Focal Positive Margin Information

Thursday, 06 November 2008
The significance of focal positive margins (FPM) following radical prostatectomy is unclear, particularly in patients with otherwise organ confined disease.

The implication in pathologically organ-confined tumors is that FPM are surgically induced, may not represent true tumor extension beyond the prostate, and thus would not impact on disease-free survival (DFS). Our objective was to investigate the significance of FPM in patients with organ-confined disease in terms of DFS.

Data was prospectively collected from 2074 patients undergoing radical prostatectomy from January 1996 to December 2006 who signed an informed consent. Clinical and pathologic stage and margin status [negative (NM), FPM, and extensively positive (EPM)] were compared with the log-rank test to determine differences in overall mortality and DFS. FPM was defined as less than or equal to 3mm. EPM was greater than 3mm.

1688 patients (81.4%) had NM, 292 (14.1%) had FPM, and 94 (4.5%) had EPM. Mean preoperative PSA for NM, FPM, and EPM was 6.45, 7.88, and 11.81, respectively. The difference in DFS was significant between the three groups (p< 0.0001). The 10-year DFS for all patients was 90%, 62%, and 41% for NM, FPM, and EPM, respectively. When evaluating patients with organ-confined disease, the presence of FPM led to significantly higher risk of PSA recurrence compared to NM. The 10-year DFS for organ-confined disease was 93%, 84%, and 55% for NM, FPM, and EPM, respectively.

Focal and extensive positive margins on radical prostatectomy specimens confer a decreased disease-free rate. Importantly, focal positive margins significantly decrease disease-free survival in patients with otherwise organ-confined disease. These data suggest surgically induced focal positive margins are important. The trade-off between sparing the neurovascular bundles and a focal positive margin must be balanced.



Frank

Frank, Thanks for sharing the information, if I am reading correctly my focally positive margin may have been a result of the surgery and not necessarily the spreading of the disease.

JEKNY...from what I read, that Positive margins can usually occur when the surgeon cuts across a small section of the tumor, because the tumor was close to the edge to start with. It is impossible to know "exactly" how much tumor cells were left behind, however for the most part any small amount (<3 mm) will not typically survive and will die out due to the loss of blood and the resulting scar tissue. So in most cases roughly 80% of the time it isn't a concern. In your case you had evidence of extention and that will be the area of concern and the reason for higher stage on the pathology report.

Frank's is close to the bladder and is of some concern. His doctors recommendations are inline with with what I have read about the positive margins and the location of the margin. The location seems to be the greater factor in his case.

Hopefully this won't be a problem for either one of you.