin status on biochemical progression (as measured by a rising PSA) in a consecutive series of men receiving RP in a non-screened population. Prostatectomy specimens from a total of 219 patients were examined microscopically. The mean follow-up time was 62 months (range 6-121 months). Tumour grade (Gleason score), pathologic tumor stage, and tumor involvement with the surgical margins were recorded. There were 71 specimens with one or more PSM. These specimens were all re-examined with regard to the location, number of locations, and total linear extent of PSMs. 

The authors report the following results from this study:

  •  In univariate analyses, PSM without regard to location, PSM at the anterior prostate or at the apex, PSM at three or more locations, and linear extent of PSM = 6 mm were all associated with a statistically significant higher hazard ratio of PSA relapse.
  • None of these variables remained statistically significant when controlling for the known risk factors.

They conclude that, at least in this non-screened prostate cancer population, PSM status (linear extent, location, and number of locations) had an impact on postoperative However, on the basis of multivariate analysis, PSM was only able to show a strong trend (p ~ 0.06) toward having an independent statistically significant negative influence on the risk of PSA relapse following RP.

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