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Prostate Cancer: Localized: Surgical Therapy VI (MP64): Moderated Poster 64: Monday, September 13, 2021

MP64-11 PROGNOSTIC IMPACT OF GLEASON GRADE AT THE MARGIN IN PATIENTS UNDERGOING RADICAL PROSTATECTOMY

Lysenko, Ivan; D’Andrea, David; Quhal, Fahad; Mori, Keiichiro; Janisch, Florian; Karakiewicz, Pierre I.; Fossati, Nicola; Briganti, Alberto; Heidenreich, Axel; Shariat, Shahrokh F.

doi: 10.1097/JU.0000000000002104.11
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INTRODUCTION AND OBJECTIVE:

The presence of a positive surgical margin (PSM) after radical prostatectomy (RP) has been associated with an increased risk of biochemical recurrence (BCR) and the need for adjuvant treatment such as radiotherapy. In this study we aimed to investigate the impact of reporting the Gleason grade (GG) at the positive surgical margin (PSM) in radical prostatectomy specimens as a prognostic factor for the outcome.

METHODS:

We performed a retrospective study to identify patients with pathologically organ-confined (≤pT3) tumors. BCR-free survival was estimated using Kaplan-Meier method and compared between subgroups using two-sided logrank test.

RESULTS:

Of 3699 organ-confined (≤pT3) radical prostatectomy specimens, 540 (14.6%) patients with PSM were identified. Compared to patients with GG3 at PSM (61.5%), patients with GG4 (38.5%) had significantly higher preoperative serum PSA level (9 vs 7 ng/mL, p<0.01), pathological T stage (p<0.01), primary Gleason score (p<0.01), lymphovascular invasion presence (19.2% vs 7.8% p<0.01) and extracapsular extension (51% vs 37% p<0.01). With a median time to recurrence of 44 (IQR 33-55) months, 464 patients (12.5% of all patients) experienced BCR. The biochemical recurrence rate was significantly higher in men with GG4 at PSM (38% vs 23%, p<0.001).

CONCLUSIONS:

Gleason Grade 4 at the surgical margin was significantly associated with an increased risk of BCR. Based on these findings, patients with GG4 at the PSM might benefit from a closer surveillance and should be considered as candidates for early salvage radiotherapy.

Source of Funding:

Ivan Lysenko was awarded a European Urological Scholarship Program grant

© 2021 by American Urological Association Education and Research, Inc.