My less than 0.1 mm "clean negative" margins have always caused concern for the last 22 months.
Almost 2 years laters looks like my odds of BCR are closer to 25% as opposed to the better number of 10% after 3 years given the current research.
Still better than 50% odds but not as good as 90%
I need to catch some good luck and avoid bad luck.
USPSA is 0.01.
I am 3+4 (20% +4) with small prostate and 1.2 cc tumor at the edge with a negative margin less than 0.1 mm.
The USPSA next blood test in 11 / 12 days will start to tell the story.
Epstein still thinks all negative margins are more or less the same. These studies seems to say otherwise.
Close surgical margins after radical prostatectomy mimic biochemical recurrence rates of positive margins.
MATERIALS AND METHODS:
Pathologic records of men who underwent RP from 2005-2011 were retrospectively reviewed. Margin status was classified as "positive" (PSM), "negative" (NSM), or "close" (<1mm from margin). BCR was defined as 2 consecutive postoperative prostate specific antigen measurements >0.2ng/ml. Probability of BCR was estimated using the Kaplan-Meier method and stratified by margin status. Univariable and multivariable Cox proportional hazards models were used to determine whether close margin status was associated with an increased rate of BCR.
A total of 609 consecutive patients underwent RP (93% robotic) and had complete pathologic data. A total of 126 (20.7%) had PSM, 453 (74.4%) had NSM, and 30 (4.9%) had CSM (mean<0.44mm). The 3-year BCR-free survival for patients with CSM was similar to those with PSM (70.4% vs. 74.5%, log rank P = 0.66) and significantly worse than those with NSM (90%, log rank P<0.001). On multivariable regression, positive margin status (HR = 3.26, P<0.001) was significantly associated with a higher risk of BCR, along with close margins (HR = 2.7, P = 0.04).
BCR for patients with CSM at RP is tantamount to PSM patients. CSM <1mm should be explicitly noted on pathology reports. Patients with this finding should be followed up closely and offered adjuvant therapy.
Short (≤ 1 mm) positive surgical margin and risk of biochemical recurrence after radical prostatectomy.
PATIENTS AND METHODS:
Margin status and length were evaluated in 2866 men treated with radical prostatectomy (RP) for clinically localized prostate cancer at our institution from 1994 to 2009. We compared the BCR-free survival probability of men with NSMs, a PSM ≤ 1 mm, and a PSM < 1 mm using the Kaplan-Meier method and a Cox regression model adjusted for preoperative prostate-specific antigen (PSA) level, age, pathological stage and pathological Gleason score (GS).
Compared with a NSM, a PSM ≤ 1 mm was associated with 17% lower 3-year BCR-free survival for men with pT3 and GS ≥ 7 tumours and a 6% lower 3-year BCR-free survival for men with pT2 and GS ≤ 6 tumours (log-rank P < 0.001 for all). In the multivariate model, a PSM ≤ 1 mm was associated with a probability of BCR twice as high as that for a NSM (hazard ratio [HR] 2.2), as were a higher PSA level (HR 1.04), higher pathological stage (HR 2.7) and higher pathological GS (HR 3.7 [all P < 0.001]).
In men with non-organ-confined or high grade prostate cancer, a PSM ≤ 1 mm has a significant adverse impact on BCR rates.
58 years old
RALP UCSF 11/19/15 Dr Carroll
PSA 19 months clean until positive at 22 months
1/14/15 5/4/16 8/29/16 12/1/16 3/3/17 6/5/17 9/15/17 9/16/17
<0.015 <0.015 <0.015 <0.015 <0.015 <0.006 0.010 0.009
1.2 cc tumor
clean margins, less than 0.1 mm from ink
Gleason 3+4 20% 4
Post Edited (jronne) : 9/30/2017 5:41:02 PM (GMT-6)