Preoperative prediction of surgical margin status in patients with prostate cancer treated by radical prostatectomy

Purpose: We sought to determine the preoperative factors associated with su rgical margin status in patients who underwent radical prostatectomy for pr ostate cancer. Patients and Methods: The study group consisted of 339 patients who were tr eated by radical retropubic prostatectomy and bilateral pelvic lymphadenect omy at the Mayo Clinic. None received preoperative adjuvant therapy. The me an age at the time of surgery was 66 years (range, 45 to 79 years). All spe cimens were totally embedded and whole-mounted. Positive surgical margin wa s defined as the presence of cancer cells at the inked margins. Numerous pa thologic characteristics in needle biopsies and preoperative clinical findi ngs were analyzed. Results: The overall margin positivity rate was 24%. In univariate analysis , preoperative serum prostate-specific antigen (PSA) level, Gleason score, perineural invasion, percentage of cancer in the biopsy specimens, and numb er and percentage of biopsy cores involved by cancer were all associated wi th positive surgical margins. In multivariate analysis, preoperative serum PSA level (odds ratio for a doubling of PSA levels, 1.9; 95% confidence int erval, 1.5 to 2.4; P < .001) and percentage of cancer in the biopsy specime ns (odds ratio for a 10% increase, 1.3; 95% confidence interval, 1.2 to 1.4 ; P < .001) were predictive of margin status in radical prostatectomy. With use of preoperative serum PSA level and percentage of cancer in the biopsy as predictors of surgical margins, the overall accuracy as measured by the area under the receiver operating characteristic curve was 0.74. Conclusion: Preoperative serum PSA level and percentage of cancer in the bi opsy specimens were independently associated with surgical margin status in patients who underwent radical prostatectomy for prostate cancer. The comb ination of these two factors provider a high level of predictive accuracy f or margin status. J Clin Oncol 18:2862-2888. (C) 2000 by American Society o f Clinical Oncology.