Da. Ackerman et al., ANALYSIS OF RISK-FACTORS ASSOCIATED WITH PROSTATE-CANCER EXTENSION TOTHE SURGICAL MARGIN AND PELVIC NODE METASTASIS AT RADICAL PROSTATECTOMY, The Journal of urology, 150(6), 1993, pp. 1845-1850
We analyzed data from 107 consecutive patients with clinical stage B p
rostate cancer in an attempt to identify those at high risk for having
involved margins or nodal metastasis. Each patient underwent transrec
tal ultrasound-guided sextant biopsies of the prostate. Patient age, s
urgical approach to prostatectomy, pre-biopsy prostate specific antige
n (PSA) level, and number, location and maximum Gleason score of posit
ive biopsies were statistically evaluated for all patient groups. Pros
tate volume and PSA density (PSAD) were calculated for all patients un
dergoing prostatectomy. Of the 101 patients who underwent radical pros
tatectomy 64 had negative margins, 37 had at least 1 positive margin a
nd 11 of the 37 had more than 1 positive margin. Involved margins were
most common at the apex (62%) and mid portion (59%) of the gland. Pro
statectomy was not performed on 6 patients with nodal metastases evide
nt on frozen section examination. Therefore, 43 patients are considere
d to be at high risk for having residual disease after surgery. The me
an PSAD, PSA level and number of positive biopsies were significant (p
<0.05) predictors of tumor extension to the surgical margin. The mean
number of positive biopsies, biopsy Gleason score and PSA level were
significantly greater (p <0.05) in patients with nodal metastases. Onl
y 15% of the patients with a single positive biopsy had positive margi
ns versus 47% of those with multiple positive biopsies (p <0.05). Of t
he patients with tumor positive nodes on frozen section 67% had 5 or m
ore positive biopsies, whereas only 9% of all others had that many pos
itive biopsies (p <0.05). The number of positive biopsy sites, PSAD an
d PSA level were significantly associated with tumor at the surgical m
argin or metastatic to the pelvic nodes.