PROGNOSTIC IMPLICATIONS OF A POSITIVE APICAL MARGIN IN RADICAL PROSTATECTOMY SPECIMENS

Purpose: We evaluated the prognostic implication of a positive surgica l margin at the prostatic apex to define the risk of failure after rad ical prostatectomy. Materials and Methods: Radical prostatectomy speci mens of 590 patients operated on between 1990 and 1994 were reviewed b y 2 uropathologists (D. G. and W. S.) to determine the percentage of p atients with a positive margin at the apex in the absence of positive margins, extraprostatic extension or involvement of seminal vesicles a nd pelvic lymph nodes. In this group of 33 patients, the significance of a positive apex could be determined without the influence of any ot her stage related prognostic factors. Treatment failure was defined as prostate specific antigen greater than 0.4. All 33 patients have been followed between 3.5 and 65.5 months (median 38.7). Results: Among 59 0 patients 236 (40%) had disease completely confined to the prostate. A total of 217 patients (37%) had either positive surgical margins (M) or extraprostatic extension and of these, only 33 (5.5%) had an apic al positive margin in an otherwise prostate confined tumor. Of 33 apic al positive margin patients only 3 in whom surgery failed had progress ively detectable prostate specific antigen 3.5 to 65.5 months after su rgery. Conclusions: A positive surgical margin at the prostatic apex i n the absence of positive margins or extraprostatic extension elsewher e does not confer a worse prognosis than organ confined disease. In th is study the recurrence rate for patients with positive apical margins was the same as for those with confined disease.